Varicocele and Male Infertility (Episode 305)

Full Transcript: Episode 305

Lisa: This is the Fertility Friday Podcast, episode number 305. Welcome to the Fertility Friday Podcast, your source for information about the fertility awareness method and all things fertility. I’m your host, Lisa Hendrickson-Jack. I’m the author of The Fifth Vital Sign and the Fertility Awareness Mastery Charting Journal. I’m a certified fertility awareness educator and holistic reproductive health practitioner with nearly 20 years of experience teaching women to connect to their fifth vital sign through menstrual cycle charting, balancing hormonal health, and optimizing the menstrual cycle without hormones.

I’m outspoken about hormonal birth control and its impact on fertility and overall health, because you have the right to know how your body works and how artificial hormones disrupt that natural process. I host live coaching programs to help you achieve optimal fertility and health, because it’s important to have healthy menstrual cycles regardless of whether or not you want to have babies. I’m also a wife and mother of two beautiful boys — I know, I know, I’m a busy girl, but I managed to fit it all in. This podcast is designed to empower you to take full control of your cycles, your fertility, and your overall health, and I’m so excited that you’re here with us today.

Today I share my interview with Dr. Mary Samplaski. I reached out to Dr. Samplaski because she specializes in male infertility, and in particular varicocele — a common issue that does impact male fertility. In today’s episode we really get into it: what is it, how does it affect fertility, is it treatable, how is it treated, what does that look like — just really great, all-around information about male fertility challenges.

So for anyone who’s listened to the show, you’ll know that I always stress the importance of having both partners fully investigated from the start when you’re experiencing fertility challenges, because as women we typically are quick to think “it’s got to be me, there’s got to be something wrong,” and even sometimes our practitioners are hesitant to look into what’s happening with the male partner. In today’s episode we really get into why it’s important to have your partner evaluated, why it’s important not to overlook it and not to make assumptions, but to really look at both parties when you’re experiencing fertility challenges. So without further ado, let’s jump into today’s episode with Dr. Samplaski.

And I’m really excited to welcome Dr. Mary Samplaski to the show today. Dr. Samplaski is a fellowship-trained, board-certified American Board of Urology expert in male infertility, and she’s the Director of Male Infertility, Andrology and Microsurgery at the University of Southern California. She completed her residency training in urology at the Cleveland Clinic Foundation, then completed a two-year fellowship training in male infertility and andrology at the University of Toronto, and she’s also done additional specialty training at the Miami Project in male infertility in the spinal cord injury population. So Dr. Samplaski is well-versed in male infertility, and in today’s episode we’re going to focus on male infertility. We’re going to talk about varicocele and how that can impact fertility, and just really dive into the medical aspect of things. So without further ado, welcome to the show, Dr. Samplaski.

Dr. Samplaski: Thank you for having me, Lisa.

Lisa: Well, I’m really excited to have you on the show and to just dive into the topic of male infertility. We were talking a little bit in the pre-chat — this is an area that I always focus on whenever I can in the podcast, because I feel like our culture is always very focused on women and their role in fertility challenges, and much of the time there is a male factor issue at play. I think just to jump in, I would love to get a sense from you — what inspired you to focus in the area of male infertility?

Dr. Samplaski: So it’s definitely not sort of what I originally thought I was going to do. I always liked surgical things, I liked procedures, so I ended up in urology. Then one of the things I really found that I gravitated towards was, number one, the microsurgery aspect. But then also I just thought it was such a cool way to help couples. There’s a lot within urology — there’s a lot of cancer — but seeing a couple come in to tell you, or send you an email, that they’ve finally gotten there and that they’re pregnant, is just one of the coolest things to be able to be involved with, to whatever capacity. So from a professional fulfillment perspective, I think that was probably it.

And then I also just thought infertility was unique in that there’s a genetic component, there’s a hormonal component, there’s both male and female factors, so it was different from other specialties where it’s just “cut it out” or “take the stone out.” I found it incredibly gratifying. And then also, the part of me that’s a little bit precise and wants things to look right was really well-suited for microsurgery, where you’re doing these small, delicate operations that have to be close to perfect — that worked for how I like to operate.

Lisa: For our listeners who aren’t really familiar — could you briefly share the difference between microsurgery and just regular surgery?

Dr. Samplaski: Microsurgery is done under a microscope. The two main surgeries I’m referring to are varicocele repairs and vasectomy reversals. Because these are such delicate procedures done on veins or the vas, which is only a few millimeters in size, our human eyes on their own can’t really accommodate that level of detail to perform precise surgery. So we actually operate under a microscope, under about 20x magnification. That’s microsurgery — surgery done under a microscope, as opposed to open surgery or robotic surgery, where the magnification isn’t enlarged because you don’t really need it.

Lisa: Wow, that’s incredible. I can see what you were saying about being very precise, because under 20x magnification, you must have the steadiest hands on the planet. So one of the questions I wanted to ask is just in general, to establish the issue with male fertility challenges — how common is male factor infertility?

Dr. Samplaski: Infertility in general affects about 15% of couples, but of those couples, up to about 50% will have a male factor component. In about 20 to 30%, the male ends up being the primary cause of why they’re struggling, and then in about 20 to 30% there’s overlap between male and female factors. So I think the female partner tends to get focused on initially because they carry a larger proportion of the burden — they’re the ones carrying the babies, and oftentimes they’re the ones driving the fertility workup. But the reality is up to 50% of cases will have a male factor component.

Lisa: Well, it’s been the experience of a lot of the women I’ve worked with over the years that even if their partner is tested and the sperm values are a little bit on the lower end, they’re often told that their partner is just fine. I’m curious if you have an opinion about that, or experience with how it’s determined whether or not there is an issue on the male side.

Dr. Samplaski: I would definitely agree with you. A lot of it depends on where these guys are initially screened — the family doctor, or a reproductive gynecologist. Family doctors, because they don’t specialize in male factor infertility, oftentimes just get a semen analysis with a list of normal reference values. But just because somebody tests “normal,” there still might be things that can be done to make things a little bit better — more sperm, more swimming sperm, ultimately means more sperm swimming at the egg every month.

We’re seeing good data now that reproductive gynecologists end up seeing a lot of these guys first, and so oftentimes we do refer men for a male-factor evaluation. Per practice guidelines, when infertility is suspected, both the male and female partners are supposed to be worked up in tandem, just because there might be things we can do to improve a male’s fertility. The semen analysis is the best test we have right now, but it’s not perfect — there are plenty of guys who have normal semen analyses whose couple still isn’t achieving their reproductive goals, and that brings up sperm DNA damage, a concept whose role in infertility is still being sorted out but that isn’t seen on a standard semen analysis.

Lisa: I wanted to get to that a little bit, but I wanted to just touch on the idea of “normal” first, because as you were talking, you mentioned that there are times when even when a man is quote-unquote normal, there would still potentially be things that could be done to improve those numbers — because as you said, if there are more swimmers, it’s just a better chance. So I would like to hear your take on what’s normal. My understanding is that those normal values have changed multiple times — the World Health Organization declared what is normal in their first edition back in 1980, and there have been five editions since, so those numbers of what constitutes normal have gone under significant change. So from your perspective, do you feel that if a man just meets those parameters, that’s fine, or what have you found in your practice?

Dr. Samplaski: It’s true, but couples don’t care as much about a normal semen analysis as much as they do about getting pregnant and ultimately having a live birth. So while it’s great to have normal numbers on paper, ultimately for couples the goal is a take-home baby. The normal parameters we’re currently using, per the World Health Organization fifth edition, are: volume more than 1.5 mL, concentration more than 50 million, motility more than 40%, and morphology more than 4%. More sperm in any of those classes is probably a good thing, but I also think, particularly in reproductive medicine, there’s a lot that we don’t know. The reality is all we’re doing is looking at sperm under a microscope — that tells us nothing about their genetic health or how they function. I personally think there are several underlying genetic conditions that medicine isn’t yet aware of — that we don’t have tests for — but that ultimately impact a couple’s fertility potential. So the semen analysis is the best we have right now, but if a couple isn’t achieving their goals even with normal semen parameters, that “normal” label doesn’t matter quite as much, because they’re still not getting what they want.

Lisa: Well, for the listeners who aren’t familiar with sperm DNA damage and what that means, and how that can impact a couple’s chance of conceiving — did you want to dive into that a little bit? I suppose one of the questions I have is, if a man’s sperm parameters are on the lower end, does that correlate with an increased amount of sperm DNA damage, or do we know?

Dr. Samplaski: I can answer your question — yes. The concept of sperm DNA damage applies even in guys who have normal semen parameters but for whatever reason aren’t achieving a pregnancy, or couples who have recurrent miscarriages despite everything else seemingly being accounted for. When sperm are forming, splitting, and dividing to create new sperm, there’s a series of breaks that occur to allow the double helix to split, and when a new sperm is formed, those breaks seal up. Guys who have unexplained infertility, or even guys with borderline semen analyses, will tend to have more of these breaks.

One of the more common tests done is called the comet assay — basically, sperm are placed in a gel, an electrical current is applied, and the heavier fragments don’t move as quickly as the lighter, more fragmented material. So the fragmented DNA forms a longer “tail” or comet shape. Guys with more DNA breaks tend to fertilize naturally at a lower rate, and those couples tend to have more success with assisted technologies such as IUI and IVF.

Lisa: So it sounds like there are men who have a sperm analysis done and it reads normal, but if they’re at the lower end or borderline, they could potentially have a higher level of this damaged DNA sperm, which could reduce the likelihood of conceiving within a certain timeframe. My understanding is that one of the challenges with identifying male infertility is that there’s obviously a line in the sand if you have no sperm at all — but if a man does have sperm, even if the numbers are very low, there’s always a chance conception can happen, whether it happens in a timely manner or after multiple miscarriages. I feel like that’s one of the reasons why a lot of men are classified as “normal and fine,” because there’s always that chance as long as there’s sperm present.

Dr. Samplaski: Yeah — and one thing I want to mention, because I get asked this a lot, is that guys who have more DNA breaks — this doesn’t necessarily correlate with offspring who are sicker or have handicaps or mutations. The female body has this amazing ability to screen out embryos that aren’t normal. So even if a guy has more of these DNA breaks, it doesn’t necessarily mean they’re going to have a baby with issues down the road.

Lisa: One of the questions I’ve formed over the years is that in the way testing on males is done, it seems like there’s this line in the sand where you’re either “normal” or not, and there isn’t a whole lot of discussion about sub-optimal versus optimal, if that makes sense. A lot of men in the “normal” category still have trouble getting pregnant. I’m curious what your thoughts are on that, or how you counsel your couples about it.

Dr. Samplaski: When I see couples, we go through their semen analysis, and there’s a wide range — the lower limit for sperm concentration considered normal is 15 million, but guys can go up to 150 million. So the question is, what can we do to help them have more? Then there are all these other things outside of just the raw semen analysis — varicocele, I think, affects sperm in different ways outside of the semen analysis itself. There are also lifestyle things we can optimize: cigarettes, marijuana, hot tubs. A lot of people think testosterone replacement is just a natural supplement — it’s not, and it will actually hurt sperm. There’s occupational exposure, and then just optimizing diet and exercise — there’s evidence that exercise and diet can impact semen parameters. I personally think that a lot of these small changes, even if the semen analysis is normal, are going to provide healthier sperm.

We always start with the semen analysis, but then we go into all the other things that may or may not contribute to healthy sperm, which will hopefully contribute to a conception. Ultimately, in some couples you’ll get to the point of, “you’re doing everything right, and I don’t know why this isn’t happening” — but at least we’ve had that discussion, and in a lot of guys we do find things we can slightly modify that hopefully help them achieve their goal.

Lisa: I really appreciate that, because it goes a lot deeper. The experience your patients are having with you is, in many ways, different from what many of the women I’ve worked with have experienced with their doctors, because a lot of women whose partner’s sperm parameters are borderline are often told there’s not a whole lot they can do, and they’re immediately directed to assisted reproductive technology. It sounds like your experience has led you to at least attempt some of these other things and educate the couple.

Dr. Samplaski: Most of my couples don’t want to use assisted reproduction — most people want to have a baby naturally, and I think that’s normal. So I ask people about their goals. There’s a lot that goes into inseminations and ART, and it’s all such a financial and emotional commitment that a lot of people just can’t afford it for something that’s not guaranteed to work.

Lisa: Well, let’s jump into varicocele, since that’s something a lot of women whose partner’s semen has been analyzed, or who’ve had a full workup, will encounter as a certain percentage of couples for whom this is an issue. Maybe you could share with us what it is, and the link between varicocele and male infertility.

Dr. Samplaski: Sure. Varicoceles are dilated veins that drain the testicle. Testicles are unique in the male body in that they don’t have a whole lot of muscle backing, so these veins have a tendency to stretch, and when they stretch, the small valves that keep blood moving against gravity sometimes don’t fully connect. That causes a pooling of blood around the testicle, and this is oxygen-poor blood. In some people, that pooling of blood — either because it’s oxygen-poor, or because it’s heating up the testicle — can hurt sperm production or testosterone production. For some people the testicle takes the extra heat just fine and it doesn’t seem to impact sperm production, and for others it seems like the heat does affect the sperm “factory.”

Varicoceles are seen much more commonly in the infertile population. There’s about 15% in the general population, but in couples with primary infertility — people who’ve never had a baby — we see it in about 35% of men, and in couples struggling with a second baby, we see it in about 80% of those.

Lisa: That’s something I actually saw in the research — that connection with secondary infertility. Are there any theories as to why that is?

Dr. Samplaski: Medicine doesn’t actually know why. I personally think it may just be that these are people who’ve been upright longer, exercising and picking up kids and doing things that exert pressure on these veins, and ultimately they stretch the same way. But we don’t have a great reason why it affects some people more than others.

Lisa: When you were describing it — these veins increase the temperature of the testicles. Could you share the importance of temperature as it pertains to sperm production, so listeners understand how the varicocele actually increasing temperature would negatively affect the sperm?

Dr. Samplaski: Testicles are outside the body for a reason — they’re kept about three to five degrees cooler than inside the body. That’s part of why boys with undescended testicles sometimes struggle to have kids later — the testicles need to be cooler, and the sperm production “factory” likes to be a little bit cooler. When it’s hotter or warmer, for some people it seems like the testicle doesn’t work as well.

Lisa: You mentioned hot tubs earlier — I think that’s a common thing people have heard about, but I often wonder if people just think it’s an urban legend.

Dr. Samplaski: There’s actually some truth to that, because sperm have to be produced at an optimal temperature. It’s not everybody — there are plenty of people who use a hot tub and go on to conceive without issues — but there are plenty of reports of people sitting in a hot tub for half an hour and having a decline in their sperm count. So if you’re trying to have a baby, it’s low-hanging fruit — it’s the easy thing you can do that may help you get where you want to be.

Lisa: Back to the varicocele — if a couple has been trying to conceive and it’s not happening, and it’s a varicocele, would a man know that he has it, or does a doctor have to examine him for this to be identified?

Dr. Samplaski: In general, it’s best to be examined by a physician, because you want to catch other things too, like testicular tumors. There are a lot of guys who come to my clinic who already know they have one — the internet provides people with pictures, and guys look around down there — and there are people who say, “yeah, I know I have this, it doesn’t bother me, so I never did anything about it,” which is totally reasonable. But there are also a lot of people where you can’t see it — some you can see, some you cannot — and there are plenty of people where, when I examine them, I feel it on exam, and it would have only been diagnosed by a reproductive urologist.

Lisa: I think this gets back to what we talked about before — if a couple isn’t conceiving and their test results are coming back “normal,” and there are also a lot of couples who aren’t even tested — I’ve spoken to women who have had to convince their doctor to even analyze their partner’s sperm. So for couples who haven’t even done the semen analysis, or who have and are just told it’s “normal” — you mentioned the standard of care is that men are referred for a workup. It sounds like this would be one of the reasons your male partner should have a workup, just in case, since this is one of the things that could be identified.

Dr. Samplaski: Yes — there are so many men who are seen who have varicoceles, and we’ve shown that fixing them — and again this isn’t everybody — but in people trying to have a baby who have a larger varicocele and don’t want to move on to more invasive assisted reproductive technology, varicocele repair can help them, since the goal is usually to have a baby on their own.

Lisa: So then, how do you fix the varicocele? A lot of women ask about the surgery — is it going to work, what does it look like, is it going to hurt him, how does it impact him? Maybe you could walk us through the treatment options and the realistic, day-to-day details of the procedure itself, and whether it actually improves sperm quality afterward.

Dr. Samplaski: There are, in general, two main ways we repair a varicocele. Microsurgery is the ideal approach, and there’s also a radiology procedure where an interventional radiologist places small plugs in the veins, called embolization. The microsurgery is a relatively small surgery — it takes about 90 minutes. Guys go to sleep for it, mostly because it’s just too difficult to do awake, and the shifting under the microscope would look much bigger to the patient than it actually is, but most guys are happy to go to sleep for it.

We basically identify the dilated vein under a microscope, and we use a small ultrasound — about the size of a pen tip — to identify the direction of blood flow, identify the dilated veins, and tie them off, so the blood is essentially forced to drain through a healthy vein. It’s a little bit like, if a road isn’t working, you block it off and cars are forced to take a healthier route. Guys go home the same day — most people use ibuprofen alone for pain control, along with ice packs and scrotal support, and most say it wasn’t that bad. They’re back to work in maybe three days, and wait a few weeks before going to the gym. There’s certainly the fear of the unknown with any surgery, but most people afterward say it wasn’t bad, and ultimately, if it helps couples get where they want to be, most guys are fine with it. As for timing — I tell people to wait about two weeks before having sex again, mostly so the surgical site isn’t bumped and doesn’t bruise. Sometimes people will schedule the surgery around their ovulation timing, which makes sense.

Lisa: Once you have the procedure done, like anything, I’m guessing it’s not immediate — his sperm count doesn’t just double two weeks later. Share with us how long it takes to see improvements in sperm quality, and whether it works for everyone.

Dr. Samplaski: Varicocele repair will improve semen parameters in about 60 to 70% of men, so it’s not everybody. Varicoceles also come in small, medium, and large varieties, and in general, larger improvements are seen for bigger veins. Sperm production takes three months — the “assembly line” for making sperm takes about three months, so we won’t see the total effect of any change for three months. What I tell people is, start trying, because the “factory” is still cooling off, and there may be improvements in the sperm released after surgery that we don’t see yet on a raw semen analysis. In general, we check another semen analysis after three months, which is really reflective of the new, cooler environment the sperm are being formed in.

Lisa: I think the varicocele topic is interesting, because as you mentioned, a certain percentage of the general population has them, and a certain percentage of fertile men have them too — but it seems infertile men have a higher percentage. Am I stating that correctly?

Dr. Samplaski: Yes — and the more I practice, the more I see that every person is different. Some people’s testicles can tolerate heat a little bit more, and others can’t, and maybe with time they develop less tolerance for warmer temperatures, since people’s bodies change over time. So for some people it becomes a problem, and for some it’s not, and maybe at one point it wasn’t and then over time it became more of a problem for sperm production — everyone’s unique.

Lisa: I think for any practitioner who’s worked with many individuals in any area, you really can’t stick to a template if you’re paying attention — there are general tenets, but there’s this broad spectrum of individual difference we have to account for. So in your experience, couples who have male infertility with varicocele go through the procedure and start to see improvements in three months — could you share a general idea of whether the improvements are dramatic or subtle, and any information on pregnancy rates?

Dr. Samplaski: There are a couple of aspects to this. In general, guys with varicoceles tend to see improvements in all of the parameters — counts usually improve, motility usually improves, and morphology improves, and the degree of improvement is variable. I’ve seen people who’ve had a doubling or even tripling of their total motile sperm count, and I’ve had people who see maybe a 50% increase — and the question is, is that clinically meaningful in terms of helping them have a baby? For some people yes, and for some people no. I tend to fix more of the larger varicoceles, particularly in couples with very low semen parameters, because I don’t want to subject people to an unnecessary procedure if it isn’t going to help them get where they want to be.

Interestingly, there’s a lot more evidence now regarding guys who have no sperm at all in their ejaculate — this is a really tough diagnosis for couples to navigate, and it’s really hard for the guys to know they’re not making anything. But there’s more and more evidence that these men could have zero sperm and, with a very good-sized varicocele, fixing it may help up to 30% of those guys have sperm restored to the ejaculate. That’s not a huge number, but for those 30%, that’s a big deal for that couple. So in that population in particular, I have a very frank discussion that there’s a good chance this won’t make things better, but if it does, we’ve done a great thing for you.

And then the last thing you asked about was pregnancy rates — there’s more and more evidence showing that varicocele repair can improve pregnancy rates and live birth rates, and to me that points back to the DNA damage aspect — that we’re providing healthier sperm that contribute to pregnancies that hopefully result in beautiful, healthy babies.

Lisa: You mentioned a few things that contribute to poor sperm quality and parameters — smoking cigarettes and marijuana, dietary things, and how exercise can help. I wanted to go back there, because you mentioned that when working with a couple, there might be a few things that stand out. Could you go into some of those additional factors that can damage sperm?

Dr. Samplaski: Sure. Outside of varicoceles, sometimes guys have lower testosterone — the testicle basically has two main jobs: to form sperm and to form testosterone. Sperm need a very testosterone-rich environment to form, and the testicle actually has about 50 times higher testosterone levels than what’s in the blood, so sperm really want to be bathed in testosterone. One of the things reproductive urologists do is modify a guy’s hormones — if their levels are low, increasing testosterone through medications or lifestyle modifications can increase sperm counts, motility, or morphology. And then there are just the other lifestyle things we touched on.

Lisa: A question for the women listening whose partner smokes cigarettes or marijuana — is it a matter of going cold turkey, or how do you address that with your patients?

Dr. Samplaski: In general, I think cigarettes and marijuana can definitely hurt motility and morphology, and there’s a lot of evidence they can hurt sperm’s genetic material. If somebody’s a very heavy user, I think it’s really hard and unrealistic, and it can sometimes create relationship stress for the woman to say “you have to stop this right now.” Obviously that would be ideal, but I feel we have to be gentle with our partner. Usually what I tell people is to try to cut down, whatever that means for them — for some it’s mindfulness, for some it’s substituting another habit, and for some, working with their primary doctor on medications that can help. I always encourage couples to be kind to each other — give your male partner the support he needs, and acknowledge him for cutting back. There’s very little evidence looking at the different forms of marijuana and even tobacco — it’s a study I’d like to see done, but it’s been hard to recruit men to compare vaping versus cigarettes, or different forms of marijuana. People say edibles are better than inhaled forms — I think so, but there’s no strong evidence to show that, though certainly there’s less inhaled material with edibles. You have to be realistic with your partner — ideally they would stop, and I always suggest a male fertility multivitamin to provide antioxidants against some of what they’re inhaling.

Lisa: I always find these conversations so interesting, because anyone who works with women in the fertility space knows that women will do everything — stand on their heads, do somersaults — they come in with this huge list of supplements, doing every possible thing, medical and holistic. And what I find really interesting is that even for the healthiest woman in the world, with an amazing cycle, no doctor is going to say “you’re so healthy you don’t even need a prenatal.” It doesn’t even occur to us that maybe he should do some things to prepare too. I’m curious what you’ve observed in medicine in general.

Dr. Samplaski: Most of the guys I see who are part of a couple already seeing a reproductive gynecologist are on some supplements — fertility-targeted supplements, and I don’t think those are bad. The evidence supporting them is mixed, but what I tell couples is it’s not going to hurt anything, and in some ways it strengthens their commitment. But I’ll say — infertility is stressful for the men too. I’ve had numerous guys break down and cry in front of me, saying “I feel like I’m doing everything right and it’s still not happening, and I know this is hard on my partner too.” So I think in general, yes, infertility should be treated as a couple’s condition — both the male and female should be seen, and lifestyle, which includes diet, supplements, and exercise, should be addressed in both partners. But I’m also a big fan of relationship health.

Lisa: I really appreciate your perspective on that, because it’s always a challenge to bring the male partner into the discussion, since it can negatively affect the relationship depending on how you approach it. At the end of the day, you don’t just want to have a baby — you also want to have that family. One of the things we talked about in our pre-chat was your openness to a more holistic approach with your patients. For women whose doctor may not be as open to that, or who may discourage them from looking at holistic options, what would you want them to know?

Dr. Samplaski: I personally think we know a lot about male infertility, but there’s also a lot about fertility in general that we don’t know. Medicine knows more today than it did 20 years ago, and I think we’ll know more in the future. So I’m a fan, if couples are interested, of a multidisciplinary approach. I’m trained in Western medicine — I’m not a naturopath, I’m not a psychologist — but I think all of those can augment your efforts. I’ve had couples go to a naturopath or another provider and see improvements, and that’s great — what makes me happy at work is helping couples achieve their reproductive goals. It’s not something I’m trained in myself, but I definitely think there’s a role for other providers to be part of a fertility care team. I’m a big fan.

Lisa: One of the things you mentioned in our pre-chat as well is that although you have this open, holistic approach — which is a breath of fresh air for your patients — not all doctors view it the same way. Given that you’re a doctor yourself and know a lot of doctors, what advice would you give a woman for how to approach that conversation if her doctor isn’t as open to it as you are?

Dr. Samplaski: You could say something like, “we’re looking at working with a nutritionist too — we just want to be sure we’re leaving no stone unturned.” Different physicians come with different beliefs about their role, but you could frame it as, “you are our medical physician, but we just want to have a comprehensive care team,” and I think it would be hard for anyone not to support that.

Lisa: Well, I appreciate that. This conversation has been so informative — I really appreciate you going through everything in as much detail as you did. I know this episode is going to be so beneficial for so many listeners. Is there anything we haven’t covered, or anything you’d want a woman whose partner has been struggling with these fertility challenges to know?

Dr. Samplaski: I’d say two things. Number one — male infertility can be a big blow for men. It’s not the same for everyone, but for a lot of guys it’s very emasculating, and most guys are really trying and want to make their partner happy. So in general, be careful not to point the finger and place blame, because really, you’re a team. But the flip side is, I see plenty of guys who just want to get checked, and when everything comes back clear — hormones, semen analysis, DNA testing, exam — they’re so happy, and they feel like an all-star. So I think getting checked is a great idea. And then also — women, be kind to your partner.

Lisa: Yeah, it’s on the one hand — I think women have every right to be frustrated, because sometimes it’s a struggle just to get your partner to take a multivitamin, and it can be frustrating to be doing all this yourself and have your partner not even do that much, or to have trouble getting him tested at all. But at the same time, if you’re in a relationship with somebody, it’s give and take — you have to meet them where they’re at and be kind. So that’s amazing advice to end on. Dr. Samplaski, thank you so much for being on the show — honestly, my brain is still spinning. I really appreciate the depth you took us through with all this information today.

Dr. Samplaski: Well, I appreciate your inviting me to talk. I’m passionate about helping couples have babies, and I love that these resources exist for couples, so I really appreciate you taking an interest in male factor infertility.

Lisa: I’ll make sure to link to some of the research studies you’ve published in the show notes page. Is there anywhere you’d like to direct listeners to learn more about you and what you do, and could you also share where you’re located, since some listeners may be in your hometown?

Dr. Samplaski: I practice in Los Angeles, at a few different fertility clinics, and I’m in practice at the University of Southern California. I can provide you with my website, but if you just Google “Mary Samplaski, University of Southern California, urology,” you’ll find my picture and a link to schedule appointments. In terms of resources, the American Society for Reproductive Medicine has a lot of really great online information for patients — if you Google “reproductive health,” it links you to their patient resource list, which covers a host of different topics. It’s high-quality, unbiased information, since there’s no opportunity for financial gain there — those are great resources for patients.

Lisa: Wonderful — I’ll make sure to link the resources you mentioned, as well as your website, so listeners on the go can just head over to the show notes page to get that information. I just want to thank you again for being here — I really appreciate it.

Dr. Samplaski: Well, thank you for having me, Lisa — have a wonderful day.

Lisa: Thank you for listening. If you enjoyed today’s show, please share it with a friend. You’ll find the show notes page for today’s episode over at fertilityfriday.com/305.

I hope you enjoyed today’s interview with Dr. Samplaski — it was just jam-packed with so much important information, and it’s always refreshing to have medical doctors on the show who are really investigating and working with their clients, as Dr. Samplaski put it, to achieve their goals. One of the parts of the episode that stood out to me was when she said it depends on her patients’ goals — most of her patients don’t want to use assisted reproductive technology, and not all couples have the means to do that financially. So one of the reasons she thoroughly investigates these situations for her patients is to really help them achieve their goals, which would be to conceive naturally when possible, and to determine if there’s something that can be done if there is an issue on the male side.

So hopefully this episode has provided you with additional information, especially if you’ve been trying to conceive for quite some time and it hasn’t been working. What I always say is that even if you’ve been told everything is “fine,” if your practitioner hasn’t sat down to explain the different parameters — where your partner’s results sit compared to the low basic limit, and also compared to what would be optimal for natural conception — then even if you were told everything was “fine” in air quotes, it’s really important to get a hold of your test results. Call your doctor’s office, make sure you have a copy of your test results, make sure you have a copy of everything in your file, so that if you ever do seek a second opinion or a consult with a different physician, medical doctor, or functional practitioner trained to look for root causes, they can have a second set of eyes on that same information and perhaps give you additional insight. Without exception, all of my clients who’ve been told “everything is fine” have found that their practitioners typically had not actually sat down with them and explained the results in any real detail beyond just saying it’s fine.

So hopefully today’s episode has continued to highlight and reiterate the importance of having both partners tested and thoroughly investigated, and if you’re not satisfied with the information you’re getting, or you’re wondering if there’s more to the story, it’s always worthwhile to consider getting a second opinion.

I want to thank you for tuning in to the show, for being part of the Fertility Friday community. If you were thinking of somebody the whole time you were listening, make sure to share today’s podcast episode — you’ll find the show notes page over at fertilityfriday.com/305. If you’ve been enjoying the podcast, if you’ve found the information valuable, if it’s opened your eyes to different things you weren’t previously aware of, I would really appreciate it if you left a review on Apple Podcasts. Leaving a review is one of the ways that helps people find the show, and it also helps people know what the show and our episodes are like. I do read all the reviews, and I really appreciate all of your support.

We’ll be talking about male factor infertility and debriefing this episode in the Fertility Friday Facebook community, so make sure to join us there — you can find us over at fertilityfriday.com/community. Thank you for spending some time with me today, and, as always, until next time, be well.