Sperm Health

Guts and Girl Bits Episode #55

In this episode of Guts and Girl Bits, Raul Pastrana joins us to discuss sperm health. An incredibly important but often overlooked aspect of fertility, we discuss the importance of looking into sperm health at the start of the fertility journey, what can go wrong with sperm health (and why) and some tips to improve it. Sperm issues can contribute to ~50% of fertility issues, as well as contribute to many issues during pregnancy. The quality of sperm also has a massive impact on the health of the child, influencing many things including their immune health, reproductive and neurological health.

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About Raul

Transcript

[00:00:04] Alison Mitchell: Welcome back to Guts and Girl Bits. Now, I know most of you listening are women, but today’s episode is one that you’re gonna wanna tune into and maybe even share with the men in your life.

Because when we talk about fertility, we so often focus on the female side of things, our cycles, our hormones, our eggs, and we forget that sperm health plays a huge role, not just in the ability to conceive, but also in the health of pregnancy. And even the long-term health of the child. Sperm health has been linked to pregnancy outcomes like miscarriage and preeclampsia, and what’s fascinating is that while women are born with all of their eggs.

Eggs that were actually influenced by our grandmother’s health. Men are constantly making new sperm every few months, so that means that there’s a much faster impact on our offspring based on what is influencing the genetic expression of the sperm. [00:01:00] So lifestyle, nutrition and environmental factors can all have profound impacts on sperm quality, which in turn shapes not only fertility outcomes, but potentially even the health of and the development of our future generations.

So now that doesn’t necessarily mean that we’re talking about like evolving mutant powers anytime soon, but we are talking about how the choices that men make today can influence things like neurological, mental, and immunological impacts of our future generation and our future children. So to dive into this fascinating and often overlooked topic, I’m joined by Raul Pastrana.

Raul is a degree qualified naturopath. Specializing in fertility and reproductive health, he focuses on helping individuals and couples optimize their fertility with a particular emphasis on male reproductive health, which is a factor that’s often underestimated when it comes to conception outcomes.[00:02:00]

Raul works closely with patients through IVF Preconception Care and Natural Conception. He creates tailored plans based on each person’s unique presentation and goals, and importantly their blood pathology and semen analysis result. He’s also the author of the Sperm Factor Fertility, A Shared Responsibility where he explores how men can influence fertility outcomes and provide practical, strategies to improve sperm health.

So in our conversation today, we talk about why it’s so important to look at sperm health early in the fertility journey, some of the key factors that influence. Sperm quality and why what’s considered normal on a semen analysis might not actually be optimal. Raul will also share some really actionable tips on how men can start to improve their sperm health today.

So whether you are on your own fertility journey, whether you’re supporting a [00:03:00] partner or you’re just curious about how male reproductive health fits into the bigger fertility picture and evolution, this episode is full of insights that might just change the way that you think about conception and reproductive health and wellness.

So let’s get into it.

Thank you so much for joining me today.

[00:03:21] Raul Pastrana: Hi, Allison.

Thank you for having me. It’s a pleasure.

[00:03:24] Alison Mitchell: I’m so excited. We haven’t done an uh, episode for Guts and Girl Bits it’s in a long time and I, I find it’s kind of interesting that the one that we do to come back is actually about a bit more to do with Men’s Health.

[00:03:37] Raul Pastrana: Yeah. It’s, um, it’s great to talk about these topic that sometimes is underestimated.

[00:03:43] Alison Mitchell: That’s right. And I mean, it is something that is going to be very interesting for our female audience as well, because a lot of the time people who, women who are going through issues with fertility, subfertility, sperm, is something that they know is an important factor that they need to look [00:04:00] at even before something has been identified, but they don’t really know how to go about it or what are the things that has an impact because there is so much information out there.

But now we’ve got. On the podcast, we can really shine, shine some light on what is the actual relevant information that people can action. How can we do things about it? So I’m really excited to get into this.

[00:04:22] Raul Pastrana: Yeah, me too. Let’s get into the nitty gritty.

[00:04:25] Alison Mitchell: So you’ve been in practice for a few years now. And what is the thing that led you into working with sperm health and fertility so much?

[00:04:34] Raul Pastrana: Since I finished is my naturopathy degree, I, I have been exposed to a large number of fertility cases and. When what came very relevant and undeniable is that when a couple is trying to conceive usually the weight of responsibilities placed on the women, on the female factors. So, um, she’s the one that usually makes the appointment, has the [00:05:00] scans.

Has had multiple blood tests, is already taking a few supplements because she has done some investigations to what could, what can she do in order to improve her outcomes. But in many cases, the male factor is under assessed undertreated and also under research.

And this is really puzzling as a practitioner because the research is telling us that this is wrong.

50% of all fertility cases are related with the male factor. So there is, at least from all the infer, uh, infertility issues out there, 50% of them, there will be some. Male factor contribution. And this is why if a couple is having trouble conceiving, both sides of the equation need to be investigated at the same time in order to have the best fertility potential and the best outcome.

[00:05:56] Alison Mitchell: So that is crazy. 50%. And it [00:06:00] doesn’t really reflect, does it, with the, the way that the, our investigations get done. It’s usually always, alright, well let’s look at the woman first. And said it should be both at the same time.

[00:06:12] Raul Pastrana: Absolutely. Both at the same time. So, the mail should be getting a semen analysis.

And in that semen analysis that is just the most basic, uh, start, we need to assess, uh, the most common findings, which may be, um, your listeners are already familiar with, which are the semen quantity or how much, how much sperm is there in terms of concentration.

Mm-hmm.

But also how is that sperm moving that motivity.

And last, how is the shape or the morphology of that sperm?

So these are usually the three factors that they are first assessed when the Mel factor is assessed at all. If so.

And that’s where, where everyone should start with,

[00:06:55] Alison Mitchell: with, with the sperm analysis and those markers.

[00:06:58] Raul Pastrana: Yes.

That’s, uh, [00:07:00] that’s the baseline. The one thing that I will say, it gets overlooked. More often is the DNA fragmentation as well. So the DNA fragmentation, it’s a test that can be done in the sperm to understand what percentage or how damage, uh, is the genetic material inside of the head of the sperm. So if the genetic material inside of the head of the sperm is fragmented, that’s gonna have repercussions for.

Conception, fertilization uh, pregnancy outcomes and the future health of the baby. The DNA fragmentation think about it as a, if the DNA is broken, the instructions to make the baby and the instructions for fertility outcomes, they’re not gonna be as good as we want them to be.

Mm-hmm.

So we want to make sure that we are addressing all the factors that they’re affecting male fertility, to [00:08:00] make sure that the copies of the DNA inside of the head of the sperm as are intact as possible.

[00:08:07] Alison Mitchell: That’s right. And have you, uh, seen that it’s often something where you get a sperm analysis that’s already been done, but DNA fragmentation isn’t included.

[00:08:17] Raul Pastrana: Yes, that’s exactly what happens very often. Mm. So we get the sper morphology, the motility and the quantity, but then the DNA fragmentation is not done.

And the thing is, it’s just much more easy to get it done all together. On the first analysis, so the then there is not, uh, need to pay again to get again to the clinic. So it’s better if you haven’t done one yet. And fertility is a concern I always recommend to include DNA fragmentation inside of the panel.

[00:08:48] Alison Mitchell: That’s right. And it’s an additional cost, isn’t it? Uh uh, whereas the sperm analysis can be covered under Medicare if there is issues with fertility over a certain amount of time, whereas the DNA fragmentation is [00:09:00] usually paid by the patient, isn’t it?

[00:09:03] Raul Pastrana: That’s correct, and something that’s, um, that’s a factor that can be a barrier for some people.

I completely acknowledge that finances can be a barrier, but when you think about the cost of some of these very expensive and very invasive. Artificial reproductive technique interventions paying a hundred of dollars to understand the quality of the DNA in that sperm it is in the scale of things is not that much.

[00:09:30] Alison Mitchell: Yeah. And it, it’s, I think it’s definitely worth it to do it, but people need to know that they do need to ask for it because it’s not gonna always be done automatically.

[00:09:40] Raul Pastrana: Yeah. And understand what it is that you’re actually measuring, like how intact or how damage is that genetic material. And it, it is very important to understand that.

[00:09:50] Alison Mitchell: So when we, when people are looking at the sperm analysis, so the, the things that you, you look at is the morphology. So how normal does the sperm look? [00:10:00] Does it have. A normal shaped, teardrop shaped head can actually penetrate the egg, or does it have a big lollipop head or a little pin head? Because all of those things need to work to actually do its job of conception.

And does it swim correctly and swim fast enough?

[00:10:18] Raul Pastrana: Yeah, so that will be, the stream will be motility, but the type of motility that we’re looking for is progressive motility.

Mm-hmm.

Because it’s not just about the sperm, be able to move, but move in a, in a straight direction. So the egg, so the sperm can meet the egg, usually in the fallopian tube.

And then they can be fertilization of the egg.

[00:10:38] Alison Mitchell: That’s right. It’s not gonna get where it needs to go if it’s swimming in circles or sideways.

[00:10:42] Raul Pastrana: Correct.

[00:10:42] Alison Mitchell: Yeah.

[00:10:43] Raul Pastrana: And another factor that I would say regarding, now that you mentioned the morphology, the motility, it’s very important to understand what we are comparing the what are the referend ranges that are on the right hand side of the piece of paper that we get with any semen analysis.

[00:11:00] So what, how are those referent ranges established and what do they really represent? Um, because that doesn’t mean. The fact that a sperm analysis fall within a normal reference range doesn’t actually mean that the sperm is optimal or healthy, unfortunately.

[00:11:17] Alison Mitchell: That’s right. And that, that was actually something I was gonna ask you about as well is, is how much has our reference ranges for sperm analysis changed over the years?

Because I’ve seen it and, but you would have the data on that.

[00:11:32] Raul Pastrana: Yeah. So only sperm concentration has dropped dramatically. It is dropping dramatically every year, and spare quality and concentration has been dropping, uh, since the year since the eighties. Um, but from, from the, from data that we have, from very, very extensive research, we know that the drop is even bigger.

Since the year 2000, so is sperm is not only declining in quality, [00:12:00] it’s also declining faster than it used to be since the year 2000. Um, and because the average male. Sperm, it’s has a such a poor, low, low quality. Then when we are, when we are creating those reference ranges, we’re, we’re comparing ourself with a sample that is not very good in quality.

Anyway, so I dunno if you know how those reference ranges were established, but in the year 2010, the World Health Organization um, did a study with over 4,000. Men from 14 different countries, and all of those men were able to conceive with a female partner in less than a year. And then they analyzed the data from sperm concentration, sperm morphology, and sperm multi for those 1400 men, and then divided from the lowest quality to the highest quality.

And they divided in percentiles [00:13:00] and they established that. The fifth percentile was the normal range, uh, and that’s what was established as normal reference range.

[00:13:09] Alison Mitchell: The fifth percentile.

[00:13:11] Raul Pastrana: The fifth percentile. So the lowest the lowest score possible. So were they able to conceive? Yes. But was that actually normal?

Not really normal will be the medium and the medial should be the 50 percentile, not the fifth percentile.

[00:13:26] Alison Mitchell: That’s right. And there’s a big difference between that. I mean, sperm concentration at the 50th percentile is 73 million per mil. Million per mil. And what’s the reference range?

[00:13:38] Raul Pastrana: Uh, 15 million only.

[00:13:40] Alison Mitchell: That’s very big jump.

[00:13:42] Raul Pastrana: Yeah. 15 million per mill. So it’s a huge ya and this is why it’s important to understand. What are you comparing, uh, your sperm or your partner’s sperm to? Are you trying to just pass the test or are you really trying to assert whether or not [00:14:00] this is sperm is good quality?

Mm-hmm.

And if you’re trying to assess that, it’s better to compare it with the 50th percentile. Yeah. So for example, for spare concentration, it’s still of 15 million. One five. You want to get closer to 73 million like you just said.

[00:14:17] Alison Mitchell: Yeah.

[00:14:17] Raul Pastrana: For sperm motility, instead of 40% of the sperm being able to have motility, you want 61% of the sperm to be able to move well.

And for morphology is the same, only 4%. It’s enough to pass only. You only need a 4% of your sperm to have optimal multi uh, morphology in order to pass the test. And don’t get me wrong, you don’t need, uh, this parameter of morphology doesn’t need to be close to the a hundred percent whatsoever. It is very normal to have a morphology on the 10%.

Even 9% is it’s enough to to have a good fertility potential, but the [00:15:00] 50% I will be 15%. So you see the huge disparity that is between what is considered normal or what the reference ranges were established and what actually health and good fertility potential represents.

[00:15:14] Alison Mitchell: And I think what we are seeing is that.

Men get told, you’re fine, you’re in the reference ranges. But we do wanna aim for a little bit better. We want super sperm. But I was thinking, and when I was researching for this, I actually realized that humans are the only species that have such a low average morphology. Mm-hmm. Compared like animals, their morphology is pretty much always like 99% normal.

[00:15:42] Raul Pastrana: Mm-hmm. Whereas

[00:15:43] Alison Mitchell: here we are as humans and. Do you have any ideas on what, what that might be?

[00:15:49] Raul Pastrana: Well, the reason that our morphology, like any other of our parameters has been declining. It’s a number of different contributors. We are, every day we live in a society that we [00:16:00] are. Moreover stimulated, there are endocrine disrupting chemicals where it is sleeping less than ever before.

We are our nutrition as an overall society and the quality of our diets is declining. The quality of our food supply, it’s, uh. Poorer than ever before with more, like I said, endocrine disrupting chemicals in the food supply. So all this is having an effect not only in morphology, but in all the other parameters.

And look what I always say to my patients or to anyone that is thinking about improving their sperm health, you want improve. Your particular circumstances, if you don’t identify the barriers and those barriers will be different from you than from someone else. Even though there are some commonalities, it’s important to do a thorough investigation to see what is affect, why your sperm health has been affected.

Mm-hmm.

And [00:17:00] things won’t get better because you take a very fancy supplement from the internet. That’s not how it works.

[00:17:07] Alison Mitchell: Just No, you have to do the work.

[00:17:09] Raul Pastrana: You have to do the work. And supplementation sometimes work. So if we have identified in your blood work and in your experiment analysis that there are specific factors that can be resolved by any specific supplement, then the intervention can be put in place.

But taking just sup, a random supplement with really good marketing behind it is not going to solve the issue.

[00:17:32] Alison Mitchell: Because sperm is such when it’s in the testes, it’s very protected. But when it gets into the epididymus, it’s much more exposed to chemicals and toxins and lifestyle issues.

So that’s one of the major things that causes the damage at that point, isn’t it?

[00:17:50] Raul Pastrana: I will say that a sperm synthesis or a spermatogenesis, which is the same thing is actually a very delicate process at all [00:18:00] stages. If we think from an evolutionary perspective, um, if there is danger, there is lack of resources in terms of nutrition, vitamin, minerals, the first thing that is going to go is sperm synthesis, and that’s because it is not required to keep the system alive.

Mm-hmm. So that’s why if there is high level of stress, if there is chemicals, a sperm synthesis is the first thing that can go. And it’s a pro, this sperm synthesis or a spermatogenesis, it’s something that takes around 72 to 74 days to fully develop. And I think this is a really important takeaway from anyone listening because your spend results.

Can be highly influenced by you making the right things. So if alcohol intake is the problem, if stress is the problem, if sleep is the issue and you resolve and address that factor, you can see results. In your [00:19:00] sperm quality and quantity in only three months because of that constant and dynamic process that is happening in the, at the testicular area.

So renewing those those sperm cells every 72 to 74 days.

And just a note about what you said. So yeah, it’s a very delicate process that can be affected and influenced in many different ways. But from those 72 days, like you mentioned, very correctly, the last 15 days when the sperm is going through the final the final track in the reproductive male system is highly, um, highly and easily damaged.

Hmm. So it’s at that stage where we want to be extra careful. What are we putting in our bodies? Alcohol intake, stress, et cetera. So what I do with my patients, if, especially for those that they’re gonna freeze their sperm and their sperm is gonna be used for XE procedures or IVF [00:20:00] procedures, I give them a high level.

Of antioxidants such as vitamin C, coq 10, lipoic acids, uh, nicotinamide riboside, and many others. Do. So we protect that testicular environment, uh, and that sperm going through the last 15 days before ejaculation.

So the DNA is intact. The morphology and the motility is as good as we, as we can.

[00:20:27] Alison Mitchell: Yeah, I, I, I think that’s a really good point because the sperm are so sensitive to oxidative stress, and so what you’re describing is loading them up with lots of antioxidants to give them the, that protection that they need.

I, um, wanted to share something that I found really fascinating when I was researching this is that when they are in the, um, epididymis, which is basically like a big, like collecting duct after they’ve gone through the testes. It’s like an a training center that they go through where they learn to swim really well and their [00:21:00] immune system changes.

And I saw some stuff where they said they, they took the sperm from the testes before they got to that point, and then they, they, but inseminated a woman with it and the immune system killed it straight away. Whereas after, had it been through the epididymis, it, it didn’t. Um, but we can talk about that immune onslaught of the sperm later because that’s also really interesting.

But they learned to, so they learned to swim. Their immune system develops and they learned to smell. How amazing I found that was just like so fascinating and that they learn to detect the smell of follicular fluid. And just like a shark, they can find one part per billion follicular fluid and this z and that’s how they know how to go.

And I was just like, I had no idea beforehand that sperm could smell.

[00:21:47] Raul Pastrana: Yeah, we’re still science is still trying to understand how is that even possible? How is possible that the smallest science, the smallest cell in the human body. Can have such a [00:22:00] complex function. How is it possible that can be attract by something that the egg is releasing?

So it’s believed that the egg is, some is releasing certain chemicals that, like you said, they are in such a low quantity, but the sperm can. Sort of smell them. Uh, and be attract to it. So it’s really fascinating. And like you said, the that training and that capacity to to have that sense is is highly influenced for what’s happening in the last 15 days before the sperm is ejaculated.

Um,

so like you said, it’s like a training center. It’s like the sperm are going through the gym in LA in those 15, last 15 days.

[00:22:40] Alison Mitchell: Yeah. All right boys. You’re being grown now. You gotta know what to do. Dear. I know the work of Leah Hechtman. She’s often spoken about how conception is a microbial event and that the sperm and the oy, the bacteria of each thing needs to agree, um, and they need to like each other.

And that, that is where a lot of that [00:23:00] olfactory sense comes in as well, which is so super interesting too because of how we know that like, for instance, the microbiome of the oral health. And the re um, gastrointestinal health, that all influences reproductive health as well.

[00:23:13] Raul Pastrana: Yeah. So in many cases, uh, when some of these factors come as clear and there is still a question mark to what could be influencing, uh, male fertility or female fertility, we can do, uh, semial microbiome.

Uh, but we can also do a vagina microbiome. Mm-hmm. And that can give us some insight into if there are any immune. Factors that could be negatively influencing fertility potentials. And, um, there is still so much data coming out. There is a lot of science and a lot of money that needs to be still put on.

So we hit better and more quality studies regarding this, but it is clear that, for example, from the female, the vagina microbiome of the female in order to have a good [00:24:00] 30 degree potential needs to be lactobacillus dominance.

Mm-hmm.

So we know that much. And, and that will easy, that will have a huge influence to whether or not the sperm can actually fertilize.

[00:24:13] Alison Mitchell: Mm-hmm. Can you speak a little to, uh, to how the, when the sperm is ejaculated into the woman, like what stage it goes through, how fast it travels and like the way that it sort of gets culled down along the way to the sperm, uh, to the oversight.

[00:24:30] Raul Pastrana: Yeah. So, um, the sperm if natural conception is, uh, how it’s happening, a sperm gets ejaculated and it starts struggling.

Like we said, that motility needs to be happening. If there is not progressive motility, which is. Swimming on a straight, uh, on a straight line is not gonna reach the egg. So the, uh, the egg has been is released obviously from, from the ovary and travels to the fallopian tube. The sper, uh, the sper is ejaculated [00:25:00] and starts swimming.

The process of swimming usually takes around two days. In order for the sperm to reach, uh, the egg, and that’s when usually fertilization of the sperm in the egg happens in the fallopian tube. If everything is going well, then that embryo already created, starts traveling slowly towards the uterus.

And in that process of traveling, which can last around five to six days, the embryo starts developing in and subdividing and. Going through a process of cell division into something called blastos. It is the blastos then that arrives to the endometrium. And uh, and if everything is going well, there is good endometrial lining.

There is good endometrial receptivity and there is also good endometrial microbiome. Again the immune system having an influence to whether or not. The, that embryo will be able to attach itself to [00:26:00] that endometrial lining and create a pregnancy and hopefully a healthy pregnancy.

[00:26:05] Alison Mitchell: Mm-hmm.

And on the way to get there, it has to sort of go through a bit of an immune onslaught, doesn’t it, from the woman’s immune system.

[00:26:14] Raul Pastrana: Yeah, exactly. So there has, has, there has to be certain immune adaptation for that for all that to happen. And that’s why the, if there is what I call low grade chronic inflammation where the immune system is constantly active and we talk about, we hear about inflammation these days in the social media over and over, and inflammation is not neither good.

Nor bad. We need good levels of inflammation when we have, if we cut ourselves or or if we have an a pathogen in our system. But when inflammation is not resolved, becomes chronic, and if, um, there is chronic inflammation that’s gonna, uh, activate [00:27:00] chronically the immune system. Now, the process of pregnancy.

Is highly sensitive to this to immunity. So we need to be able to lower our immune defenses in order for that embryo to attach to the endometrial lining. And if notice is not going to happen, if that is constant hyper surveillance because of that low grade chronic inflammation the embryo will be rejected.

[00:27:29] Alison Mitchell: Yeah. So these are the things that like would potentially be shown up, uh, in the case of like a failure to conceive naturally. Um, and then would, the woman would usually have to go and get some immune markers tested to see if that was the case. What about sperm antibodies? Is how common is that?

[00:27:50] Raul Pastrana: No, it is common, but it’s not that common. Hmm. They, they are there and it’s not some, it is also another, another factor that can be investigated. I [00:28:00] don’t like to place a lot of emphasis on that into the general population because it’s not something that has a huge representation. When you’re talking statistically, uh, for example, DNA fragmentation statistically is just being shown how important it’s to test.

And I advise all my patients to get test. The DNA fragmentation on their first semen analysis sperm antibodies is on the other hand not my first line of, uh, assessment if for, that’s

[00:28:35] Alison Mitchell: something you might invest in later if we, we don’t get the information that you need. Yeah,

[00:28:41] Raul Pastrana: correct. Correct. If, if we’re still having questions, okay, everything has come clear, why is pregnancy still not happening?

Then we can investigate that.

What I would say with experiment antibodies is one of other little thing that, uh, will come in most cement analysis is something called agglutination, and [00:29:00] that is how is the sperm behaving the whether. They’re all together in the sample or, or not. And if agglutination of the sperm is very high, then I always test that.

Semen antibodies, sperm antibodies.

[00:29:14] Alison Mitchell: Yeah. Okay. Interesting. Um,

[00:29:15] Raul Pastrana: yeah, so agglutination is something that if in the first analysis comes as as high, then it is a pro for me to test, uh, further do more testing.

[00:29:26] Alison Mitchell: Inter, I was thinking when you mentioned that about how naturally like the, the, like the nature of sperm in all species has to be quite sticky in order to sort of like to get there.

Um, and so the whole concept of like a woman having to lie down for a period of time after sex, like, so women, I think that they have to lie down for like, you know, half hour or an hour or something like that. Whereas it’s really not that long, um, because of how sticky it is. But I, that comes from like.

Like way back evolutionary times when a bit like a praying mantis or a spider, like the man’s gotta get in and run.

[00:29:59] Raul Pastrana: [00:30:00] Mm-hmm. Mm-hmm. Um,

[00:30:01] Alison Mitchell: and uh, that, now obviously that’s hopefully different now.

[00:30:06] Raul Pastrana: We have changed a little bit as a society since, but I think the main principle is still apply.

[00:30:13] Alison Mitchell: Yeah. And I think actually that I think that, you know, we were talking about how the sperm in animals is very different to humans.

[00:30:21] Raul Pastrana: Yep.

[00:30:22] Alison Mitchell: I think that’s also got to do with a bit of an evolutionary trait as well because of the, like, the rising impact of varicose seals and all of that, and it’s all about like how we’re upright creatures and so the blood flow doesn’t go back out very easily and so then there’s so much more blood there, and especially people do have varicose seals, but men have do have vari seals.

It’s such a hot environment which causes the damage that oxidative stress.

[00:30:49] Raul Pastrana: Yeah. Yeah. Baral is actually very, very common.

[00:30:53] Alison Mitchell: Mm.

[00:30:53] Raul Pastrana: And for everyone listening, what Barcos Seal is like nothing else, that a Barco veins the same one that some people [00:31:00] have in their legs. But instead of being in the legs, they are in the scro, in the scrotum.

And what a baril is, is nothing else than at function of the cardiovascular system. So it’s, um, part of the cardiovascular system that is not working well. So if it’s not working well, the blood that is arriving to the testicles to bring in nutrient. Reach and oxygen reach blood and removing waste products is not working well.

The other thing that an optimal cardiovascular system is doing at the testicular area is, uh, making sure that there is no rise in a scrotal temperature like you just mentioned. So. Again, we, we were talking about evolution and, and why things are the way are so, females, they have their ovaries inside of their body and that’s because the process of egg production and egg maturation doesn’t require different temperature than body temperature.

Um, for, for male [00:32:00] fertility, the process of experi nitrogen is requires around two degrees lower than. Total body temperature. So that’s why the male go nuts are hanging out,

right?

Mm-hmm. Now, if for whatever reason that temperature rises, one of the things would be vari cell because there is not enough.

Um. There is not enough blood flow, and blood flow is not optimized. Uh, but another thing is w wearing tight underwear, uh, being sitting for long periods of time, pushing the testicles towards the body, going to saunas, all those factors are gonna negatively influence the quality and the quantity of the sperm.

And what you were saying about you know, the cardiovascular, uh, the system and the vari cell. If we think about it, what is the number one cause mortality for men worldwide. It’s actually, poor cardiovascular health and cardio cardiovascular events. I mean, unless that it has changed [00:33:00] recently.

If it’s not, the number one is at the top, at the top there. So one dysfunction that happens from having issues with the cardiovascular system is having vari cell, which again, has a huge influence in sperm health. And the way to assess whether or not someone has vari cell ultimately is with an ultrasound of the testicular area.

[00:33:21] Alison Mitchell: Um, some highly trained physicians can even palpate it.

[00:33:25] Raul Pastrana: Yeah. They can palpate it and some, uh, some even are visible just with, uh, visual inspection, but ultimately for a proper diagnose, uh, at least in Australia, what the guideline said is, uh, the ultrasound is needed.

[00:33:40] Alison Mitchell: Yes. Uh, and it’s usually surgery is the.

Treatment, isn’t it?

[00:33:47] Raul Pastrana: Yeah, so it really depends from person to person. And not every single male patient with vari cell and who is experiencing fertility challenge will be offered uh, surgery. It really depends on the person [00:34:00] because the recovery time. I’m talking about the time that the sperm will need to recover in terms of quality and quantity, it can take from six to six months to a year.

Mm-hmm. Um,

and this is based on research and unfortunately, some couples don’t have their, that time on their hands. And then instead of, uh, surgically removing the Barco cell, other options are offered like IBF or other artificial reproductive techniques.

[00:34:27] Alison Mitchell: Mm-hmm. Okay. So while we’re on that, um, topic of things that can go wrong, let’s talk about some of the other factors that may be an issue in terms of affecting sperm health.

[00:34:40] Raul Pastrana: Mm-hmm. Yeah. Do you have one in mind or do you want me to tell? I’d love for you to just go

[00:34:46] Alison Mitchell: for it.

[00:34:48] Raul Pastrana: Uh, look, there are so many factors affecting, uh, sperm health these days. I always like to let the patient when I have a patient in front of me. I like to, uh, allow the [00:35:00] patient to expand on their health.

Tell me your clinical history. You have you had any major, uh, health events? Do you have any? Diagnose medical condition because that’s obviously gonna have a huge effect on your sperm health. So that’s how I start a consultation, letting the person speak. And if they haven’t talked about this, then I always chat about what I consider the pillars of health.

So that will be how is your nutrition, how is your sleep, how is your stress management? And are you exercising at all If those are not addressed. Usually I start from there.

Mm-hmm.

Uh, improving their diet, improving their sleep, their stress management, which goes hand in hand with the sleep. And then I always encourage someone to start exercising if they’re not exercising at all.

Little by little, so that will be the way that I think about a consult. But a above and beyond the four pillars of health. There are so many other [00:36:00] things affecting a sperm quality. One of the things that I speak a lot in my, in the book that is coming out, the Male Factor and why fertility should be a shared responsibility is about the role that pharmaceuticals play in, in, in male fertility.

For example the use of antidepressants has been linked with poor semen analysis. I remember this particular case for one of a patient that I had, um, a couple of years ago. Uh, this person was having this male patient was taking 150 milligrams of an particular SSRI, and then we analyzed.

Many of the other factors that could be influencing him, his diet, his sleep whether or not he had nutritional deficiencies, whether or not he had low testosterone, which obviously also influences sperm health and everything came as [00:37:00] normal. Nothing, nothing else than the antidepressant was an alarm bell.

So I obviously gave her, gave this person high level of antioxidants. Um, I gave him a multivitamin, an Omega-3 to make sure that we were protecting that testicular environment and giving a mass of the nutrients that the sperm that the, the body needs to create this sperm. But then the one thing that I work with.

As well as in conjunction with his doctor is to slowly reduce the dosage of the SSRI. And this is a case to case, uh, scenario. Some people, unfortunately, they cannot reduce the dosage of their antidepressants because they really need it, but in this particular case. The patient was open to, to try, and we worked together making sure that his his neurotransmitters were repleted, that everything was working as, as, as well as possible for him.

And he went from 150 milligrams to only [00:38:00] 25 milligrams in the course of six

[00:38:02] Alison Mitchell: months. That’s a massive drop.

[00:38:04] Raul Pastrana: It is, it is a huge drop. But he, I have to say, this person also at the same time start exercising, improve his nutrition. Uh. There were lots of things that he was not doing before that. Now he then he did, and I think that also allow him to drop the antidepressants with retest his sperm.

I, I can’t remember on the exact number, but I think he’s concentration went from like something like 9 million to 39 million, something like that. Mm. Um, and. I think exercise plays hit a huge role and we will never know how much what was the percent of the influence. On each of the factors, but SSRIs is a good example of how a specific pharmaceuticals can have a huge effect on sperm health.

[00:38:56] Alison Mitchell: Mm. And I, I do, I do think that it’s a very [00:39:00] big issue overall because I. Most medications aren’t studied on their effect on fertility. And when you do see a lot of these medications being used in younger and younger generations, like blood pressure medications or antidepressants, which maybe they were originally put onto the market thinking people would be passed their fertility years at this point.

So we don’t need to study sperm, uh, in that case or female reproductive ’cause. God, I haven’t, haven’t forbid anyone study that. It’s like, it’s one of these things that is, it’s just an unknown and it often doesn’t get thought of at all until much later. Or it takes someone that’s a little bit more savvy to go, maybe it’s the medications causing the issue.

[00:39:42] Raul Pastrana: Mm. Yeah. Yeah. And there is definitely more research that needs to be conducted into all these factors and. Some certain medications, we don’t know whether or not they’re having a huge effect. I’ll give you another really good example. So Finasteride or [00:40:00] the, the drug that it’s been highly used these days for male patients to prevent head loss, and what this drug does is basically prevents the conversion of testosterone to its small.

Potent form, DHT. So this medication prevents that conversion and therefore, because that doesn’t happen in the body head loss is prevented. So these days there are lots of 20 year olds, 30 year olds taking this medication. And, um, I have seen some preliminary studies that point towards how this medication is negatively affecting sperm health.

Clinically, I have seen a few cases of it where stopping the medication, uh, doing a bit of work with the male patient and retesting three to six months later lead to great improvements in sperm analysis. So, um. This is another factor, right? Um, this drug was not designed with the idea [00:41:00] in mind that could affect male fertility, but it is indicating that it, it does.

So if. A couple is having trouble to conceiving. I think it’s important to review all the medication that the two parts are taking the female part and the male part.

[00:41:18] Alison Mitchell: Um, another big one would be anabolic steroids, wouldn’t it?

[00:41:23] Raul Pastrana: Yeah. And I talk a lot about this in the book because I’m seeing more and more and more of it.

It is very common. It is, it is very common amongst teams, use users these days. I think, look, we could get into the rabbit hole of why is this happening in the first place, which will be, uh, social media putting body image placing attainable body, um, yeah. So social media these days, what I think it’s doing to our jam population is very clear.

It’s affecting their mental health, right? And then you have all these social media influencers telling [00:42:00] them, you can get the body that I have. You just have to follow this diet. And they’re not telling them the whole picture. In many cases, not all of them, but in many cases they might be using anabolic steroids.

And then this is filtering into the younger population. Everyday more and more I see, uh, the effect that anabolic steroids has in the medium and in the long term of a sperm health. So even if the person had used anabolic steroids a year ago or two years ago and they tr are trying to conceive the long-term effect that anabolic steroid had is still visible.

[00:42:37] Alison Mitchell: And, and I think that obviously it’s, there’s much more detail in your book, but. The anabolic steroids do have much more longer consequences, whereas some other medications you may be able to like reduce the dose or take them off of it and it can be reversible. Whereas anabolic steroids really does shut down a lot of the communication that causes the sperm development.[00:43:00] [00:43:01] Raul Pastrana: Yes, it can. So definitely the long term consequences can be huge, but not for everyone. It is, it’s a case to case. It would

[00:43:09] Alison Mitchell: depend on how long you’ve been taking it for as well.

[00:43:12] Raul Pastrana: Yeah. And also very important how well you recover, which will ha a huge factor will be how old you are. So when you’re taking just to give an example, when you’re taking testosterone, uh, what you are doing is having an influence on the negative feedback look that happens in between your brain and your testicles.

What you’re really doing is telling your brain you can shut down the communication between the brain. And the testicles. You don’t need to stim the brain doesn’t need to longer stimulate the testicles for more. Yes.

[00:43:43] Alison Mitchell: So we’ve got enough. We’ve got heaps. Don’t worry.

[00:43:45] Raul Pastrana: Yeah, we have heaps. So then endogenous or the, the production of testosterone that happens in the testicles stops, but also sperm synthesis diminish, uh, highly.

And

then like you said, how long do you [00:44:00] take the anabolic steroids for, and what doses did you take and how old were you when you were having this? All these will have an influence to how fast you recover if you recover.

[00:44:11] Alison Mitchell: So we are going to probably wrap up now. So I thought that it would be great to share some tips that you have for people, just general things that you would say to people who are wanting to improve their sperm health if that’s okay.

[00:44:27] Raul Pastrana: Yeah, sure. Well, the first thing that I would say is get the book because it’s fantastic. But look seriously for anyone that is trying to improve their sperm health, first of all. What are you comparing your sperm to? Like we already said, don’t go for the bare minimum. Try to do as much as possible because I’m sure that your female counterpart is also trying to do as much as she can.

So let’s, let’s share the way of. Responsibility when it comes to fertility. Let’s go to those [00:45:00] appointments. Let’s make sure that if we haven’t prescribed a supplement, we’ll take that supplement that if we’ve been told that we need to stop alcohol, which we haven’t spoken about, but obviously it’s huge, we stop alcohol altogether.

Or maybe you reduce from having seven drinks per week to just having one to two per these drinks per week with your friends, but do your contribution. That’s what I will say.

[00:45:24] Alison Mitchell: That’s so important. I don’t think, I don’t think, um, it’s widely known how much sperm has an impact on pregnancy rates, pregnancy loss, and as we said before, the health of the child.

[00:45:37] Raul Pastrana: The health of the child. Yeah. Don’t think that, for example, because you, your partner is able to get pregnant, but she’s discouraging. The issue is lives within her. And this is not about shaming, but about education.

Or sperm health can lead to early miscarriage. Let’s do our part into supporting our counterparts, our partners, as much as we can, and share the weight [00:46:00] of responsibility.

And let’s do what were asking me. What are the main things that someone can do? Let’s tackle the big ones, right? Like the, the obvious ones. So alcohol, huge. Like, I mean, there is so much research and do we need more research? I mean, we always do need more research, but it’s very clear the toxic effect that alcohol has in sperm.

So just stopping alcohol is gonna have a huge, huge effect in improving your fertility outcomes, uh, making sure that you are sleeping well and that you’re prioritizing rest. It’s really, really, really huge. Um, I. Eating, eating well, uh, making sure that you’re getting your protein, your fiber, that you’re eating, a food that agrees with you.

Those are huge factors. And then what I will say as well, if you are not working with a health professional and you are unsure what the factors will be, that that’s when you need to ask for help. And I think females are much better than males are asking for help.

Mm-hmm.

There [00:47:00] is. There is not nothing wrong with saying, okay, I don’t know what to do who can help me to improve my outcomes.

I think that is an important factor to, to acknowledge when Google doctor is not enough and when you need to look for a health practitioner that can guide you in the right direction.

That will be my main takeout.

[00:47:21] Alison Mitchell: Okay. So yeah, actually ask for help. And make the changes and accept the responsibility.

[00:47:29] Raul Pastrana: A hundred percent. Accept the responsibility. Shared.

[00:47:33] Alison Mitchell: Yeah. Share, yeah, share your load.

[00:47:36] Raul Pastrana: Yeah. Be, uh, an active participant in the process because it just helps so much with the outcomes. And when I have. And when I’m seeing a patient and when I’m seeing a couple in clinic and both parts are involved and both parts are you know, are engaged and they want to make the changes.

I can tell you the success rate was always [00:48:00] much higher.

[00:48:00] Alison Mitchell: Definitely. I, I see that too. And there’s also a lot of chemicals that are in our environment that, especially certain workplaces that I think that a lot of people need to be aware of as well. So like, like all the like smelly fuels and like benzines and those sorts of things.

Those have a big impact too, don’t they?

[00:48:20] Raul Pastrana: And there are so many in our society, I mean, our food supply the big ones of not eating food from plastic containers, making sure that you have a million steel water bottle. So all those things is something that I try to bring into the conversation.

Maybe it’s not in the. First consult, but it’s in the second consult. Or I give them some some handouts for them to read or websites that they can visit to understand the if their. The things that they’re using at home to, to clean, uh, to clean the house is affect, could have a negative effect. So I like to give all those resources, which are very important.

Another big one is where are you working? What [00:49:00] are you spending most of your time? If it’s a pain factory, for example, then we know that that can definitely be one of the reasons for low or poor quality sperm. Mm

[00:49:11] Alison Mitchell: So there’s so many things that can be addressed. And at that initial point with diet, lifestyle, as you said, the pillars of health chemical, um, avoidance and assessing medications.

And then beyond there, we, we’d have to consider the things that are genetic or structural, like the vari CILs we mentioned, or conditions like, um, like Kleinfelter syndrome or mm-hmm. People who are structurally missing vans, deference, or other, other, like under sended, testes and those aspects. Mm-hmm.

So beyond when we get to that point, that’s when, you know, you have, we have the referral network and the dis usually at that point we’d be seeing very big things in the sperm analysis, like zero sperm. So that’s a big red flag to refer on for that. Um, so people don’t usually have to worry about [00:50:00] that.

If they have already got the sperm analysis, they can sort of go, okay, it’s probably not too bad.

[00:50:04] Raul Pastrana: Totally.

[00:50:05] Alison Mitchell: But so beyond that, um, I think that there’s so much to talk about, but obviously we have a lot of content that like you’ll be able to share within your book, and that’s a really great thing too, because I, I do know that as we’ve spoken about, it’s true, it’s challenging for a lot of men to actually get to the appointments.

To wanna talk about it. So if they have something that’s in front of them that they can sort of sit down and privately assess, that’d be really good. So I’ll, um, I’ll pop some links in the, in the show notes in the, in the description to help people find all of this as well. But can you just share your links.

[00:50:41] Raul Pastrana: Yeah. So if for anyone wanted to find me on Instagram my, my name in Instagram is @RaulPastrana_HormonalHealth. At the moment I’m working as a part of the team in RH Reproductive Health, which is a clinic, with naturopaths and [00:51:00] exercise physiologists that. Have a big bulk of our of our, of the clients that, of the patients that we see are fertility based, but also in conditions such as polycystic ovarian syndrome, endometriosis, PMDD and PMS.

So all those, uh, important conditions regard regarding the reproductive system and obviously male fertility. So that’s what I’m working at the moment. So, the website is rhreproductivehealth.com. For anyone interested to contact me, uh, they can do it through the website and I will be always happy to answer.

[00:51:36] Alison Mitchell: Lovely. Thank you so much for all of your wealth of information for today.

[00:51:41] Raul Pastrana: That’s my pleasure. Thank you so much for having me and looking forward to talk more.

[00:51:47] Alison Mitchell: Okay. See you. Bye

[00:51:49] Raul Pastrana: bye.

[00:51:50] Alison Mitchell: Thanks for listening to Guts and Girl Bits. As usual, here is the disclaimer: Please remember that All information is general and not a [00:52:00] specific recommendation that replaces consulting with a practitioner. Please talk to your healthcare practitioner before undertaking any changes to your treatment regime. If you enjoyed listening to this episode I’d really appreciate you sharing this with your friends, and what is really helpful is leaving a 5 star review, or if you’re watching on youtube, liking and subscribing. You can find me at www.naturopathnsw.com.au. Thanks for listening, until next time.