Paul Turek
speaker
358 appearances
1 recordings
1 series
first heard Jun 2025
last heard Jun 2025
Paul Turek’s voice in public audio — every appearance, attributed to the second.
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Or at low levels, like low viral loads where there's no disease. I'm not sure. But these are concerning cases. But then it was transmitted at a low viral load, an even lower viral load. Right. So it's tricky. There may be bulbar urethral glands. Maybe it's somatovesical. It's hard to know. But yeah, it's getting away. But most viruses don't go there. So the big one would be COVID.
What did COVID, there was a big deal about the AC receptor being in the lung and being in the testicle. And maybe COVID infection would make you sterile. There was one Zika paper in Nature that looked at if you infect mice or was it rats with Zika, the testicles shrivel up and they get infertile. And that caused a huge scare in the field. But we really didn't see it.
maybe see it and see if we don't see it in fertility. And what is it about the Zika virus that does this? We're not sure. Why did it in rats? It's a blood testis barrier thing. It's an amazing barrier and nothing really gets through, including viruses, but mumps does, only at puberty. And Zika does. Zika doesn't in animals, but we didn't see it in humans.
But I thought you said that Zika was leading to anencephaly in cases. Yeah, but that could be seminal. That could be just in the semen itself, not in the sperm. Like Ebola is probably seminal, not testicular. It's not on sperm. It's around sperm or in the fluid. That's the conclusion so far. So...
COVID, the big worry was when this Chinese paper came out, like, oh my God, it's going to the lung, buying to the AC receptor. It's testicle has it too. It's going to make men sterile forever. And there were cases of infertility with bad infections. Was that just the fever, which typically does it even after a flu, or was that COVID specific? And we didn't know.
A couple of colleagues did some papers. One which impressed me was out of Cedars was a bunch of men, maybe not reproductive age, died with florid COVID. So they got autopsies and they looked for virus in different locations in the body. And I think out of 10 men or seven men, one had it in the testicle. So these are the men with the highest viral load you can imagine, and only one of them had it.
So I believe that there is a risk of it. But I'd say in the thousand men I've seen since COVID, I think there were two cases that I would say were unexplained where men were either fertile or had normal semen quality, had a bad COVID infection, maybe hospitalized, and three months later, sterile. So I think there's a low perfusion rate there.
So the third thing we do, history, physical semen analysis is a third. Fourth would be hormones. And that's what we check in men too, because production of sperm is driven by the brain. So nothing happens to sperm being made without the brain telling it what to do. Similar with eggs and controlling. It's all a homeostatic mechanism with negative feedback.
I consider it sort of a poker hand. There's a volume, how much of the semen volume. There's a count, concentration of sperm. That's numbers per mil. And then there's motility, which is percent motion. You do a forward progression. So how good is the quality of motion? And typically some measure of shape called morphology. There's three liquid issues, liquefaction, agglutination, and viscosity.
And then you look for other cells that aren't sperm. They're called round cells. And either they're going to be pus cells or immature germ cells that are ejaculated early. And presumably you want to see fewer of those? There's a number, like less than a million is normal. Okay. So if you ask me, well, how do I look at a semen analysis? That's a little different.
I look at that as a poker hand with each card has a meaning, but they have a look. So if you said, what do you mean by that? So if the volume is low... It's one of five things. You're always going to find something. It's at the collection error. I call it first sample syndrome. Guy's not good at it. You know, it's like, okay, I got to put it in the cup and I got to stop doing what I'm doing.
So you do a second sample. And then there's low testosterone can cause it. There's an absent vas deferens, which means you have an absent seminal vesicle. There's ejectory. And by the way, do you ever have that on one side and not the other? No, it's very variable. It's segmental. So there's five real issues. So when I see a low volume semen as a surgeon, I'm going to find something.
So that's really good. Other than that, the semen analysis, I think I've been published as saying it's a blunt instrument for fertility. Unless it's zero, you can't really say much about their fertility because people conceive at all levels.
So one of them is called, I call it syndromic sperm shape problem. So you can have a perfectly normal semen analysis, count motility, volume, progression, and the sperm look terrible. And so there are rare conditions, one in 5,000, where you might have globosospermia or two-tailed sperm or pinhead sperm. So if you look at shape, 4% should look normal, which is terrible.
We can have a whole discussion about why 4% of human sperm being normal is normal when 99% of animal species in the wild have normal-looking sperm. But it's all a construct. It's all a construct of someone decided what normal is. But in men who have large abnormal forms, like 4% is normal if they're 1% normal, and you look at the abnormalities.
But again, it's a construct. It's like putting stars, ordering stars in the universe, Cassiopeia. Someone named Kruger said, this is what a normal sperm looks like.
Yeah.
But most of them are going to be amorphous. Head's a little rounder, head's a little narrower. Those are called stress patterns. And things like hot baths and varicoceles and smoking will do that, which isn't that bad. In the case of 1% normal, you've got to look at the 99%. Because that's not the story. The story's in the other chunk. And if they're all looking the same, then it's syndromic.
And then you have a problem.
And that's hard to fix. I mean, they'll fail with sex. They'll fail with inseminations. They'll fail with IVF. They'll fail with IVF. Yeah, they'll fail with IVF and ICSI. Sometimes with globosuspermia, where they're called lollipop sperm, they just have a big round head with no acrosome. If there's all nucleus and there's some of the components, they'll just bounce off an egg. They'll never work.
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