INFERTILITY. ACCORDING TO THE CENTER FOR DISEASE CONTROL, NEARLY SIX MILLION AMERICAN COUPLES
HAVE TROUBLE GETTING PREGNANT OR STAYING PREGNANT. AND IT'S NOT JUST A WOMAN'S PROBLEM, NEARLY
ONE HALF OF INFERTILITY ISSUES CAN BE TRACED DIRECTLY TO THE MAN. TO DISCUSS THIS TOPIC
THIS MORNING WE HAVE DR. DON EVENSON, AN INTERNATIONALLY RECOGNIZED EXPERT IN INFERTILITY. AND DR.
MICHAEL JACOBS, A NOTED INFERTILITY EXPERT FROM MIAMI, FLORIDA. GOOD MORNING DR.
MORNING OLGA. MORNING.
THANK YOU SO MUCH FOR JOINING US DR. JACOBS. THANK YOU.
DR. EVENSON LET ME START WITH YOU, LET'S START ABOUT, TALKING ABOUT YOUR PROFESSIONAL JOURNEY
IN THIS MEDICAL FIELD IF YOU DON'T MIND. YES SOME YEARS AGO WHEN I WAS ON THE FACULTY
OF THE MEMORIAL'S SLOAN KETTERING CANCER CENTER IN NEW YORK CITY...
MHM. ...I WAS CHALLENGED WITH A QUESTION OF IS
IT POSSIBLE FOR US TO MEASURE THE POTENTIAL AMOUNT OF DNA DAMAGE IN SPERM FOR GUYS UNDERGOING
CHEMOTHERAPY. AND AS YOU KNOW CHEMOTHERAPY AGES CAN BREAK DNA...
MHM. ...AS SO THIS IS WHAT WE FOUND AND THAT PROJECT
WAS VERY SUCCESSFUL. AND YOU HAVE DONE SO MUCH WITH THAT AND WE
ARE GOING TO TALK ABOUT THAT IN JUST A FEW MOMENTS DR. JACOBS YOUR HISTORY AS WELL?
I AM A SPECIALIST IN REPRODUCTIVE ENDOCRINOLOGY AND FERTILITY. I AM A MEDICAL DIRECTOR OF
THE FERTILITY AND IVF CENTER IN MIAMI. AND WE HAVE BEEN TREATING COUPLES HERE IN SOUTH
FLORIDA FOR TWENTY TWO YEARS NOW. BOTH MEN AND WOMEN THAT HAVE DIFFICULTY CONCEIVING
WHILE MAINTAINING PREGNANCIES. CAN YOU TELL ME WHAT SPERM DNA FRAGMENTATION
IS AND GIVE ME THE LAYMAN VERSION PLEASE. WELL IF YOU LOOK AT A DNA MOLECULE, IT IS
A DOUBLE HELIX. SO THESE TWO STRANDS OF GENETIC MATERIAL THAT ARE INTERTWINED TOGETHER...
MHM. ...AND WHEN YOU HAVE BREAKS IN THE STRUCTURE,
THE INTEGRITY OF THE DNA IS NOT NORMAL. AND IN SIMPLE TERMS, IF THE DNA IS NOT STRUCTURALLY
INTACT, THE GENES THAT ARE RELATED TO CODING FOR FERTILITY AND THAT ARE RESPONSIBLE FOR
HELPING MAINTAIN AN EMBRYO IN EARLY DEVELOPMENT AREN'T FUNCTIONING PROPERLY SO THE SIGNALS
ARE NOT BEING PROCESSED. AND SO EITHER THE PATIENTS HAVE TROUBLE GETTING PREGNANT OR
STAYING PREGNANT. BUT WE HAVE COME A LONG WAY I HAVE TO SAY
AND THERE IS SO MUCH HOPE OUT THERE FOR COUPLES TODAY. DR. EVENSON LET ME ASK YOU WHAT DO
THE LETTERS, AND I AM READING IT HERE, S C S A IN YOUR COMPANY STAND FOR?
WELL THE 'S' IS FOR SPERM. OK.
AND THEN 'C' IS FOR CHROMATIN. CHROMATIN IS THE WHERE THE PROTEINS ARE WRAPPED AROUND
THE DNA TO PROTECT THE DNA AND THAT STRUCTURE AND THEN 'S' FOR STRUCTURE. IT IS IMPORTANT
THAT THE STRUCTURE OF THE PROTEINS AND THE DNA ARE CORRECT OTHERWISE YOU DON'T GET A
PROPER READ OUT OF THE GENES THAT ARE NECESSARY FOR EMBRYO GROWTH. AND THE EMBRYO MAY DIE.
AND THEN 'A' IS SIMPLY ASSAY OR TESTS. OK. NOW I AM GOING TO BE COMPLETELY HONEST.
MY HUSBAND AND I ACTUALLY HAD PROBLEMS GETTING PREGNANT AND I WAS---I DON'T WANT TO SAY THE
PROBLEM---BUT IT WAS THE ISSUES THAT I HAD. AND I TOOK SOME INFERTILITY PILLS AS WELL.
AND WE HAVE TWO BEAUTIFUL GIRLS TODAY BECAUSE OF ALL THE HELP THAT WE GOT ALONG THE WAY.
HOW OFTEN IF I CAN ASK IS INFERTILITY TRACED BACK TO PROBLEMS WITH MEN AND SPECIFICALLY
THEIR SPERM? DR. EVENSON. BASICALLY IT BOILS DOWN TO ABOUT 1 IN 5 MEN
HAVE THIS PROBLEM AND HAVE COME IN TO CLAIM. THERE IS SOME DRAMATIC EXAMPLES HOWEVER FOR
EXAMPLE WE WERE JUST STUDYING AT A PLACE IN THE CZECH REPUBLIC WHERE THIS HEAVY POLLUTION
AND NEARLY THERE IS A HIGH LEVEL OF INFERTILITY AND MISCARRIAGES. AND WE FOUND THAT THE POLLUTION
LEVEL WAS RESPONSIBLE FOR BREAKING THE DNA AND THE SPERM OF THOSE MEN.
AND DR. JACOBS YOU AND I WERE TALKING ABOUT THIS A FEW MINUTES BEFORE WE STARTED TALKING
RIGHT NOW ON THE SHOW. ABOUT HOW WAY BACK WHEN, IT KIND OF HAD THE STIGMA OF BEING THE
WOMAN THAT HAD THE PROBLEM, BUT NOT SO? IT'S ABOUT 40 PERCENT OF THE TIME IT'S GOING
TO BE A MALE FACTOR. 40 PERCENT A FEMALE FACTOR AND THE REST ARE GOING TO BE A MIXTURE OF
BOTH OR JUST UNEXPLAINED. SO IT BECOMES VERY VERY IMPORTANT TO TEST THE MAN AND THERE ARE
A COUPLE OF DIFFERENT CLINICAL WAYS TO DO THAT.
AND CAN YOU TALK TO ME ABOUT SOME EXTERNAL FACTORS THAT KIND OF MAKE THE SPERM INEFFECTIVE
WHEN IT COMES TO MEN? WELL ENVIRONMENTAL FACTORS THINGS THAT PEOPLE
CAN HAVE SOME CONTROL OVER YOU KNOW HEAVY SMOKING...
OK. ...USE OF DRUGS. EXPOSURE TO THE ENVIRONMENTAL
AGENTS. YOU KNOW IF YOU ARE A LANDSCAPER YOU AE INVOLVED WITH PESTICIDES AND SO FORTH.
THOSE ARE THINGS THAT YOU CAN SORT OF TAKE PRECAUTIONARY MEASURES TO TRY TO AVOID. SOME
THINGS THAT CAN'T. IF YOU HAVE AN ANATOMIC LESION SUCH AS A DILATED VEIN IN THE TESTICLE
KNOWN AS VARICOCELE... MHM.
...IF YOU WERE BORN WITH A UNDESCENDED TESTES CALLED CRYPTORCHIDISM THAT HAD TO BE CORRECTED.
IF YOU NEEDED CHEMOTHERAPY BECAUSE YOU WERE TREATED FOR SOME KIND OF CANCER. IF YOU HAVE
HYPERTENSION AND YOU ARE ON MEDICATIONS. ALL OF THESE THINGS HAVE BEEN ASSOCIATED WITH
INCREASED BREAKS IN THE DNA AND INCREASED LEVELS OF FRAGMENTATION.
BUT LIKE I SAID THERE IS A LOT OF HOPE SO STAY RIGHT THERE GENTLEMEN IF YOU WILL BECAUSE
WHEN WE COME BACK, HOW THE SCSA TEST CALLED THE GOLD STANDARD FOR SPERM DNA FRAGMENTATION
SCREENING IS HELPING COUPLES SUFFERING FROM INFERTILITY. DON'T GO AWAY WE WILL BE RIGHT
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WELCOME BACK EVERYONE WE HAVE BEEN TALKING WITH DR. DON EVENSON PRESIDENT AND DIRECTOR
OF SCSA DIAGNOSTICS AND DR. MICHAEL JACOBS FROM THE FERTILITY AND THE IVF CENTER OF MIAMI.
BOTH LEADING EXPERTS IN THE FIELD OF HUMAN INFERTILITY. DR. EVENSON LET ME START WITH
YOU FIRST EXPLAIN TO ME WHAT THIS SPERM DNA TESTS AND THE PROCESS INVOLVED TO GET IT DONE.
THE PATIENT SIMPLY CAN GO TO A INFERTILITY CLINIC...
OK. ...AND PRESENT THE SEAMEN SAMPLE. THAT SAMPLE
IS THEN FROZEN AND SENT TO OUR DIAGNOSTIC CENTER. WE THEN THAW THE SAMPLE. WE TREAT
IT WITH SPECIFIC CHEMICALS... MHM.
...AND A DYE THAT STAINS NORMAL DNA GREEN AND ABNORMAL BROKEN DNA RED. THEN WE RUN IT
THROUGH A COMPUTER THAT THEN MEASURES 5000 SPERM PER SAMPLE AND IT SHOWS EXACTLY THE
AMOUNT OF DNA BREAK IN THE SPERM AND WHAT PERCENTAGE OF THE SPERM ARE BROKEN.
DR. JACOBS TELL ME SOME ADVANTAGES ON OF HAVING THIS TEST AS OPPOSED TO OTHER TESTS.
WELL IT COMPLIMENTS WHAT WE ALREADY DO. THE ISSUE IS THAT A MAN CAN HAVE A TOTALLY NORMAL
SEAMEN ANALYSIS. TRADITIONAL COUNT MOTILITY MORPHOLOGY. HOW MANY OF THERE DID THEY MOVE?
ARE THEY NORMAL IN SHAPE? AND HAVE VERY ABNORMAL FRAGMENTATION IN THE DNA. AND IF YOU DON'T
LOOK AT THAT, YOU ARE NOT GOING TO GET A FULL PICTURE OF THE POTENTIAL OF THAT MAN TO FERTILIZE
HIS WIFE'S EGGS. I CAN ONLY IMAGINE THAT THE COUPLES THAT HAVE
COME TO BOTH OF YOU. WHEN YOU SEE THAT FAMILY AND YOU CAN MAKE THAT DIFFERENCE DR. I CAN
ONLY IMAGINE THE FULFILLMENT YOU FEEL. DO YOU HAVE A STORY THAT YOU WOULD LIKE TO SHARE
WITH US? BECAUSE I ALWAYS LIKE TO END ON A HIGH NOTE.
WE DID A LARGE STUDY IN CANADA WHERE THERE WERE THIRTEEN COUPLES THAT HAD A IDIOPATHIC
OR UNEXPLAINED INFERTILITY FOR YEARS... MHM.
...THESE MEN HAD MORE THAN A 30 PERCENT THRESHOLD OF FRAGMENTATION. THESE COUPLES THEN VOLUNTEERED
TO DO A DONOR SPERM... OK.
...AND IT TURNED OUT THAT ELEVEN OF THE THIRTEEN COUPLES WERE PREGNANT WITHIN THREE MONTHS...
(GASP). ...IT CERTAINLY SHOWED THAT THE MAJOR FACTOR
HERE WAS PROBABLY THE MAN'S SPERM DNA FRAGMENTATION. 11 OUT OF THE 13.
YEAH. WHAT A FABULOUS SUCCESS STORY. DR. JACOBS
DO YOU HAVE ONE? WELL WE HAD A COUPLE THAT CAME TO US WITH
UNEXPLAINED INFERTILITY... MHM.
...AND HAD BEEN THROUGH MULTIPLE TREATMENTS ELSEWHERE INCLUDING IVF THAT WAS UNSUCCESSFUL
WITH NOT GOOD QUALITY EMBRYOS. AND THEY NEVER HAD A DNA FRAGMENTATION TEST. WE DID THE TEST
FOUND OUT IT WAS ABNORMAL. WE WERE ABLE TO TREAT THE COUPLE WITH ANTI---THE MAN PARTICULARLY---WITH
ANTI OXIDANTS. INVITE HIM IN THERAPY AND AFTER THREE MONTHS HIS VALUES BECAME MORE NORMAL.
WE THEN DID IVF WITH AN INJECTION OF THE EGG AND THEY HAD BEAUTIFUL EMBRYOS AND NOW HAVE
A BABY. THAT'S AWESOME. SO FOR ANYBODY OUT THERE DR.
JACOBS THAT MAYBE HAS SAID, "OH FORGET IT, IT'S NOT GOING TO HAPPEN." WHAT WOULD YOU
SAY? NEVER GIVE UP HOPE. THERE IS TREMENDOUS MEANS
OF TREATING PEOPLE. TREMENDOUS OPPORTUNITIES TO HAVE A FAMILY. AND TO SEEK OUT A SPECIALIST
THAT CAN DO THE APPROPRIATE EVALUATION AND GUIDE YOUR TREATMENT TO END UP WITH A HAPPY
OUTCOME. DR. THANK YOU SO MUCH FOR WHAT YOU ARE DOING.
THANK YOU. REALLY APPRECIATE IT DR. JACOBS, THANKS FOR
BEING HERE. AND IF YOU WOULD LIKE TO LEARN MORE ABOUT THIS MORNING'S TOPIC VISIT US AT
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