Semen Analysis Explained with Olivia Musa, Andrologist and Founder of The Male Fertility Clinic

Join Andrologist Olivia Musa and myself to discuss the factors which can affect male fertility, what a semen analysis actually means and a holistic approach to improving sperm parameters. 

Olivia Musa Founded The Male Fertility Clinic which offers private semen analysis in Central London whether you are trying to conceive or just want to know whether your sperm are in good health. 

Transcript

Unknown: 0:01

Good morning, everybody. And welcome back to another episode of our fertility podcast. So joining me this morning, we have Olivia Musa, and Olivia is an anthropologist, and she is also the founder of the male fertility clinic, which is a male sperm testing facility based in Victoria. So I'm gonna let Olivia introduce herself a little bit more. And then we're gonna talk all about male fertility issues, and any practical tips that we can give you that can help. So welcome, Olivia. Hi, Rachel, thank you for having me. Thanks for coming. It's cold morning. It's freezing, isn't it? It's freezing. Do you want to just give us like a little bit more information about yourself? And tell us kind of like how you became an anthropologist, because it's not the sort of like, area of work you'd like fall into. Right? Like, no, it's really, it's really, really niche. And it's one of those job titles, which gets the conversation started at a party, because people are always really intrigued to kind of know what you do. And yeah, it's a good icebreaker. And it's, it's really nice, and I kind of, well, when I finished uni, I kind of knew that I wanted to go and work in perhaps an IVF setting, I was always kind of really interested in learning about pregnancy and early embryonic development. And that was what kind of piqued my interest. So IVF just seemed like the, the LPS option. So I went and did some training in private labs and some NHS labs as well. That the Andrology position came up at my local hospital. And because they were just kind of refiguring out how they were doing things, they wanted to create a separate Andrology department because it used to be run in pathology. And so yeah, I got chatting with the the lady who ran the place, and she wanted me to come along and help her to set up the facility. So I saw from that point, you know, how to set up the lab, you know, what was needed and what was involved. And quite quickly, you know, was running the department and just really quickly realised that there was such a demand for this kind of really tiny part of the fertility journey. But it was such a massive thing for the men and it just didn't seem like what was being offered through the NHS was just wasn't good enough, you know, when you see something, and you just think this could be so much better. And, yeah, from there, I decided that it was something I was going to pursue, we had the lockdown. I had my children in that time. But in 2021, we decided to go for it. And yeah, our focus has always been on just filling in those gaps that perhaps aren't being offered in other places. So, you know, the NHS, you know, you're you're put into a small room to produce your sample, there's long waiting lists, you know, you've got to wait a long time to get a referral in the first place and get your results back. Quite often. There's no one there to talk about the results with you afterwards. So we've tried to eliminate all of those problems and create a nice, well rounded service. And yeah, three years, almost three years later, we're doing really well. And people are really happy with the service. So I'm just really happy to be able to help people my journey. No surprise, they're happy, because like you said, there's such a massive gap for that, right, like something I bang on about a lot is the difference between NHS services for fertility men and female and, you know, Women's Health generally. And, you know, it's not an NHS NHS bashing session, but you know, it's like, the resources and protocols just aren't there are there and like you said that it can be done so much better. When you have that sort of comes down by the surface. Yeah. Yeah, absolutely. You know, the people, the people in the NHS are amazing, like, they really want to help, but they don't have the resource there. So for you to kind of see that gap and then go okay, right, we can really make this better when they realise the waiting lists for quite so long for ontology, though, like, that's pretty interesting that you have to wait that long even to just produce a sample even to just produce a sample. So yeah, you know, to even get a referral. You need to have been trying for a certain amount of time, I believe a year. And then you then need to get a referral for semen analysis before your partner can even be seen. And that can often take about three or four months. And then not to mention maybe a two or three week wait from the GP for the results to come through. You know, then making an appointment with your GP. We all know how long that takes at the moment. So it is really really lengthy process and something which can be turned around in a day, to be honest. And also a GPS not like a GPS like a general practice. via GPS, not a male fertility specialist or sperm specialists. So like that's important to bear in mind, they do have basic training. But it's not the same as having a conversation, someone like yourself after the test where you can really give loads and loads of helpful practical advice and go in depth into kind of what that result means in relation to fertility, right? Because when you look at something, you need to look at something in the context that someone's coming in for the test for. So yeah, I feel like absolutely, everybody's completely different. And quite often, we speak to guys who've been through their GP, and they don't even see the report, it's just more okay, lo count, go and repeat it in three months, and they didn't actually get to see any of the data and how that might correlate to the rest of the parameters, as well. And as you say, their own background. Interesting, so I'm not surprised you're busy, there's definitely a need for it. So let in your, in your clinic then. So it's called the male fertility clinic. And it's based in Victoria, we're going to talk a bit more about that towards the end. But like you offer basic semen analysis, which is like a semen test that looks at the parameters. What let's I think, before we talk about things that could affect fertility, maybe if we talk about actually what the test shows us. Yeah, and what testing is available. That might and then we can then go on to talk about like, what factors affect facility? Yeah, of course. So yeah, the semen analysis, we analyse a fresh sample. So we have private rooms in our clinic. And that's the best way to ensure that the results are as accurate as possible, we're looking at how much sperm the body is producing. So the sperm concentration, and then also how the sperm are functioning and how they look under the microscope. So looking at the motility, the percentage of sperm that are moving well. And then also, we look at the number of normal forms. So we look at under a high magnification lens, and we can establish and see if there are any abnormalities in the cell structure, which might prevent, you know, fertilisation from occurring. There's some other things as well, that we look at to do with the pH, the sample volume, antibodies, as well, which can be an underlying cause of infertility. And that just gives us a good indication, you know, based on the reference ranges that were provided with by the World Health Organisation, you know, is this, you know, it's perfectly natural conception, something which is likely to happen? Is it something which can happen, but we need a little bit of work before we you know, perhaps get there? Or does this person need to sort of seek additional investigations? Or do they need to go down a treatment pathway? So it really, really depends, what we see, as you say, depends on how long that person may have been trying for, you know, what some of their clinical background might be as well. So, how important is that you talked at the beginning about coming into the clinic for a sample, and this is something that comes up in my clinic quite a lot, where people say, Oh, I had a sample and I had to drive it to the NHS testing unit, or I did even sort of more worrying in my mind sometimes is when you're having a basic sample done using a home testing kit, like how important is it that the sperm is tested within a certain time from being produced? Yeah, it is really important and makes a really significant difference. So first of all, there's the time factor, and we, you know, our guidelines state, we should analyse the sample within one hour, particularly for the motility of the sperm, you know, they are very, very tiny little vulnerable cells and, you know, if they are exposed to heat, or cold temperatures, and also the time effects can impact the majority of the sales. So in order to get a you know, a really accurate result you do really need to provide a fresh sample on site is that is the best way to do it. So that's why we've kind of really focused on making sure that we've got a really nice space for the men to to not feel that they're coming into a stressful or, you know, awkward environment. So that's something we've really focused on to make sure that the guys are comfortable to do that we do have a home option if people want to drop off their sample from home because they do feel really uncomfortable about doing it in the clinic. But we do make it really clear that you know, you need to be within a certain radius of the clinic, particularly in central London, it can be difficult to get to us within one hour. Yeah, something to be mindful of the home kits and things are there. I guess they're okay. If you're trying to, you know, get a first idea of where you might be, but they're quite expensive. Some of them are almost the cost of going for a fresh sample. Yeah, but you would definitely get a more accurate result going for a fresh sample, wouldn't you like it's like the likes of the sperm? We'd like, yeah, you've got the time control there, you've got a temperature control there. And you can just make sure that the sperm aren't exposed to any of those, those risk factors. Can we talk a little bit more about the parameters that you talked about? Because I think I would envisage that there's people listening at home who maybe have a copy of a sperm sample test. And they're looking at that, and no one's explained it to them, because like you said, that just doesn't often happen. Right? So someone's got a copy of a sperm test. And they're looking at the thinking of what is motility? What is morphology? Like? What's normal? Like? What am why? Why am I struggling to conceive? Maybe, with this test result, like, can we just talk about sort of like what it actually means in the fertility context? Absolutely. So obviously, the sperm concentration is important, we need good numbers of sperm to be produced. And the reference ranges state, we need to see ideally around 16 million sperm per mil or above, or, you know, the chance of natural conception. But also they spend need to be moving. So it's no good having all of those cells in there, they're not going anywhere, the sperm have got quite a journey to go on to reach the egg. So we need to see good levels of what we describe as progressive motility. And we see those sperm under the microscope, but they have to be moving in a certain direction and speed in order to be you know, classed as progressive. And we were looking for around 32% of the sperm to be moving in that fashion, again, according to the reference ranges. And if the motility is low, you know, we can obviously talk about things we can do to improve that. And then also, we look at the morphology, which is the number of normal forms. So if there are any disruptions to the way that they sperm are formed, that may impact the chances of those sperm actually penetrating through the egg membrane. And it may, you know, hamper their chances of actually, you know, moving as well as they should. We're only looking for around 4% normal sperm in the sample, that is the guideline at the moment. So it is a relatively low number, which often surprises people, because there's over 90% abnormalities in any given sperm sample, which is quite shocking, actually. And the range of things we may be looking for, you know, it could be to do with the size or the shape of the head. Sometimes there may be vacuoles, which form which is sort of like air bubbles, which which could impair fertilisation, sometimes part of the app resume may be missing. So that's the enzyme in the head, which actually, you know, penetrates through the egg. So that may be missing or not complete. There's another there's a wide range of things, you know, if we do if we see a pattern, you know, for example, all of the sperm of pinheads or something like this, then, you know, we would make a comment on that that might be something which needs, you know, further investigation. But generally speaking, you know, there's, there's a wide range of, of abnormalities in the shape that we might see. So all of these things combined can can give us an idea of if lateralization is likely to be a challenge. And am I right in thinking that, like these parameters has changed, like quite a lot over the last sort of 50 years, like, you know, morphology, I mean, I in my clinic rarely see sort of, I mean, obviously, I am treating many people that are struggling to conceive, but you know, I rarely see above 4% morphology, I do have loads of couples who conceive naturally with a morphology at like 2%. Obviously, you have to look at the bigger clinical picture of what else is going on in the female partner and any other underlying factors. But like, people will automatically look at their sperm test result and maybe based on the comment or things that Google Online would read, oh, my morphologies like 2% That said, I'm never going to conceive naturally, like, these parameters have changed. And sperm is kind of, generally as a population, not as healthy as it used to be 50 years ago. But that doesn't mean that you can't conceive naturally, with polar parameters. Am I right? It's a tricky one to explain to people and I and I guess the thing is, is it gives us an indication, right, those reference ranges are pulled together by studies which have been carried out on men around the world and establish how long they've taken to fall pregnant. So I, you know, in an ideal world, we want everyone to fall pregnant within this normal timeframe, which is considered as 12 months. If everything falls into the normal ranges, it gives us an indication that it's likely that spontaneous conception will happen in that 12 months. Obviously, that's just the male side we have to take into consideration the female as well. But it's not a black and white bra. You know, we know people that are living sub, you know, they're not living healthy lives. They're smoking drinking, definitely don't have optimum sperm and pregnancy happens in the blink of an eye. On the other hand, we can see people come in, they've been trying for 18 months. You look at their sperm sample and it's amazing. Anything Yeah. How has it not happened? It's always a bit of a jigsaw puzzle. That's what I that's what I kind of saying. It's not just one plus one equals two, it's, it's multifactorial. And, yeah frustratingly so in some cases, yeah. I think that's like a really important point to get across like, because you probably, again, come across that regularly. And I certainly do in the clinic where people turn up with test results, or people are looking at their own test results and asking you questions where it's like, they want a black and white answer. And the really, really frustrating thing about fertility and loss is that there are lots of grey areas. And you know, what, on paper looks good for one person in the context of another person's picture might not be so good, or vice versa. And, you know, the bodies and amazing thing, right, like you said, like, I see couples who I think they're really going to be up against it based on like, the bigger clinical picture. And actually, you know, conception happens more quickly. And then you have the cases where, you know, on paper, everything looks like a lot easier, it should be a lot easier. And it, you know, it's not, and I think it would be great, wouldn't it if it was a bit more of a tick box sort of exercise, but when we're looking at test results, you know, you know, it's the same with sperm, that, you know, it's not always black and white. So I think that's, yeah, it's really important to talk about that. It is it is, and then in the same, in the same kind of conversation, it means as well, that because we always say we don't want people to rush into IVF, in these kinds of treatments, especially if it's in the early stages of trying, but somebody might see their results that have come back a little bit on the low side, and they think, well, that, you know, I'm going to have to go down that route eventually. And it's difficult to kind of explain to them, you know, it could just be taking a little bit longer, there are things you can try in between to improve things. And often, it takes a little bit of work and dedication as well. And it's, I think, for men as well, that often coming in for the first time seeing those, those test results, it can be quite black and white, you know, this is below the reference range, this is low, this is low, and just really disheartening. And quite often guys don't really expect it to be them. They don't expect to see an issue there. For whatever reason, but as you say, it's quite rare to see normal morphology who is Yeah, isn't it's not not common that people come in and, and have normal results, unfortunately. But these Yeah, these parameters have changed over the years, quite drastically over the last 30 years or so, what was considered normal, is much lower, and I guess, we have to pin it down to our modern lifestyle, you know, our way of living the way that foods have changed the way that our lifestyles have changed the tech around us. And it's not really possible to get out of that is it you know, we live in this world we're immersed in, but we have to try to find the things that we can do within our control to overcome those, those challenges. So what are like in your opinion, then what are the main factors that can affect male fertility? So, you know, I know we've we've talked before and certainly in our clinic, we was talking about, you know, hormonal factors, toxins, things like that, you know, what are what in your opinion, like with your experience, what are the things that are really affecting sperm that, you know, whether we can or can't control them to some degree, like what are the issues we're dealing with as a population? Yeah, so quite commonly, we see men with it may be a testicular issues that may or may not be something that they're aware of. So things like Verica cell, which is like varicose veins in the scrotum, sometimes something which might bother a gentleman that other times might be undetectable. In which case, they may need to be referred for an ultrasound in order to get that detected. That's something which can impact the sperm quality. Sometimes there may be things like mumps infection in the past or an underlying infection, you know, underlying STI or something like that, which could impair against them function t. Then we have lifestyle factors. So obviously, people who are smoking or drinking or using recreational drugs, people who aren't highly stressed at work, people who are involved in certain types of occupations or certain type of exercise or training, sometimes find that can be detrimental for spam quality. And what are the other usual things steroid abuse in the past? You know, people have used steroids in the gym quite common for guys. There's a whole host of things, how things can be difficult to pinpoint, and it can be difficult to get an accurate history from people actually, they can be a bit embarrassed to say, that shouldn't be at all. It shouldn't be at all. There's a real kind of lack of education, I think, sort of young men so Why would they know that that would affect their sperm later in life? But, like I always say to people, like the good thing about sperm is that it reproduces every 72 days, right? So men are constantly reproducing new sperm. So if someone's like, perhaps, you know, not led, you know, this saintly lifestyle in the past, which like you said, you know, when people are young, why why would you and you know, the education is not there. So, it's quite common for people to come in and say, Yeah, I used to smoke or used to take drugs or, you know, used to take steroids, steroids is a big one at the moment in the clinic. We're seeing that a lot. But you know, it's just as people are sort of, really into fitness, and have been, you know, for the last sort of 1015 years of fitness industry has taken a massive boom, right? So, you know, people are coming in the door with these things. But like, if sperm is reproduced every 72 days, how is it that those things still affect sperm? I guess it depends what the underlying what the underlying root causes. So if there is something which has severely impacted the, you know, hormones, obviously, we need to make sure that that is treated accordingly. Again, if there's an underlying infection or something, which is, you know, laying there and not being treated, then that will continue to cause problems. So, you know, we can talk about lifestyle and how that can make, you know, a positive influence over the course of those three months. But if there is something underlying which hasn't been treated, then it's important to get to that root, that root cause. If it is more, if it is more lifestyle based on for example, somebody has recently quit smoking, and that's something they've been doing for a long time, we can notice quite a significant improvement. Actually, when people do make those drastic lifestyle changes. Those that show up that was on a few months ago, which shows them celebrities. Yeah, so the one Yeah, and I just thought that was really good at illustrating how there were a couple of lifestyle factors there. So one was drinking excessive caffeine, like really excessive caffeine. One was eating loads of sugar, the other guy was smoking. And just by cutting those things out completely over the course of 1012 weeks, I think it was, there was such a dramatic improvement. So I'm really, really worth, you know, looking at all of these factors that can make a real significant difference. Yeah, definitely, I think, and certainly from a female perspective, and having, you know, struggled to conceive myself and had IVF. In the past, I think, you know, you, as a female, you kind of want your partner to do as much as possible. And it's really hard to get them like on board with, you know, okay, maybe we need to look at some lifestyle changes, because you never want to be that one that nags that one that kind of like tells them oh, you can't do this, you can't do that. So it's really good to hear from the experts that in seeing things like that on TV that, yes, these things do make a difference, if you can just stick to them for you know, it's not really a long time in the grand scheme of things. If you can just commit to something, you can see the difference, you know, on paper, after the test, really worth doing. It's a small amount, isn't it a small amount of your of your life in the grand scheme of things? I mean, I even get people say, Oh, do I really need to quit smoking. You get some people who obviously they're very dedicated to it, but some people who just really don't want to knock the habits and I just kind of, you know, tried to explain to them, it's, it's a short amount of time, you know, the reward in the long run will obviously be so worth it. But it's difficult, isn't it, as you say, if we don't have that education, it's not something that men are kind of thinking about their whole lives. It's, they only have to think about it, once they get to it, and then it's all of a sudden, you've got to stop there. So you've got to stop that. And it can be a bit of a process mentally to kind of learn that and take that on board. It feels like a bit of a raw deal, doesn't it? I guess when you're told all of a sudden, you can't do any of these things that you're enjoying in your life. It feels like something's been taken away. So if someone had, like, you just wanted to touch on something you talked about earlier, if someone had mumps when they were younger, because again, I think that's something that comes through the clinic quite a lot. Like how would that affect sperm? Right? Is that to do with antibodies? So that's something different. The so if you have mumps when you're a child, it's different if you have mumps when you're then later in life, so mumps can spread quite easily. I think at university I think once people start living with each other, it can can spread quite easily, and it can actually affect the size of the testicles. So that is a direct cause of low sperm count. Actually, the testicular size is directly related to, you know, sperm concentration, which another thing that maybe people don't know. But also, if there is infection or trauma in the testicular area is something which can lead to antibodies being produced. So we do it a test, which is not always covered by clinics or the NHS and it looks at that immune immunological infertility. So if there are a high level of antibodies that can actually attack your in sperm, and we see that picked up in one of the assays that we do everything, everything could look fine on the surface. But if you've got antibodies, which are actually attacking your own sperm, that can be a reason why they spend may not be able to transit through the mucus in the cervix, and then, you know, achieve the fertilisation successfully. So it's definitely a test worthwhile doing and like, like he said, like, antibodies aren't always tested on the NHS, or they if you have had a basic NHS sperm analysis done, and you can't see antibodies on there, and you're still struggling to conceive, you know, and you've ticked lots of other things off the list, and it is worth coming for a private. Second. I always say to people, it's worth having a second sample done anyway, just as any second opinion. Yeah. No, that is something you test a standard. Is it as part of your basic sample? We do a standard? Yeah. Because I don't think it's worth as you say, you know, giving somebody an answer as to what might be going on. But you're missing parts, that that part of it, it's not a super common thing to be picked up. But everything can look completely fine. On the surface, you know, you do the initial assessment, and everything looks fine. And then you come to do the the mock test, it's called. And you see plenty of finding, and there's your answer. Yeah, so worth checking. So what sorts of things would you do then to help sperm? So we've talked a lot about the problems that might occur and the things that might come up on a sample report. But what can be like what are the practical things people can do? Like? What is your advice to someone that maybe has is looking at their sample report at home and going, you know, what, these parameters are not ideal? What can you do? What would you what advice would you give them a whole host of things. So again, you know, we would look back and see, you know, are there any of those underlying issues that patient might be aware of, if so, particularly if the sperm concentration is low, for example, we may suggest going and having some additional tests run, perhaps a physical examination, or some some blood work. If that doesn't really seem to be the issue, maybe it's more motility, and morphology, and we're looking for improvements we can make them, we would definitely think about lifestyle, and maybe some holistic treatments as well, that can help. So nutrition is obviously a massive, massive thing. Quite often people think that they're eating well, which is fine, but there's always improvements, which can be made. And obviously, there's a whole host of really amazing, you know, practitioners dietitians out there. And, really, I suppose, trying to guide people on if they are following more of a restrictive diet, making sure that they're getting all of the nutrients in, they should be if they're following sort of a vegan or vegetarian diet, or to speak to quite a lot of people that do intermittent fasting and things like that. So it's just making sure that they're, you know, eating in the correct way to support this firm health. Obviously, just guiding people on the correct amounts of alcohol, if any, you know, keeping it to a very, you know, very minimum, we usually advise sort of Max five to six units a week. So a couple of drinks at the weekend is not going to tip you over the edge, but just don't overdo it. Caffeine and excess sugar, and anything which may raise inflammation in the body is something that we want to avoid. So we talk about oxidative stress and how that can impact the sperm. So just avoiding any of these areas, finding ways to reduce stress, and you know, looking at sleep patterns and things like that as well, can be really beneficial. So we do sort of 20 minute consultations, it's quite a lot to go over. So we can kind of give a basic understanding to people, but direct them in the in the right way. If we think that they need some additional support, using obviously a good quality supplement as well. So there's obviously some really good brands on the market, we'd suggest trying those, maybe some of the others. And then if people do want to look at treating themselves in a more holistic way, you know, we talked about things like reflexology, and acupuncture, which can be really beneficial for people. I think it's all about trying to find ways to, you know, give yourself that chance, you know, over the course of three to six months, you can give your give yourself a you know, a real improvement, hopefully. And if you do need to then fall back on IVF or something like this, then that's always there as a backup option. And what I always say to people is those efforts that you've made is not going to go to waste. You know, if you do go through IVF you know, you're putting yourself in a position where you've got a better chance, a better outcome. My advice is, if people are thinking about IVF you know, it's always to give yourself three months to do things like this, you know, if you're thinking about IVF go and have a sperm sample We'll have a second one, get a second opinion, and then start looking at the small tweaks you can make, because often it's not massive changes, it's just a couple of small changes, like you said, like maybe some changes to your diet, improving your sleep, you know, maybe trying alternative therapy, like, there's all these different things you can do. And like you said, it's not wasted, because then, you know, when you go into that IVF sample cycle, and you produce a sample and the embryologist is, you know, looking at, you know, the fertilisation rate, you're probably going to see, you know, an improvement and hopefully get some better quality embryos at the end of it. What are your thoughts on that? Because I get asked this a lot in the clinic, especially like the last couple of years on like, protein powders, like gyms type supplements, you know, obviously, we know steroids are not great, but these sort of like supplements a lot of people take, like, obviously, pre workout is full of caffeine, like but things like protein powders, what are your, what are your thoughts on those? Um, I, obviously, there's so many on the market. So I do ask people about them if they are, I know that they're in the gym. And to be careful of, you know, just looking looking at the ingredients and making sure that there aren't any ingredients in there that are mimicking steroids or anything like that. There's some that are really, obviously high in sugar, the flight, you know, the flavoured ones. It's not something that I, I've tried that before, it's not really something that I like, I don't think they make you feel good after you've dated them. Because they're always quite heavy, aren't they? And they're whey proteins aren't they say, you know, derivative of a milk, you know, products. So, not something that I personally would rave about. But if you are going to use one, I suggest, you know, looking for the cleanest option possible and always looking at the ingredients. But yeah, there's so many of them on the market. Yeah. know which ones to kind of advise or Yeah, or not advise. Yeah. They are really popular. And again, like pre workout, you know, people will come in and say, Oh, my husband is super fit and healthy. He's always in the gym. The first question I ask is, Does he take a pre workout? You know, it's full of caffeine? Like what is the what is he taking to not necessarily enhance his performance in terms of steroids, but you know, what is he taking? About because most people who gym will take something, whether it's a pre workout or protein powder, you know, there's something going in there, or creatine? What, what supplements, like in terms of like the man's version of a prenatal, what supplements would you like, say that are all like nutrients, would you say a really key for sperm, and what to be careful of, if any. So that there's some sort of more basic ones. So zinc and selenium would be two of the main ones. And also your vitamin E, vitamin C coenzyme. Q 10, is a really powerful antioxidant, which we usually suggest taking, quite often you can find those combined. In you know, it easy to take once or twice a day supplement, which is great. So you don't need to be taking everything individually. Folic acid is usually spoken about for women or, you know, folate, which is the better the better form of folic acid to take. And, you know, beneficial for men as well to be taking. So that's another one. Quite often people aren't getting enough Omega three through their diet. So a good quality fish oil, we'd usually suggest taking as well as there's one brand in particular, which we like to suggest for that. Anything to avoid, I mean, some people, I think nowadays, there's some more kind of herbal remedies, which are becoming more popular. Not too sure on the science behind them. But it's obviously nice to try. If you've read something up and you think it might help you. things to avoid. Not too sure. I think what would you say to people actually was firm like you have to be a little bit careful because it is so sensitive. Like there's a reason sperm are in the testicles like that outside the body. It's almost like they, they they're very reactive to their environment, and actually being careful not to over supplement. And I think what you said is here that you can often buy a supplement that has all these things in the right quantity, and then not sort of taking loads of one thing for example, I think selenium in like in very high doses can be toxic for sperm. So if you're taking like a combined tablet, and then you think oh, I I'm going to take something else. Just make sure it's not already in that combined supplement. Yeah, yeah. I mean, there's a couple of really good ones on the market that have everything in right and actually with men I find it's harder to get them to take loads of supplements anyway, like they prefer just to take one And even that sometimes can be. Yeah. So yeah, I think not taking too much. But yeah, I think in terms of advice, like, yeah, not having too many hot baths, you know, the testicles are meant to be cooler. And then I always, you touched on it earlier. One thing I always ask people is like, hobbies and jobs. So I've been caught out over the years where I've seen test results, and I can't understand why the sperm parameters are so poor, because it looks like they're leading a really healthy lifestyle. And then, you know, and other things have been eliminated. And then I find out that they are like, doing, like, hobbies in their spare time, that means they're coming into contact with lots of oils. So like tinkering with mechanics, where there's lots of high toxins and things like that. I once worked with someone who was a commercial gardener, who had like, really poor sperm, and I like the only thing I could put it down to, was the contact with like, these pesticides on a daily basis, like he was doing proper commercial, big jobs. You know, and I think it is important to just scratch a little bit deeper into someone's history. Now, if you're renovating a house, you know, are you coming into contact with lots of paint stripper paint? All those things that can be toxic to the body? You know? Yeah, can can you limit that as much as possible in your daily lifestyle? Again, it's only short term I like, it doesn't have to be forever, but just looking at what you're doing. It's difficult when it's somebody's occupation, and I've got a couple people that come to mind. So we had, we had a real mystery one where there was a guy who was having really kind of inconclusive semen analysis. And it was because he was we found out he was a deep sea diver. So the wow factor was affecting Yeah, his sperm completely would just deplete if he'd been out, deep sea diving. And then if he'd been back on the land for a few months, his bank account would come back. And there was all this confusion about it until we kind of realised that was the that was the problem. And had another guy clinic. Yeah, had another really, really lovely guy. He came into office about five or six times. And his his partner was a nutritionist, and he was taking all the right supplements and things I think he was using z two s actually at one point, but his span just wasn't improving and that he was an airline pilot. And I kind of thought that he's sad, you know, all day. Yeah. Dr. Radiation in aeroplane radiation? Yeah, exactly. poor air quality, probably not eating very well, and sleeping very well, because of his shift pattern. And I used to be cutting jobs. Yeah, I was I was cutting crew for ba for 12 years. And yeah, like, the radiation. And yeah, like pilots will sit for like 10 hours, they might have a break for an hour or two. But again, they're probably lying down. You know? Yeah, it's warm there in the area of the aircraft that is most exposed to the sunlight. You know, it does get hot in there. And yeah, like, there's different time zones and time zones? Yeah, there's, you'd be amazed the amount of couples that struggled to conceive who fly but it's I don't think it's necessarily just flying. It is like anything where there's a big shift pattern. So anyone doing lots of night shifts, you know, the circadian rhythm becomes massively messed up. And obviously, that has a lot to do with hormone production in men and women. But I think with flying, there was definitely this element of like toxicity like that, that radiation level, they actually give you now, at the moment, I haven't flown for, like, what, eight years, but when I was there used to be able to log on to like, your portal with your staff number, and you could have a look at what your based on your roster for the last 12 months, what your expected level of exposure to radiation was, like, so they made that information available to you. So obviously, you know, they're doing that because they have some obligation to give that information to you. So it must affect you in some way shape or form. i But then, you know, the number of health problems I developed Hashimotos, which is autoimmune thyroid disease, for those of you to see what that what that is, and yeah, like there's loads of people flying that have thyroid issues, it's that constant dysregulation of the, of the circadian rhythm. It's just not healthy. You know, the food on board is really high in salt and fat. Yeah, like, you're constantly knackered, like, yeah, it's just it's so not good for your health. But like you said, when it's someone's job, what do you you know, it's really hard, you're up against it, right? Certainly with a job like a pilot, you've trained for years and years to do that. You're not just thinking to quit to improve his bone quality, right? So it's about looking at everything else you can do. Exactly. What happens with him? Did you did you manage to see some improvements in the end? Do you know what it was such a shame and I remember him because he was so sweet. And he, yeah, we didn't even really see much of an improvement to be honest. And every time he'd come in, I would hope that okay, he's, you know, been speaking to us. And they're doing, you know, the nutrients and the probiotics and everything. But yeah, it just didn't really improve. I mean, maybe he I don't think he's been in for maybe about a year now. So I'm not sure. Maybe I have to reach out to him and see if they've had any luck. But yeah, fingers crossed, maybe they did. Maybe not be in touch. Yeah, so much to think about isn't there so much to think about, but it's hard when it's something that you can't control, I think that just makes it makes it harder. So talking about people you've had in the clinic then and like to talk us a little bit through about, like, what happens when someone comes to see you because, like, I know, we've spoken about this before, like, it's quite a daunting thing for a man to go and produce a sample. And sometimes, you know, no disrespect to men, but like, sometimes, like, it needs a lot of coaxing from the female partner and like a lot of encouragement, or they tend to put it off, like, how do you make that an environment and what happens like just to maybe put people's minds at ease about, you know, the environment they're coming into? Yeah, so it's something we've really tried to focus on, as I say, because of having that experience of seeing, you know, that was a problem for men in those other settings that I've worked in. So where we're based, is quite good, because it's kind of nice and discreet, you go down the stairway, you don't need to kind of ask anyone where to go, you can just let yourself down. And then you'll be greeted by the oncologist who's on shift, and what we've created as two separate waiting areas with two separate production rooms. So that if you do want to bring you know, your wife or girlfriend along with you, then they can come and sit in the waiting area. And that's all completely discrete from anyone else that might be attending. And the way that we've organised our appointments as well, we don't really have two people in the clinic at the same time, to be honest, unless there's a slight overlap, that there would never be kind of bumping into people in the corridor or anything like that. Any awkward waiting rooms or anything like that we've, we've we've eliminated that. And then we've just ensured that, you know, everything is nicely as I say, Titans nicely spread out. You know, we don't have kind of bright in invasive lights, you know, it's obviously a clinical environment. But we've also tried to make sure that it's quite nice and relaxed and timely and warm as well. And hopefully, just as a space where, aside from home, it would be the next best thing to come and provide a sample that yeah, it does take people a lot of courage to come in, as I was saying earlier, it's men will put it off to the very last minute. So our bookings will kind of come in, you know, the day before or because or two days before. And we've got a lot of wives and girlfriends as well, who kind of call us and say this isn't my thing. I don't even have sperm, why am I having to make this appointment? But, you know, it's, yeah, it's a really common problem, I guess, men in general, when it comes to healthcare, a little bit avoiding, you know, even going to the GP to get anything sorted out, they can be a little bit in denial about, you know, what's going on. And, yeah, I guess it's that fear of seeing a result that might not be optimum, you know, having a baby is such a there's so much pressure isn't, isn't there. And I guess, as we were saying earlier about education, we're kind of taught that, you know, you have sex you fall pregnant, it's gonna be the end of the world when you're 16. And then you get to that later in life, and it's completely turns on its head. And once you get it into your mind, I know I've been in that position where you get it into your mind that Okay, we're ready to start trying in from that instant, you're just obsessed with the idea. You're just and I don't know about you, but it just becomes like, the only thing you can think about and for it to not happen after a month to six months. 12 months. Yeah, that pressure internally and what that can actually cause within your relationship as well. It's not an easy thing to deal with, to then have to kind of face going for the appointment. I get it, I get it. But yeah, it's, I guess, women have to go through a lot of tests and things which can be quite invasive as well. So you kind of feel like that the least they could do is like produce a sample when you've been prodded and poked a lot. So I think things are getting better though in terms of like the awareness so I've kind of feel like whereas before, the woman might have had to go through like a year or so worth of tests for anyone to perhaps even look at the man like now like certainly for recurrent loss as well with all the evidence base kind of around links with sperm health and recurrent loss. Like we're now starting to look at the man a lot earlier. You know, and, like the fact that you've set up a private service and it's busy. It just is like testament to that right like we know that like people are doing the investigations. People are much more aware. People are listening to podcasts googling about male fertility much more. So I think And, you know, very, very slowly things are are getting there. But there is still that, like you said that avoidant kind of like, I will go if I have to, or do I really have to, you know, and it's different. Because, you know, obviously, we're in central London, so we've got a whole range of, you know, cultures and faiths as well for people coming in. So that's another thing which can impact people, you notice in certain cultures, you know, there's still a really, really big stigma of, you know, around infertility, there's real pressure on them on the man to, you know, make their wives. And, yeah, that's, again, again, that's something which is really deep rooted and is going to take a long time to overcome. But, you know, obviously, as the generations are changing, you know, people have, you know, just I guess, becoming more liberal in their thinking, and that's changing, because time is going on, but also conversations between men and their friends. You know, there's been lots of campaigns recently about men opening up for their mental health and things. So I think that's all really helpful in just helping them to kind of chat and, yeah, and TV, as well. ones. Yeah, a couple of really good, you know, celebrities, Dave Osbourne, there's been a couple of others that, you know, Jonathan Ramsey's done recently, and I think, yeah, like, just programmes like that, on mainstream TV, you know, are critical to sort of changing our perception of how we deal with fertility. Yeah, from Yeah, not just a man's perspective, but from a couples perspective. But yeah, you know, obviously, male male involvement is 50% of that, right? Like, I think, again, it's like this, this mentality that, like, fertility problems are 80%, female 20, you know, the man doesn't really matter. It's like a small it's not, it's 5050. Like, we know, yeah, you know, 50% of that embryo is sperm, like, so it is really important to Ghana. So it's not something which just affects a small amount of, of this society, most people will want to have a child at some point, not everyone, but you know, it's a problem, which will, you know, most people will encounter at some point in their life. So, there should be more resources and more conversation about it. Absolutely. Yeah. I hope, like, you talked about education as well, you know, I hope the education changes to away from this, like, Oh, don't look at a boy, when you're 16. Or you'll get pregnant to you know, getting pregnant is sometimes not as easy as you think it might be. And actually just having those conversations at a younger age with both girls and boys about you know, look, you know, you really need to look after your health, because that will affect your fertility might not be as easy as you think. So yeah, it's been wonderful speaking to you. Thank you so much for coming on. Thank you so much for having me. Oh, no, it's been great. How can people like get in touch with you if they want to come? You know, I know, you talked about being in central London, like, tell us a little bit more about the clinic and how people work and what the process is. Yep. No worries. So that's another thing which we've tried to streamline and make it nice and easy for people. So you know, you don't need to make an inquiry or call up, you know, to register with us or anything like that, you can simply go online, and book an appointment at a time, which is most convenient for you. You don't need a GP referral. So if you are struggling, or if it's something you're just curious about, you can hop on there, and you can book an appointment, whenever you want to, we do have the private room option, and also the drop off option, most people go for the private room option. And that's what we tend to encourage as well. And then there's a couple of options you can go for as well, if you want to get a same day result, then you can, we also do spam photographs, which are quite interesting. We've got sort of a camera which we attach to the microscope, and just gives people a bit of a visual aid to help them understand the results. But yeah, other than that, the results turnaround time is three working days, we send everything by email, and we've got a couple of really good additional resources that we've put together, just to help break down the results. And, you know, communicate that in layman's terms to people. And then we have the option to book a consultation afterwards, with either myself or one of my colleagues, which will, you know, go through the results in more detail. And if we need to guide you and putting you in a direction for for further testing or for further assistance, then we you know, obviously got connections and places that we can send you to, to help with that. So it's all really discreet, it's all really easy. You know, if you've got any questions at all, you can always pop us an email. Our website is www dot the male fertility clinic.co.uk. So you can just pop on there and hopefully find all the information that you need. Awesome. I'll link that in the podcast episode information as well. So people who are listening can can go straight to your website and have a look. So yeah, thank you so much for joining us. It's been brilliant. We'll speak to you soon. Thank you, Rachel. Take care