The Ultimate Guide To Increasing Fertility, Sperm Health, Semen Quality, Storing & Freezing Sperm & Much More With Dr. Amin Herati.

On this episode of the Ben Greenfield.

Fitness Podcast, one of the things that I'm very passionate about is advanced maternal aging and the effects it has on the genetics. One of the strategies where you can avoid all of the negative effects of all the exposures is to bank sperm early. Kids these days are probably not as active as they used to be. We're getting hit by phones in our pocket. The risk with some of these antioxidant therapies is that sperm lose portion of the cell that is around the nucleus and it sloughs it off.

And so help performance, nutrition, longevity, ancestral living, biohacking, and much more. My name is Ben Greenfield. Welcome to the show. All right, folks. Well, I get asked a lot of questions by honestly, both males and females about fertility or perhaps more accurately, infertility. Increasingly these days. I don't know, maybe my audience is aging as I age or people are just stuck at home during the COVID pandemic, locked away, trying to figure out how to make babies. I don't know. But yeah, I get questions like how to increase sperm count, how to store and freeze sperm, the best diets and supplements for fertility, and a whole lot more. So I was, you know, I've never done an episode just devoted to how to get your swimmers a little bit more dialed in or how to optimize fertility, particularly when it comes to males and sperm. I know there's a whole bunch of topics related to fertility. There's an entire, you know, other consideration for the egg component for females, et cetera, et cetera. But for you couples who may be wanting to conceive, or for you guys who may want to analyze your sperm, get your sperm stored, et cetera, I think that's gonna really be the topic of the day for Today's podcast with Dr. A.m. amin Haradi. He's an M.D. he's an assistant professor at the James Buchanan Brady Urological Institute and works at the Johns Hopkins Hospital. He's also the director of men's health and director of male infertility there. And he's the advisor to Daddi Dadi, which is an at home male fertility services company for sperm testing and for sperm storage. I actually just sent in my own kit to store my sperm. And Dr. Haradi will be able to debrief us on why that might be a good idea. But he also, you know, he researches everything from spinal cord injuries to genetic bases of male infertility to hypogonadism to pelvic pain syndrome and a whole lot more. So this guy knows his Way around our nether regions, I suppose, would be the best way to describe him. So, Dr. Haradi, welcome to the show, man.

Thank you so much, Ben. It's a true honor to be with you.

Yeah. And I was actually thinking, you know, I hadn't planned on asking you this question right off the bat, but, you know, as. As I was kind of filling folks in on your. Your history, you know, for some reason, when I said genetic basis of male infertility, that kind of got me thinking just a second here. Like, is. Is this something like. Like, in terms of male infertility, which I do want to get into more with you regarding statistics and stuff on it, but are there actually genetic SNPs that would, like, predispose you to being less fertile?

Absolutely. Really? There are gene mutations. There are epigenetic mutations that are passed on from generation to generation to generation to generation. And that's one of the things that we harp on whenever we talk to our male patients who are interested in fertility evaluation, preservation or optimization, that if there's a lifestyle factor that they are consuming or imbibing or whatever exposure that they're getting, that. That impact on their sperm quality is marked on the DNA of the sperm and passed on multiple generations. So our health is a factor of our great, great, great great grandparents health and their health.

Interesting. Is that something that, you know, because a lot of people will just get, you know, for example, a 23andMe evaluation. Is that something that would show up on an evaluation like that? Or do you have to test specific SNPs? If you wanted to see if genetically you were actually predisposed to have a. I guess, you know, a little bit more of an uphill climb in the fertility department.

Yeah. So unfortunately, those 23andMe tests wouldn't be able to identify the mutations. The hard part is that there are thousands of genes, between 3 to 4,000 genes involved in sperm production. And then within those genes, there are areas, the genes that code for protein, areas that don't code for protein, areas that sit on top of the DNA called epigenetic markers. So it takes one inflection of one of those markers epigenetically or a ding in the DNA to cause a mutation. And unfortunately, we've only identified less than 10 mutations in animal and confirmed it in humans that cause infertility. So we still have a mountain of work left to do to identify the true genetic cause of infertility. We've only scratched the surface of it.

Wow, that's. That's crazy. And then I know, there's. There's probably a few research papers I can hunt down and put in the show notes for people. The shownotes are going to be@BenGreenfieldFitness.com Dadi I know that for women, Dr. Haradi, you know, there are a variety of predisposing conditions that are probably related to genetics. You know, like polycystic ovarian syndrome. I know is one issue. I think there's another gonadal gene issue. It's like the XX gonadal dysgenesis and, you know, premature ovarian failure and a lot of stuff that goes on with women. But before I interviewed you, I started to look into it, and it appears that about 50% of infertility cases, from the stats that I could find, are not related to women, but are indeed related to men. And there's mitochondrial DNA mutations and endocrine disorders and chromosomal abnormalities and all sorts of things that, that you can look at to find out whether or not you're kind of at a higher risk of being infertile. But one of the main things that I seem to run into over and over again is that it seems that infertility is really on the rise. You know, they say that guys testosterone is decreasing as I guess more little boys are probably sitting at home playing video games, not out chopping wood and doing hard manual labor, like bailing hay with their dad out in the field, which kind of makes sense. But along with that general drop in fertility or general drop in testosterone among men, infertility seems to be on the rise. Is there a good reason that you think that infertility kind of seems to be a bigger issue amongst guys?

I think part is the fact that we're focusing a little bit more on it than we have in the past. If you look at the media portrayal of male infertility, there's very little in pop culture media that talks about male infertility. And one of the shows that comes to mind most recently was the Show Ballers on HBO Season 3, where Dwayne Johnson's character was dealing with infertility. And he was going through the process of getting checked for his semen analysis and visiting with the urologist, and he was given really bad information. It was a very poor depiction of what the infertility process looked like. And all too often we hear from patients that their wife went in for the evaluation first and then the husband begrudgingly went in for his check. And then when he was checked, they found out that there was a problem with his sperm counts and semen parameters. And then they found their way to a urologist. So rarely does it happen. Reverse where we see male partners seeking out fertility care first and then the female partner. That's the way it should be. The American Society for Reproductive Medicine actually recommends that after a year of not being able to conceive, that the male and female partners should be studied and evaluated for their fertility. So that's something that I'm glad that, you know, we're having this conversation. I'm glad that your readership, your audience is interested in tuning in for this, because this is something that really we need to be talking more about.

Yeah.

Reason being is fertility is a barometer of a man's health. And I call the semen doctor.

Yeah. By the way, you know, I think I heard, I believe it was Tim Ferrissaid that in his book Four Hour Body way back in the day. He's like, if you wanna get a glimpse into how healthy you are, one of the first places to start is to check into your fertility. Because as the body becomes unhealthy, I think this is the reasoning behind that. It's like from an ancestor or an evolutionary standpoint, nature doesn't want a sick dude to go out and make babies. Like, that's kind of the general overview. Is that basically accurate? To a certain extent.

I couldn't agree more. So when the body's under stress, such as from a COVID infection, an illness like a malignancy in the body, or a genetic condition that predispose them to cancers down the road, we start seeing those changes developing in the semen parameters, the machinery and the metabolism and the cell turnover associated with infertility is so robust that the timing of it, the feast or famine mentality, that if this is a time to feast, then reproduction is on the table. If it's a time of famine, then it's not. So that concept holds true. And we find a lot of problems in guys with infertility at a higher rate. So how progressively worse off their semen parameters are, the more likely we are to find low testosterone. Guys with infertility are at higher risk of having testicular cancer and blood tumors like leukemia, lymphoma, prostate cancer down the road. So there are a lot of different conditions that can be picked up as part of the evaluation, and a lot of conditions that bring guys in who didn't realize that if they had Covid, that their sperm counts could go to zero afterwards.

Yeah, and just kind of maybe a dumb question here, but a little bit of a logistical question I was curious about. So, you know, when you say that you are infertile, you know, and just basically a catch all term as a disease or condition of the reproductive system, you know, characterized by an inability to achieve pregnancy, is there a point at which you would actually diagnose someone as being infertile? Like, what I mean by that is let's say a male and female are having regular unprotected sexual intercourse with for a certain period of time. And let's go ahead. And since we're kind of focusing on sperm and semen and males for this podcast, let's say that the woman has been checked out. Like she doesn't have polycystic ovarian syndrome or any of these gonadal dysgenesis issues or premature ovarian failure. And the woman appears to be all right from a fertility standpoint. And maybe it's the guy's. We'll just say the guy's fault, so to speak. How many days or weeks or months of unprotected sex do a male and female have without producing a baby? At which point you say, yeah, the male could be diagnosed with some type of infertility. Or is there a general consensus?

So our general consensus for couples is that they should try for about 12 months if the female partner is under the age of 35, and then if she's over the age of 35, then six months. So if no success after that, then have both partners checked out. And the reason.

Wait, you said if you're over 35 and you've been trying for six months, or if you're under 35 and you've been trying for 12 months, that's when you would diagnose infertility.

Yeah, exactly. So we would call that couple subfertile because we don't know at this point if they're truly infertile or if they're reducing their fertility potential.

Okay, okay, got it. All right, so basically we have infertility on the rise. And you said when I asked you that question, that part of it is because we're just able to test for it more, which of course makes sense. Any. Any disease or condition that you have better testing methods for and you're testing more of, you know, it's gonna obviously throw in a variable where more conditions are gonna pop up just due to the increased testing. But would there be other reasons that you suppose infertility is on the rise?

Yeah, so we know that there are environmental exposures that are occurring day to day. So we have environmental endocrine disruptors that we're getting exposed to. There are.

You mean, you mean like, like personal care products, household cleaning chemicals, stuff like that?

Exactly, yeah. So over time we're getting exposed to this, and it's a compounding effect on the sperm. So the sperm is getting marked with changes over time. And a lot of these changes, a lot of these mutations the body can fix. But over time, the more stress on it from these exposures and changes in hormones as a result of exposure to these endocrine disruptors, the less healthy the sperm is, the less able it is to repair itself for DNA damage. So we know that there are environmental exposures that are affecting our hormones and affecting sperm health. We know that there are electromagnetic fields around us, ionizing, non ionizing radiation that is affecting us. And then also our health, as I mentioned before, is a factor of our parents health and their great grandparents health, et cetera, et cetera. So the longer they're waiting to have kids, the more DNA mutations they're accumulating, the more likely the kids are to have a problem down the road as well. So it's a snowball effect.

So those DNA mutations, if your parents, if you were born and your parents were older, those can actually get passed on to you. And so you might have just drawn the short straw. If you were, I don't know, last in line in your family and your parents had you and maybe they were 40 years old, you might actually have increased risk for infertility.

Yeah, absolutely. And other conditions. So we have recognized that if somebody's grand. So even if their parents married and had kids at a young age, even if their grandparents were of advanced age, so specifically advanced paternal age, that the grandchild's risk of having a learning disorder or even having schizophrenia is increased, so skips that generation and shows up in the great grandkids, so those things will show up. And that's the transmission of genetic information from generation to generation that we're seeing. And I think some of the changes are, as you mentioned, kids these days are probably not as active as they used to be. There's a lot more exposure to different chemicals. We're getting hit by phones in our pocket, computers on our laps, electromagnetic fields from all over. And that's an area of our research as well here at Hopkins is looking at electromagnetic fields and non ionizing radiation effects. So that's an area we're interested in. We know that these things are snowballing and the exposure is cumulative. So over time, the more these stressors come on, our system the more DNA mutations occur and the less fertile we'll be down the road.

Yeah, yeah. So the environmental causes. A couple of quick questions for you. Obviously, you know, I mentioned, like, personal care products and household cleaning chemicals, and it, you know, everybody listening in, they're pretty smart. It's not that hard to go to the environmental working group's website or, you know, like, I talk about this in my book Boundless. I have a whole chapter devoted to, like, you know, what to replace common household cleaning chemicals and common personal care products with to have fewer endocrine disruptors in them or pesticides and herbicides would also be something to consider.

Yeah, absolutely. Yeah. Chemicals within them. Cleansing agents that we commonly use at the grocery store. You know, we're constantly wiping down surfaces to protect ourselves from COVID But there's a component in a lot of these cleansing wipes called benzalkonium chloride. And studies from Duke University have shown that when you expose benzalkonium chloride, which is an FDA approved, quote, unquote safe drug, you expose cells called sertoli cells, which are the nerve cells that enable sperm production to proceed. Those cells will be wiped out. The sertoli cells will be completely gone as a result of exposure to benzalkonine chloride.

Where do you find that form of chloride?

Primarily, it's in eyedrops, and it's also in cleansing wipes. Wow.

Okay, that's crazy. Like the little cleansing wipes they hand you when you walk onto the airplane, for example.

Yeah. So I routinely check if I can see now if it's alcohol. That's not as bad. But in a lot of these wipes that you see at the gym, where there's a larger sheet rather than these little smaller hands.

Yeah, that's right. They're all over gyms as well. That's interesting. You know, it's the impact of some of this stuff when it comes to male fertility. Seems kind of similar in my mind to looking at a book like the end of Alzheimer's. When you look at Dr. Dale Bredesen's multimodal approach to Alzheimer's, it's like there are so many variables that he goes after, you know, ketosis, high dose fish oil, infrared light therapy, hyperbaric oxygen. It's kinda like withwith fertility, it seems to me as though, as you become aware of some of the stuff that we're talking about and that we're gonna talk about, ideally, if you wanted to be as fertile as possible, you'd stack a lot of this stuff. Right. It's not Just about switching your shampoos or bringing your own natural wipes to the gym. I would say there's probably a lot of variables that you want to check. I did a podcast interview with one of my friends, Adam Wengauer, some time back and I'll link to that in the show notes. But you know, he was trying for a few months, he and his wife, to get pregnant. And towards the end of that podcast we started talking and he laid out, you know, what he wound up doing. And I mean, he did everything from HCG and follicle stimulating hormone to optimizing his coenzyme Q10 levels. He was on a couple like Chinese medicine based herbs. He was using cannabidiol to decrease inflammation and did a lot of things, stacked a lot of things. But it seems like increasingly when I talk to guys who have been struggling for a while and then found success, they're actually doing a lot of things at once in order to boost fertility. So it seems as though a lot of stuff adds up. Now, speaking of the airplane and cleansing wipes that they hang on an airplane, what about radiation or X ray exposure similar to emf? Do you need to be careful with X rays?

Definitely. So X rays, definitely. Whenever we see a male partner of an infertile couple, one of the things we check for, we check for structural problems that could be causing DNA damage. And we check for specifically varicose veins. And varicose veins, when present, they're dilated veins that allow the blood to yo yo in the veins that would normally be taking the blood from the testicle back up towards the heart. But when those blood, when those veins are yo yoing and not allowing efficient unidirectional flow, what can happen is that it brings body temperature blood back down to the testis, it heats up the testicle, it damages the DNA of the sperm, makes the sperm less successful for natural conception and use with ivf. And one of the treatments that we have for that is either a surgery to fix those veins to tie the big veins off, or we can send them to radiologists and the radiologist can put a coil on the inside of the vessel in order to embolize it. And a lot of patients are interested in that embolization approach where they can get a coil on the inside, not have to go through a four day period where they're out of work and a two week of no heavy lifting restriction. But the downside is when they go for that embolization, the average time of X ray exposures, 24 minutes. As part of that treatment to get their fertility improved. They're correcting one problem and getting exposed to another. So to the extent possible, I try to steer patients away from radiation from medical sources to the extent possible. X rays and CT scans, things of that nature, will expose patients to a significant amount of radiation. But walking through the airport and going through the scanners, that's going to be a low level amount of radiation. We know that non ionizing radiation, the radiation that doesn't change the DNA material can also affect the way that the cells function. So radiation even from our computer, from our phones can flip the polarity of our cells. And there are studies have shown that when the testosterone producing cells called Leydig cells have exposure to electromagnetic field, that the testosterone production will be lower.

Hmm, interesting. Yeah, yeah. The non ionizing and ionizing radiation I think is sometimes a little bit confusing to people in terms of the difference between them. But from what I understand, the non ionizing radiation is any type of electromagnetic radiation that doesn't ionize the atoms or the molecules. Like totally remove an electron from an atom or a molecule, but still has sufficient energy to kind of like excite the electron to higher energy states, you know, whereas like ionizing radiation, from what I understand would be something that would be a little bit more intense, like, like higher power, higher frequency, I suppose. Would ionizing radiation be something closer to say like some type of nuclear exposure or how would you, how would you differentiate for the average person between non ionizing and ionizing?

So UV light, there's different types of UV light, There's abc, I believe, UVB or I can't remember if it's UVB or C that flips between non ionizing and ionizing. It's just like you said, when you have ionizing, you're flipping the electrons and that's when you start getting the DNA Damage is when you start knocking out the electrons of DNA and the DNA breaks in it. And that's when mutations occur when you have non ionizing. So when you think about the electromagnetic waves, and the less frequent the waves are, the more spread out they are, you start going down the path towards infrared light, the light spectrum, power lines that were around on a day to day basis, the electric cables in our walls, the computer, microwave, things of that nature. So ionizing would be X rays, gamma waves, CT scans, things of that nature. And non ionizing would be more of our day to day exposure.

Okay, all right, got it. But we should be aware of both when it comes to fertility.

Exactly, yeah. Because ionizing Affects the DNA of the sperm. Non ionizing can affect the functionality of the cells that produce testosterone. And potentially, which is an area of our research, is potentially also the development of the sperm cells and the architecture of the tissue.

Okay, got it. Now, this might be confusing to some people because obviously we hear we shouldn't overheat the testicles, right. Because elevated temperatures can impair sperm production and function. And so frequent use of hot tubs and saunas, you know, sitting for long periods of time, wearing very tight clothing, you know, using your laptop computer. Even if you're, even if it's, if it's not a radiation issue, it's just like the heat issue. You know, anything that's going to increase the temperature in the scrotum. I think that's pretty common knowledge amongst guys, is not that great of an idea when it comes to sperm production. But there are a lot of guys now using the like red light therapy, right, in terms of like infrared saunas or even using red light therapy devices. One very popular one I've even talked about on my podcast before, it's like this joov light that supposedly increases the mitochondrial activity, the Leydig cells and the testes, and may increase fertility to a certain extent. Do you think that's true or do you think that that type of even like infrared sauna, infrared light exposure is something that could impair fertility? Because to me, it's a little bit confusing. You know, it seems like you're stimulating the Leydig cells, but at the same time, could that radiation be causing some type of DNA damage that would impair fertility?

Yeah, so the main thing there would be the depth dependent trace of that light. And if the depth isn't to the level of where the Leydig cells and the sperm cells are, so it's multiple tissue layers deep, then it likely isn't improving the situation by much or hurting it much. I would be on the fence about it as far as it hurting. And I think if somebody's interested in trying that, I wouldn't discourage them.

Okay, all right, got it. And I know we're kind of right now just staying focused on the things that might decrease fertility. And then I want to throw a few things by you that I know a lot of guys are doing, you know, herbs, supplements, et cetera to increase fertility. But I know there's a few other things that a lot of people are or have been asking me questions about guys on testosterone replacement therapy, you know, lessyou know or that's more common obviously than long term anabolic steroid use, which I know can decrease fertility. But when it comes to all the different pharmaceuticals and drugs out there, obviously some can impair sperm production and decrease male fertility. But testosterone placement therapy, it's kind of a catch 22 for a lot of guys, right? Because they. They do it to increase libido, increase virility, increase, you know, attraction to the opposite sex, et cetera, et cetera. But at the same time, it's something that seems to, from most of what I've seen, impair fertility. Is it true that testosterone replacement therapy can do that? And if so, are there certain things that guys can do along with testosterone replacement therapy that would cause infertility to be less of an issue?

Yeah, so, great point. We see this too often with guys that are going to these men's health clinics and wellness clinics where they're getting testosterone therapy to improve their libido and their virility. And then they're coming in saying, you know, I've been trying to have a child for the last two years. No success. And now I have a semen analysis that shows no sperm. And the reason for it is that whenever there's exogenous testosterone given specifically through pellets or intramuscular injection or cream based, where you have testosterone sticking around in the system for longer durations, it can negatively feedback on the areas of the brain called the hypothalamus and the pituitary. And it basically suppresses the signals that would come from the hypothalamus and the pituitary that would go to the testicle to stimulate testosterone production endogenously and sperm production. So it specifically drops down LH and fsh, luteinizing hormone, follicle stimulating hormone, which are the two signals, the gonadotropins from the brain. So when guys take HCG to boost up their testosterone, that is analogous to luteinizing hormone. So if they were to take testosterone with hcg, that could have a sperm preserving effect. But I would recommend, if they're doing this, they do it in consultation with a urologist and track their numbers beforehand and during treatment to make sure that they haven't dropped their sperm counts. But there are papers from Baylor, where I trained, that where sperm counts were analyzed at baseline and at one year after, when men were given testosterone therapy, even intramuscular with hcg, that their semen parameters at one year out were no different, not statistically significantly different from their baseline.

Okay, got it. So if you're on testosterone replacement therapy, you think that simultaneously being on HCG would be A good strategy because HCG.

Is LH and you're replacing the gonadotropin from the pituitary that would have been suppressed if it wasn't for hcg. There are other types of. There are other types of testosterone therapy that can be taken that don't have as detrimental of an effect on sperm production. So nasal testosterone is one type of testosterone that has been studied as a method of giving testosterone exogenously, but it has such a short half life that it doesn't disrupt the functionality of the hypothalamus of the pituitary. And potentially one of the newer testosterone modalities called jatenzo, which is an oral based testosterone, may also have that same quality, although that is in an area.

Of our research that's called jitenso. Okay, cool. I'll take notes. For you guys who are driving 60 miles an hour down the highway, want to have babies and don't have time to take notes, I'll put them all@BenGreenfieldFitness.com Daddy BenGreenfieldFitness.com Dadi the other one that in addition to HCG that I talked with that podcast guest, Adam Wengauer that I mentioned to you, Dr. Haradi, was FSH, follicle stimulating hormone. Do you think that that's also something that would be prudent to include along with hcg?

So the data is mixed on it. There was recent research presented in one of our national meetings that said that adding FSH for guys who are taking testosterone with HCG would have a beneficial effect. And one would say, if it's a naturally occurring gonadotropin and it's necessary for sperm production, why wouldn't it be necessary? We're not sure. What we're finding is that once guys pass through puberty, that LH seems to be the main driver of testosterone. And then once testosterone is present, then sperm production seems to continue on from that point forward and FSH becomes less important. And when you look at studies where researchers have given guys medications, completely suppress the activity of their hypothalamus in their pituitary and then replaced hcg, and then in another group replaced HCG and fsh, that group with the FSH did no better than the HCG alone. Okay, so once you go through puberty, the FSH becomes less important. It may still have a role, but not as critical of a role as lh.

The other one I think that he had mentioned, actually there are a few. Kisspeptin. That's interesting because I know Kisspeptin plays a pretty strong role in female fertility and infertility and can be down regulated. I see this a lot in lean active females who do a lot of fasting. Apparently it's, it significantly suppresses their kisspeptin levels. And of course women who want to be fertile, one of the best things you can do is eat a whole bunch of healthy fats and super nutrient dense and calorie dense foods like a Weston A Price type of diet is one that I find myself recommending quite a bit. Ghee and butter and full fat fermented dairy and organ meats and all these wonderful compounds. I've worked with a few women who are either trying to have a baby, who are pregnant or breastfeeding. And I always recommend to them that diet because it seems to work out pretty well. And in addition to that, avoidance of long fasts, not doing fasts that are longer than like 10, 12 hours for intermittent fasts and things like that. Which makes sense again based on what you were explaining earlier about how the body, if it has the impression that it's starving or that food is not plentiful, why bring babies into a famine type of situation? But I think that Adam had mentioned that Kisspeptin is like an injectable peptide, might also be something that could regulate some of these fertility related hormones in males as well. Have you ever looked into something like Kisspeptin as a therapy?

Yeah, HCG is an easier way of doing what Kisspeptin would do. So Kisspeptin would allow better functionality, the hypothalamus and the pituitary to bump up the lh, but we can give HCG to do that. And so I don't see a strong role for Kisspeptin in the male and fertility population.

Okay, all right, got it. So. So that'd be kind of redundant if you were already using something like hcg, for example.

Exactly. Well, one more side is that the body likes to live in equilibrium and it has its patterns that it likes to see. So one of the things that I see in male and fertility treatments is that we try to ramp up LH as high as we can and FSH as high as we can, hoping that the more lh, the better the fsh, the better. That may not be true. What we're finding is that whenever we have guys at their physiologic levels of lh, things function better. The body wants to see LH in a cyclical low dose fashion. If you give it a flood of LH signal, that may not be a great thing. In fact, it can actually make the cells that are normally responsive to LH less responsive.

Okay, so the other one is the estrogen levels in terms of healthy metabolism of estrogen in males. I don't know how much high amount of estrogen in males would be an issue. Obviously we talked about phytoestrogens in the environment, plastics, household cleaning chemicals, personal care products, et cetera. Those would be prudent to avoid as potential endocrine disruptors. But what about things that would traditionally be used to promote healthy metabolism of estrogen or even act as estrogen receptor antagonists like diindolmethane or. I think it's diindy methane. Dim is one that a lot of people talk about. Indole, three, carbinol, a lot of these things that guys and girls will use for estrogen metabolism. Are you a fan of anything like that?

I would recommend that if somebody had a really low level of estradiol and they were having sexual dysfunction, from a fertility standpoint, we look at the ratio between the total testosterone and the estradiol, and if you ignore the units on the side of it, it should be a ratio of 10 to 1. So if somebody's testosterone is, for example, 350, then their estradiol should be no more than 3.5, for example. No, sorry, 35. That is the ratio that we use. And as long as that ratio is kept, then patients are kept in the sweet spot. If their estradiol creeps above 50, then we start talking about estrogen blockers to suppress the production of their estrogen level.

Okay, got it, got it. When it comes to testing for things like that, you know, a lot of times I find myself recommending a urine test versus a blood or saliva test is a really good test for checking out hormone balances. Everything from testosterone metabolites and testosterone free testosterone, Estrogen, estrogen metabolites, cortisol, even melatonin, things like that. There's one test that I like called the Dutch test, the dried urine test. Do you have a certain form of testing that you really like when it comes to looking at actual hormones?

Yeah. So testosterone is the one that I'm really critical about. There's a type of test that it should be run on called a mass spec liquid chromatography, mass spec. And the reason for that is that when you. Another common type of test that's run to determine the testosterone level is something called an immunoassay where they've got antibodies attached to the testosterone and you measure the amount of testosterone based on the signal that you get from the amount of antibodies and beads attached to it. The downside is that when you go on the outer ranges, so the patients that are low on testosterone, really high on testosterone, immunoassay becomes unreliable. And so when you're wanting to have a test with good accuracy, you want to go with the most precise testing tool. And that would be liquid chromatography, mass spec, where they have a very narrow range of variability between test results.

And would that do you know if a test like a dried urine test is using that form of analysis?

I'm not aware of it being tested on anything except for peripheral blood at this point. If there is, I'm not aware of it.

Doctor. Okay, got it. Alright, so back to a few of the things that could impact fertility. I've heard that being obese or overweight, and I'm guessing maybe it has something to do with over aromatization and increased estrogen in people with a higher number of fat cells is an issue. Is that true? If you're overweight or obese, is it a good idea to try and lose weight if you're trying to get fertile?

Absolutely. So there was a poster presented at one of our national meetings that stated that for each 5cm of waistline, reduced fertility potential improved by 9%. Oh wow. And I quote that statistic to my patients when I see them to encourage them to lose weight. And we're not sure exactly why. I mean, aromatization of testosterone, testosterone is converted to estradiol, then the balance can go off kilter. But also the heat between the legs can also probably damage the sperm. And as we're talking about before, you really want a cooler environment. And that's why we recommend not taking baths and using hot tubs. But the heat between the thighs is detrimental. Likely the foods that they're consuming probably has a lot of environmental intoxicants within it. But absolutely the estrogen balance is also going to be off.

Okay. Related to that heating component, you know, there's the old, you know, Russian lore of the power lifters who will like ice their balls to increase testosterone before they go and compete. And you know, there's even some companies now, I think it's funny, like, like there's these, these ball icing companies and literally they, they are marketing ice packs at like, you know, six times the cost you'd normally pay for an ice pack. But it's kind of sort of shaped like your crotch so you're able to ice your balls. I suppose somebody's kind of raking in the cash on something like that because I don't imagine it's that expensive to buy and reshape an ice pack in something that can then be marketed as the ultimate ball icing strategy. But have you seen anything when it comes to actually not just keeping the gonads away from excess heat or ionizing and non ionizing radiation, but actually making a concerted effort to cool the balls on a regular basis? Have you seen that there's any efficacy to something like that?

Yeah. So there's a cooling patch called Fertilmate and I believe it's available on Amazon that has a. I'm not sure the mechanism, how it cools, but I think it's menthol based. But you place it on the scrotum and it cools. And there are studies have shown improvement in the sperm concentration and motility. But for those who have used it, they've been uncomfortable with, I think, the alcohol component within them. And there's a little bit of a burn if there's alcohol exposure to the scrotum. And one of the things that I was really interested in, I was going on a bike ride with an engineer and he said, well, if varicose veins are heating the testicles, why not have a cooling mechanism with cables that wrap around the scrotum and a heat sink, just like a computer has a microprocessor. And digging through, sure enough, somebody holds a patent on such a device, but never came to fruition. So the patent exists for this device for like a scrotal cooling device, just like you'd have for your computer, but never came to market. But if something like that came, I think it would definitely help fertility potential.

Yeah. Speaking of the bike seat, when I used to race in an Ironman triathlon, I always use the ISM saddles, which is at least one brand of bike saddles. And if you look at it, it's essentially like more of a competition style bike seat. So it's still aerodynamic, but it's shaped in such a way to where it kind of leaves a ton of pressure off of your balls. I think it's. ISM is the main company that makes these. Do you think that that's a good idea in terms of a strategy for cyclists who want to stay fertile?

Great idea. Yeah.

Okay.

I think the less pressure on the prostate, the less heat, the better the blood flow to reproductive organs that are necessary.

Far less exhausting than trying to stand. The whole time that you're cycling, you get. Get massive bicycling triceps, but you get pretty tired. So, yeah, choose your bike saddle wisely, fellas. Tobacco, alcohol and drug use is obviously something that's, that's frequently recommended to moderate pretty intensively. I know men who spoke have been shown in some studies to have a lower sperm count. Even secondhand smoke from tobacco might impact male fertility. I know that drinking, particularly excess drinking, you know, not the typical healthy, you know, Mediterranean style, you know, glass of organic wine at the end of the day, but excess drinking I know can cause both erectile dysfunction and decrease sperm production. And of course, the effects on the liver can also affect estrogen metabolism, which is an issue. And then of course, there's a huge variety of drugs. I found one research paper that just goes into to a ton of the different drugs that I'll link to in the show notes. So if you go to BenGreenfieldFitness.com daddy I'll link to this, this wonderful study. It's called the Impact of Drugs on Male Fertility, A review. It came out in 2017 and it just goes over, gosh, every last drug on the face of the planet. And you may want to look at any pharmaceuticals that you're taking and compare them to that list to make sure there's nothing on there that might be interacting with fertility. I mean, we're talking like antidepressants, diuretics, like, there's a lot of stuff on there that seems to have an impact that I think a lot of guys might be unaware of. But of course, amongst the healthy population, even the alternative hippie health folks who maybe aren't using a lot of pharmaceuticals, marijuana seems to be something that's very frequently used these days. Now, like I mentioned earlier when I spoke with that guest Adam about what he was doing for fertility, he was really into CBD and he actually found some interesting studies on endocannabinoid receptors found in sperm and in the female reproductive tract. And that CBD might be a way to improve a sperm's ability to fertilize an egg, maybe decrease some inflammation, oxidation that could be having an impact on fertility. However, on the flip side, I've seen some chat out there that not isolated cbd, but marijuana in general may impact not just testosterone, which I think is well established, but may also impact fertility. Do you think that marijuana, particularly the THC componenting elements of marijuana, would impact fertility?

Absolutely, yeah. So at our most recent reproductive meeting, there was a poster presented in a paper presented that showed a 50 to 60% reduction in the testicular size for guys that were using marijuana and thc.

Wow, that's great. I wonder, I wonder, you know, sometimes these, I've seen some studies like that, and then you look at the dosing and they're taking like, you know, 100 milligram edibles or some crazy, crazy bomb like that. Do you know if this was just like regular use, like, you know, vape pens and things like that?

This was a randomized trial, I believe, and I, I don't remember the, the dosage that they had used in their subjects, but this was a controlled experiment where they had guys who used it and guys who didn't. And then when they compared the two, there was a significant reduction. Now, interestingly, the sperm counts were not different. The sperm concentration was not different between subjects, which one would assume, if the bulk volume of sperm production accounts for the volume of the testis and if the two are proportional, that if you have a significant reduction in the size of the testicle, then you should see reduced concentration of sperm as well. But for whatever reason, they didn't see that. So I think that there may be a buffer zone potentially between the two where the body can compensate and will keep sperm counts going. And one thing that a lot of people don't know is that, that there's a very high number of sperm cells that are taken out of circulation before they ever leave the testis. So it's estimated that 2/3 of sperm that produce on a daily basis never make their way out. And they're pulled out due to quality control mechanisms from that Sertoli cell that I was talking about earlier. And if that Sertoli cell is not working properly, then we can see a lot of sperm exiting that are not of good quality.

Interesting. Okay, so probably a good idea if you're trying to conceive to avoid marijuana, maybe not cbd, which might actually be helpful, but avoidance of marijuana would probably be a good idea.

Agree.

Okay, got it. Now, when it comes to other things to avoid, I know that in terms of triggering of autoimmune conditions, which it seems can have an impact on fertility, if you're sensitive to certain things like dairy, wheat, soy, et cetera, it might be prudent to avoid those compounds. But for you, as somebody who works with people on fertility, do you actually do that? Do you run food allergy tests or any type of genetic evaluations for predisposition to celiac disease or the implementation of more of a paleo diet or an autoimmune based diet or anything like that in your practice?

I, if I could, I Would. And it's. I think the limitation of our current medical system is that it doesn't give me the time to be able to go that deep into their care to be able to talk about diet and test them for autoimmune conditions. And I've seen patients even recently who dealt with autoimmune disorders of their GI tract and their sperm counts went down and everything was going really well. Humming along, we fixed this guy's varicoceled veins and unfortunately, inflammatory bowel set in and his numbers changed. So this is definitely something that we see and we recognize. Any inflammatory condition, stress on the body can cause a detriment to the counts.

Yeah, yeah. I mean, speaking to testosterone, not fertility per se, but for testosterone, I've noted that in guys who kind of take the dietary component too far, like excess carbohydrate restriction, excess calorie restriction, particularly when paired with high calorie burning sports, especially chronic repetitive motion sports like marathoning, swimming, triathlon, et cetera, there seems to be a pretty big impact on testosterone levels. And I think that one thing I want to mention is that I've noticed that when people start to adopt a healthy diet, sometimes they synonymize the healthy diet with just restricting calories and restricting carbohydrates. And I don't think that that's necessarily a good idea, but what I do think is a good idea is to do some type of, like a Cyrex food allergy test or looking at genetic components related to celiac disease and just making sure that from a dietary standpoint, particularly an autoimmune related dietary standpoint, you're not consuming food products that would cause, even if they might be healthy for one person but not healthy for you, like if you're, I don't know, sensitive to oxalates and the. Your neighbor is doing a bunch of almonds and spinach in their smoothie, you know, that that's something that for you could be an issue and trigger some type of inflammation or oxidation or trigger an autoimmune response. You know, I think it's important to test that as well. And it sounds like from what you're saying, you know, sadly, if you could, you would. But it's one of those things where you just don't necessarily have the time in your practice.

Right.

Okay. All right. Got it. Okay. I want to get into a couple of other things related to, to popular strategies that folks are championing out there to increase your sperm count. But one quick aside, because we've thrown this term around a couple of times. And that would be semen versus sperm. And the reason I want to ask you this question is obviously semen's a little bit different than sperm, and maybe you can explain the differences. But if a guy is ejaculating and noticing that there's a certain healthy looking volume of the ejaculate that theythey must be fertile. Cause there's a lot of stuff coming out the penis, right? So therefore stuff must be working, okay, because you got a bunch of, you know, white milky fluid coming out. But correct me if I'm wrong, just because you can make a bunch of semen does not necessarily mean that your sperm are healthy. Correct.

You're absolutely right.

So what, whatis there, like a standard for the amount that most guys produce, or does it widely vary as far as the volume of the ejaculate itself?

So I'm quoting the World Health Organization, the fifth edition of their guidelines on what the reproductive counts should be. And when these studies that they performed were on 2000 guys from different countries, different continents, were able to conceive within 12 months of trying. When they looked at the bell curve for those guys and they looked specifically at their ejaculate volume, 1.5 milliliters was at the fifth percentile for them. So as long as patients are above 1.5 milliliters, then it tells us that they're in that 95% of guys, at least in that range where they could be successful. But if they're less than that, then it doesn't mean that they're infertile, it just means that their numbers are less. And 5% of guys in that who study were less than 1.5. We start asking questions when the volume is less than 1 milliliter. So if the volume is less than 1 milliliter consistently, then we start looking at did the ejaculate go backwards into the bladder, or is it obstructed at a certain point? And it leads us down a whole slew of tests that we start considering and talking about in order to delve a little bit deeper about why the ejaculate volume is not what it should be.

1.5 milliliters for ejaculate volume. That's somewhere right around the range of the size of a quarter or something like that, isn't it? I think that's about the approximation I've seen for guys who can't picture 1.5ml and instead need currency. I think. What's the other one you see thrown around there? The size of A very, very small cube of cheese. But is that about what you'd be looking at, the size of a quarter or so?

Yeah, I think that's a great analogy. I've never actually compared the two, but if I had to think back to last time I saw somebody with approximately that volume, I would say that's fairly accurate.

Yeah. Guys, just a little tip for the relationship department. After you've made love, don't take out the quarter right away to compare volume or anything like that. It ruins the moment. But maybe keep a quarter in your back pocket for later, just to check. Okay, so let's get into a few other strategies here. We talked about hcg, fsh, Kisspeptin. We talked about CBD a little bit. When it comes to the mitochondria, obviously sperm have cells that contain mitochondria. I mentioned that that one of the reasons people like this red light therapy is based on the idea that it might increase the mitochondrial health of the Leydig cells and the testes. But another one that I've seen thrown out there quite a bit, and perhaps this is related to the mitochondrial health component. As far as studies that have been done on fertility is coenzyme Q10. You looked into coenzyme Q10 at all?

Yeah. So I do recommend it for guys with idiopathic, meaning we don't identify a cause of their fertility. So I will recommend it for that population, but I more likely to recommend it if I know that there is another component to their infertility that is off. So if they have a structural problem along with varicose veins, if they have obesity, or if they have a known deficiency of CoQ10, then definitely recommend replacement.

Okay, got it. In women, Inositol. Inositol is something that several studies show can significantly increase ovulation and fertility rates. Have you seen any data on inositol supplementation in men as being something that would be effective at all?

Yeah, so just a few studies, I think, on the topic of myonostat, they had guys over 45 years of age and they looked at their hormone levels and their gonadotropins, the lh, fsh. And it seemed as though when they were taking the myo inositol that their testosterone levels improved. And also it helped improve the semen parameters. So it helped the morphology of the sperm and improve their concentration of sperm as well.

Okay, got it. So thumbs up on Coenzyme Q10. Thumbs up on inositol. What about astaxanthin? Astaxanthin is another one that I noticed a few decent studies out there for increasing pregnancy rate of couples when the man was taking Astaxanthin.

Yeah, so the studies seem to be mixed on that one. There's some that show no benefit and some that show improved motility and dropping the amount of free oxygen radical species that are around, which would be very beneficial. And the one study, I think that I may have seen, the same study as you that showed an improved pregnancy rate compared to those who weren't taking it. But with small studies, everything has to be taken with a grain of caution.

Yeah, yeah. Well, I mean the nice thing about astaxantha I interviewed Dr. Actually she's not a doctor, she's just an author. Sandra Kaufman, who wrote a book about longevity and she kind of ranked, prioritized based on studies, all the different compounds that might be smart to take for the anti aging and longevity compartment or component. NAD was pretty high on there. Curcumin was pretty high on there. I think Spermidine, oddly enough related to Sperma, is increasingly a popular supplement for men and women for just overall health. And the anti aging effect was up there. But astaxanthin was another one that kind of seemed to cover a lot of bases from an overall health standpoint. And I mean like, you know, in terms of that pregnancy rate study that, that I think both you and I saw, I think they're only using like 10 to 20 milligrams, which is pretty standard for nasaxanthin dosage. So that that just might be prudent as something to throw into the mix. And many supplements are including that now as well. Zinc is one that pops up a lot as something that could potentially increase both fertility as well as possibly address low circulating testosterone. What do you think about zinc?

Zinc has been shown to have benefit, but only when taken with folic acid. So zinc alone, no benefit. But with folic acid there's been increase in the amount of ejaculate volume. So for guys who want to try to improve their ejaculate volume, they could try zinc supplementation with folate.

Okay, got it. I wonder why that, why do you think the folate acid is a necessary component?

I am not sure. Yeah, I'm not sure what it is about folic acid that makes it be more functional, perhaps in the turnover of cells. And I think it is important in the turnover of DNA so it improves the DNA replication efficiency of replication.

Okay, got it. Yeah, that's interesting. You know, a lot of times zinc in combination with the Zinc ionophore is something that I know have improved outcomes in hospitalized COVID patients. And, you know, it seems that a lot of times zinc, when combined with something seems to. Seems to work a little bit better. So zinc withwith folic acid or with. I suppose you could also just consume zinc and have a dietary source of bioavailable folic acid. Like, I like organ meats for something like that, or liver extract. So that's another one. And by the way, guys, I'm a bigger fan personally just because I've seen some increases in homocysteine and inflammatory markers. And guys who do like, like a synthetic folic acid, more of that natural bioavailable folate, such as you would find something like organ meats, or it's typically listed as like methyltetrahydrofolate on a multivitamin instead of synthetic folic acid. Seems to be a better idea. One other I was gonna ask you about, doctor, and that's D Aspartic acid. D Aspartic acid, also a lot of times called DAA in the supplement realm. Is that one that you've seen much data on for increasing fertility?

I believe it's just one study that I've seen in the past, and it did improve the count and the motility. But just one study.

Okay. All right, got it. So theoretically, you know, if you guys go to the show notes, I'll link to a lot of stuff, but you could probably, as you're listening in, visualize some kind of like a stack that you could try that might include CoQ10 and Inositol, maybe some astaxanthin, some zinc, some D. Aspartic acid. Actually, there was one other study. I just saw it come through last week because I subscribed to a lot of these digests that send you research papers related to a wide variety of topics. I think this one came through from the website examine, which is wonderful. And that was vitamin E combined with selenium that increased a number of sperm parameters related to fertility in men who had low sperm motility or abnormal sperm morphology. Have you. Did you see that paper on vitamin E combined with selenium? Or have you used much vitamin E or Selenium?

Selenium, yes. Vitamin E. I think from what I've seen, the data has been mixed, but perhaps there's a newer study that I just haven't come across. But selenium has some antioxidant properties to it that would be helpful to improve sperm concentration, motility morphology, and potentially even semen volume.

Yeah, okay. I interviewed Dr. Barry Tan from Designs for Health a couple of years ago about vitamin E. And there were so many benefits from muscle protein synthesis to testosterone to the antioxidant capability of a well formulated vitamin E compound. He talked about the importance of having both your alpha tocopherols and tocotrienols in. There's four different tocopherols and four different tocotrienols and vitamin E and a well formulated vitamin E supplement. I think it kind of covers a lot of bases, similar to astaxanthin anyways, so that's probably not gonna hurt you to at least look into something like that. And then there's a couple of other things that I think are less common, Dr. Haradi, that might fall into the same category as cold packs on the balls. One is more of like, I suppose, an Ayurvedic or Eastern strategy. And that's this idea of reduced eject or reduced reduced ejaculation frequency. Like just basically either, you know, having sexual intercourse but not ejaculating or reducing the amount of sexual intercourse you have. I think the reasoning here, I don't know how scientific it is, is that, you know, if you're just basically wasting less sperm and less semen when you do ejaculate, it might be a higher quality or by holding stuff back, you might increase your testosterone a little bit. Have you seen anything at all in terms of like reduced ejaculation frequency?

Yeah. So we're actually going the opposite way right now in our field. We're recommending more frequent ejaculation and quicker turnover. And really the main thing is that sperm concentration, when it's in a normal range or even subnormal, it really doesn't fluctuate that much with more frequent ejaculation. And abstinence of longer periods doesn't add much more to the concentration because there's constant cell death and cell turnover even in the reproductive organs that have sperm parked and waiting to go. The more rapid the ejaculation, the less the DNA fragmentation and the better the DNA health. And so we're seeing is that when you study DNA fragmentation levels between guys who have less than a day abstinence or a day abstinence versus two days versus seven days, that the DNA fragmentation is less in the more frequent. And so one strategy that we sometimes use for guys with really high amounts of DNA damage in their sperm is to try around natural conception cycles to have intercourse as often as they can.

I could get behind that strategy. I like that better than reduce ejaculation frequency, which I tried for an article that I was writing, just kind of looking at from an immersive journalistic standpoint, these subjective effects. And I found that it made me a little bit too amped up, a little bit grumpy, and did. I definitely didn't enjoy sex as much. Obviously, that should go without saying, but I love it when you tell me that increased ejaculation frequency could be helpful. That sounds like a far more pleasant way to increase fertility. When I was working on that article, that was actually an article for Men's Health magazine on male sexual health. One of the things that I did as part of that article, I actually caught a lot of flack for this and still haven't lived it down. I got a stem cell injection. Well, I did a stem cell injection into my penis, and I also did a PRP injection as part of that. And this idea of injection for erectile dysfunction or Peyronie's disease or something like that, there's obviously some literature that supports that approach. You've seen anything when it comes to actual injections, though, Dr. Haradi, for increasing fertility? Like the fringe number of guys who might actually go out and get a stem cell injection or a PRP injection or something like that.

So I've had patients come from international locations who have come to see me, and they brought papers showing PRP injection, which there is, I think, a rationale to it. I don't recommend it, because anytime you inject the testicles, you can introduce foreign objects that can lead to an infection, inflammation, and that can lead to its own set of issues. But with some of these medications or agents, there can be growth factors inside that could be helpful. So I think the jury's still out on this one, and the toll of studies are done. It'd be hard to say yay or nay to it, but the growth factors could be helpful to them.

Okay, gotcha. Gotcha there. There's. There's a book out there, I think it's called. It Starts with the Egg, the Fertility Cookbook. It's really just like, I checked it out because I, you know, whenever I'm going to interview somebody, I like to just see what's floating around out there. Because obviously what's floating around out there is what people are being told. And sometimes podcasts like this can clear things up. That particular cookbook just basically appeared to be a bunch of like. Like Mediterranean diet type of recipes, which I think overall, the Mediterranean diet seems to be a pretty healthy diet, as long as it's not the Olive Garden version with unlimited breadsticks and iceberg lettuce drenched in ranch. But when it comes to dietary guidelines, I also mentioned I'm a huge fan of the Wesnay Price diet, possibly due to the fact that that one just does a pretty good job not sending the body a message that it's in starvation syndrome because it's a bunch of full fat milk products and wild fish and you know, fish eggs and organ meats and you know, fermented vegetables and you know, all sorts of pretty calorie dense and nutrient dense foods. But when it comes to diets or just foods that you might find yourself recommending frequently, even though you know you've already established you don't do a lot of that as the doctors do, to time limitations, Are there any particular foods, food groups or diets that you just, you see over and over again? You're like, well, it'd be pretty prudent to include this stuff in your diet if you're trying to have a baby.

Yeah. So I actually generally recommend the guys if they don't have an identifiable structural problem affecting their fertility, such as varicose veins, then if they're thinking about the antioxidants and the vitamins, to try the diet based approach first. And a diet rich in omega 3 fatty acid rich foods like tuna, mackerel, salmon, having walnuts, flaxseed, things like that, replete in the diet. The body will take from it what it needs.

Okay.

And then if there is a structural problem, that's when these vitamins typically come in. The risk with some of these antioxidant therapies is that sperm lose their cytoplasm, the portion of the cell that is around the nucleus, and it sloughs it off. And so it keeps a very small amount of oxidative species around and you need some amount of that oxidative species for sperm function. So if you take the pendulum, you swing it the other way, or you go from oxy stress to reductive stress, you can actually hurt sperm function to some capacity. So the balance is really important. And keeping that balance well maintained is probably a better approach for a lot of guys. Now there are some guys who definitely benefit from it, and obviously the studies are supportive of it. But as far as sperm functionality, such as allowing the sperm tails to start whipping faster, to be able to penetrate into the egg, that process of sperm and egg fusion that is dependent on reactive oxygen species, so keeping that balance is really important. And the cells that are the sperm cells don't have the ability to counteract or produce any more of those ROS species.

Okay, so basically what you're saying is it sounds to me like avoiding excess use of antioxidants so that you're not completely suppressing your reactive oxygen species signaling pathways is something that you should think about. This reminds me of the studies that have shown that excess use of synthetic vitamin C or vitamin E in a post workout scenario or extremely long cryotherapy or ice bath sessions after an exercise session, which would, you know, decrease oxidative species to the extent to where you don't get as much post exercise mitochondrial proliferation or satellite cell generation or muscle growth or anything like that, you know, that would dictate that excess use of antioxidants related to exercise would suppress your reactive oxygen species signaling pathways too much. What you're saying is that that would also be something that you may want to think about when it comes to fertility. Just because vitamin E and selenium is good, it doesn't mean more or excess use is. Is best.

Exactly, yeah. And that's why seeing a reproductive urologist is always a great idea. If there is something that can be identified fine tuned structurally, hormonally, and then to supplement it with the vitamin approach is oftentimes a really good strategy to try to do it all with dietary can perpetuate the problem and maybe even compound the problem.

Yeah, yeah. I found one interesting article that went into differentdifferent foods that actually have been studied andor looked at, or different dietary approaches. And the main thing that I saw over and over again was making sure you get adequate protein, which I just did a big podcast on protein. That one's pretty straightforward and probably related to that idea that we've already a horse we've kicked to death related to not sending the body a message that it's in a protein restricted or calorie restricted scenario. Folic acid, like really good sources of folic acid, beans and legumes are pretty high up there. And you already mentioned that folic acid and zinc would be good. Some of these foods that are higher in zinc, like sunflower seeds and pumpkin seeds, avocados come up. There's this idea based on the doctrine of signatures, that things in nature that look like something might actually be good for them, that particular body part. So people say, well, avocados look like the gonads. And it turns out avocados have a lot of folic acid. They got a lot of monounsaturated healthy fats, they got vitamin K, they got potassium they have a lot of things that might influence fertility. Have you ever come across that idea that there are certain things in nature that look like the testicles or that might look like a pair of ovaries and therefore they might be good for fertility?

That's very interesting. Aphrodisiacs sometimes have phallic shape or the shape or consistency of a testicle or structure of, I guess, the female reproductive tract. And that's always considered as an aphrodisiac and something that would stimulate libido. But as far as the correlation between the shape and the benefit, I haven't seen that before.

Yeah, well, one other I'll throw in there for you guys, wild caught salmon. Our wild caught salmon is chock full of selenium. It's got natural levels of astaxanthin in it. It's got fat soluble vitamins like vitamin D and like vitamin E. So that'd probably be a pretty good protein staple in your diet as well. So there you have it, folks. Have some wild caught salmon, have some guacamole, you know, maybe throw in some beans and lentils, pumpkin seeds, sunflower seeds, you know, a limited amount of antioxidants like small berries or walnuts or, or things like that. And I don't think that it's necessarily rocket science to eat healthy for fertility. I think that really, for a lot of guys who I talk to, it comes down more to avoiding a lot of those environmental variables that we talked about. So many guys just won't stop putting their cell phone with the wifi turned on in their pockets, hitting the sauna and not changing out their personal care products or household cleaning chemicals. I just think that, that it seems to me it's more of an issue of more things needing to be omitted for a lot of guys rather than yet another pill to pop or supplement to take. We talked about this company, daddy, that you work with, Dr. Haradi, which from what I understand, because I sent my kid in, you, basically you ejaculate into this little box that gets sent to your house and then I send it off to you guys. Now, you guys analyze sperm first of all. Or this company, daddy analyzes sperm. What are they looking at when they analyze sperm? Like, what does a semen analysis report actually tell somebody?

Yeah, so the company will issue a semen analysis and send that back to whoever is submitting a sample to them and then you can go through that analysis and find a lot of good information. So they. A typical standard semen analysis report would tell you the ejaculate volume, the concentration of sperm, seen the motility of the sperm, how well they're moving, whether are they moving, are they moving forward or not, the shape of them, the morphology of them. And then tell you if there are other types of cells that may be present, such as white blood cells or neutrophils, that would be suggestive of an infection or prostatitis. The hard part with the semen analysis is that we sometimes get couples that come in and they say the semen analysis looked normal. Husband never got checked, or male partner never got checked. He wasn't deemed to have a problem. But then when you look a little bit deeper, he did have some structural things or had something in his lifestyle that was impacting the DNA. This burn, which isn't always as visible on the semen analysis report. And the semen analysis report is like the 60,000 foot view of the forest. And then the individual trees are obviously more important. And the DNA quality within the sperm isn't always indicated by the semen analysis report, but it gives you very good information. The more semen parameter abnormalities that are identified, the more likely there is a problem. And this is something that Daddy will issue with their sample whenever it's sent in, that they'll analyze the semen parameters and then that can be turned back around to the male partner so that he can see what his numbers look like and be able to take that back to a their physician reproductive urologist and say, how do I make heads and tails of this? Do I need to get checked for anything? What does all this mean?

Okay, got it. And that's just like, do you just get like a PDF mailed to you or something with that analysis of your semen?

Correct.

Okay, all right, got it. So what would be other reasons that a guy would actually send in? I mean, obviously the storage component makes sense. Like you just store it so that when you want to use your sperm at a later date, you could actually use it. But are there other reasons that a guy would actually deposit and store and freeze his sperm with a company like Daddy?

Yeah. So that brings me to how I found Daddy myself. One of the things that I'm very passionate about is advanced paternal aging and the effects it has on the genetics of sperm. And one of the strategies where you can avoid all, all of the negative effects of all the exposures, environmental exposures, through all the endocrine factors and EMF and et cetera, et cetera, is to bank sperm early. You know, if you have a campaign where you have 18 to 22 year olds who bank sperm, put it away. You can potentially avoid a condition called secondary infertility or even primary infertility, where primary infertility being couples have never had a child and secondary being coupled so had a child but are having trouble with the subsequent trial because male, female age has advanced or a new condition has set in. So you can do away with a large portion of fertility if, if guys are more proactive in freezing their sperm. And so I had reached out to the leadership daddy and I said, hey, I'm really interested in this and I'm interested in getting the message out there. And I think what you guys are doing is fantastic because you're giving guys who don't want to go to a laboratory and go through the formal process of going to a lab in an exam room. It's very awkward. To be able to do this at home would open up the opportunity for young guys to put away some sperm and keep it as an insurance policy. So if, God forbid, something changed down the road, they were involved in a car accident, they developed a malignancy, they had to go through XYZ medication, they don't have to think about it because they have healthy young sperm that hasn't gone through all the genetic stress that somebody who is 45, 50 years of age has had inflicted on their sperm. So that's my segue into the company. That's how I reached out. That's why I reached out. And that's how the union formed for my advisorship was that passion. So this is actually a great platform. I appreciate you inviting me on to speak about this because I really am hoping to get the message out there that more people should consider this at a young age.

Yeah, yeah. Well, I mean, especially if you're just, you know, I'm one of those guys who believes that children are a blessing from God and that when you decide you're going to have kids, you're never quite feel fully ready. Like you, like if you wait until you're ready to have kids, kind of similar if you wait until you feel like you're fully ready to get married, you're probably going to be waiting a while. Sometimes you just got to. You just got to do it. But at the same time, you know, if you're like, like 20 years old, incredibly healthy, virile, fertile, and maybe you just got married and you want to just go globetrot for a couple of years with your wife and enjoy some time with just your wife until maybe you're 25 or 30 or whatever. It seems like banking your sperm and soaring would be a good idea from that standpoint. And also just for generally having that peace of mind that you got something kind of, you know, just waiting for you and ready, should you need it. And I would imagine, like, if I have my sperm, because I'm gonna store my sperm with you guys, and if I store it and I want access to it, like, how's that actually work? Do I just likebecauseI've stored my stem cells down in Florida before and I literally can just like call them up and have them. It cost me like 200 bucks. They can ship it to any doctor, and that doctor can then inject those stem cells into joints or do an intravenous infusion for anti aging or what have you. Is it similar with the sperm? Would I just call or email? Daddy can say, hey, I'm ready, and they send my sperm up? Is that kind of how it works?

Yeah. So there's a partner lab that has the cryogenically stored sperm, and the team of Daddy can help ship that sample out to wherever you like it to be sent to.

And at that point, I mean, like, logistically, are you just like, if you get it shipped to your house, you're just using like a, like a horse baster with your partner. How's that actually work logistically?

So I wouldn't recommend that because usually the sperm is oftentimes a precious commodity, not something that you'd want to not give it the optimal opportunity for it to have the best effect. But typically with these cryogenically stored, they have to go through a thaw cycle, so they have to come out of the liquid nitrogen, be thawed to room temperature, and there's a protocol that labs use to do that. And then that either can be sectioned out into really small amounts to do ivf, or can be used for a process called intrauterine insemination. Which is that turkey baster that you're referring to? It's a little catheter.

I think I said horse baster. I meant to say turkey baster, folks. Turkey baster.

And that can be advanced up into the uterus, and then the thawed ejaculate can be passed into the uterus.

Do folks do that at home or. I assume they go into a clinic to have something like that done in a clinic.

Yeah. You wouldn't want to really handle liquid nitrogen.

Yeah, yeah, I wouldn't imagine. Especially not in the bedroom with romantic jazz music playing in the background, you know, as you take out your Box with your cryogenically stored sperm and your turkey baster. I feel like that might eliminate a little bit of the romanticism from that scenario. What about storing, like, should you store more than one sample? Is that prudent?

I'm of the mindset that it's a good idea to have a couple samples frozen. And most labs will divide the sample out into different vials held in different tanks. So God forbid, if the tank goes down for whatever reason, there's a backup. But more vials, more opportunities for more IUI cycles is the way I see it. If you have only one vial and that's. And God forbid something happens to a male partner, gets chemotherapy, loses the ability to produce his own, then that amount saved is what he has. And there is, unfortunately, with each freeze and thaw cycle, decay of sperm. So we see some cases half to two thirds don't make that life cycle of being able to go through freeze and thaw. But still, the more you have, the better the outcome is.

Yeah, yeah. And, and, and I, I think with Daddy, it's like, I believe it's around 200 bucks. You get like your, your year of free storage. You get your semen analysis report, and then I think there you guys have like a slightly more expensive version where you can do like additional storage, additional kits, you know, et cetera, et cetera. So it's not, it's not that expensive. But I agree that storing more than one sample, you know, I'd like. I did the same thing with stem cells, right? I have my. All my fat stem cells harvested and stored with, with the US Stem Cell Clinic. I have all my bone stem cells stored with, with Forever Labs in Berkeley. So I've got a couple of backups should I need it. And so that's all. I'll put a link to all this stuff. You guys can also go to BenGreenfieldFitness.com Daddy Kit. That's BenGreenfieldFitness.com DadiKit it's kind of cool. This little blue box comes to your house. It's got all the instructions. You do your deposit and then you ship it off same day. Or actually you got to bring it to a FedEx ship center or do a FedEx ship center. And then I have a code that's $20 off. They gave me a code. It's BEN20. Get you $20 off@BenGreenfieldFitness.com DaddyKit that's D A D I kit. And then the show notes for this particular interview, you're gonna find@bengreenfieldfitness.com Dadi now, the DaddyKit folks, they actually have a really great blog where they have a whole bunch of fascinating articles that delve into other aspects of fertility. Like one recent one that I read was that sperm concentrations are highest in the winter. There's actual seasonal variations in sperm count in men, which was super interesting. Another one found that watching TV, more than 20 hours of TV weekly resulted in a 44% lower sperm count compared to guys who didn't watch that much tv. They've got like the ultimate guide to Semen, the ultimate guide to Sperm. So useful website anyways. But related to all this information, just while I have you on the call, Dr. Haradi, is there anything else that you would love just while you're on this platform talking to a whole bunch of people to share about fertility that you haven't had a chance to share yet in our discussion?

Yeah, for me, the main thing was to encourage people to make the lifestyle changes that they need to, to take their health seriously to get checked out. A lot of times fertility, as we talked about before, is a barometer of a man's health. And when there are changes in fertility, there's a higher likelihood of developing other conditions down the road. So if there is a problem with fertility, get checked out and be seen, go through the motion. It's sometimes uncomfortable to think about going to a doctor's office to talk about fertility, something so intimate. But it's not a condition that should be taken in isolation like that. It's something that there are reproductive urologists that are very sympathetic to the condition of and are happy to see and evaluate and screen for all these other conditions. So it's something that I would encourage guys that are listening and women, if they're listening, to send their male partners over to get checked out early and often.

Yeah, yeah. And you guys have had a super helpful team. You made it pretty simple. And I realize for you ladies listening in, I mean, you can forward this to the male in your life who you would like to see stepping up their game in the fertility department. I fully understand that we stayed pretty one sided when it comes to which sex that we are speaking to on this podcast. But you know, there are a lot of, there's a lot of information out there, I think more information at least from what I've seen in the podcasting realm for, for female fertility and endocrine balance than for males. And so, you know, selfishly enough, I'm also a dude. So I just, I had a whole bunch of questions in the back of my mind I wanted to ask Dr. Haradi. So I think this has been super helpful. So what I'm going to do in the show notes@bengreenfieldfitness.com Dadi is I'm going to link to a few things. I'm going to link to some studies that we talked about that take a deeper dive into a lot of the different drugs that will have an impact on male fertility. I would recommend that if you are using any pharmaceuticals or any drugs, you go and review that list. I'll list to link to some of the other research articles that we talked about, talked about, related to CoQ10, vitamin E, et cetera. I'll link to the previous podcast I did with Adam Wengauer where we talked about all the different kind of fringe stuff that he was doing for for fertility and some of our discussion about things like Kisspeptin, FSH and HCG and things along those lines. And that's all going to be@BenGreenfieldFitness.com Daddy that's BenGreenfieldFitness.com Da where you guys can also leave your own comments, questions, feedback, things that you've found, studies you've noted that maybe we didn't get to, etc. Just don't go sit in a hot tub or a sauna while you're reviewing the show notes, all right? Do it in a cold bath or with these ice ball packs applied and we've established that would be prudent. Dr. Haradi, thank you so much for coming on the show and sharing all this stuff with us.

Thank you for having me. This is wonderful.

Yeah, I agree. I learned a ton. So go to BenGreenfieldFitness.com dadi for the show notes go to BenGreenfieldFitness dot com dadikit if you want to order your kit, you can use code BEN20 for 20 bucks off. Until next time, I'm Ben Greenfield along with Dr. Amin Haradi signing out from BenGreenfieldFitness.com have an amazing week. In compliance with the FTC guidelines, please assume the following about links and posts on this site. Most of the links going to products are often affiliate links of which I receive a small commission from sales of certain items. But the price is the same for you and sometimes I even get to share a unique and somewhat significant discount with you. In some cases, I might also be an investor in a company I mention. I'm the founder, for example, of Kion llc, the makers of Kion branded substance supplements and products which I talk about quite a bit. Regardless of the relationship, if I post or talk about an affiliate link to a product, it is indeed something I personally use support and with full authenticity and transparency recommend. In good conscience, I personally vet each and every product that I talk about. My first priority is providing valuable information and resources to you that help you positively out optimize your mind, body and spirit. And I'll only ever link to products or resources, affiliate or otherwise, that fit within this purpose. So there's your fancy legal disclaimer.