The Hidden Sperm Damage you need to know about with Claire Mooney.

In this episode we are joined by the wonderful Claire Mooney, andrologist, embryologist and founder of Fertility Solutions, a specialist male fertility clinic in Beaconsfield, Herts.

Claire brings her wealth of knowledge to the table to discuss:

What is sperm DNA fragmentation and how it can affect a man's fertility
The importance of optimising sperm and how you may be able to avoid IVF with better sperm health
Bacterial infections and how they harm sperm
Treating couples to improve fertile parameters before signposting them straight to IVF and the ideal scenarios for IVF preparation if necessary

Claire offers short fertility consultations to discuss male fertility test results and offer support and guidance here. You can undergo a wealth of male fertility tests at Fertility Solutions including consultations with renowned Fertility Urologist Jonathan Ramsey. 

Transcript

Unknown: 0:00

Hi, I'm Rachel Sherriff and welcome to the fertility suite podcast. Our aim is to educate and empower couples who are struggling with all aspects of fertility by giving you the information to make informed decisions along the way. We've had a little rebrand since series, one with formerly the fertility method podcast. But in this second series, rest assured we still have the same high standard of fertility experts coming to share their knowledge and support you. So if you are struggling with fertility, miscarriage or you just want to arm yourself with the facts, and this podcast is for you. Hi, everybody, and welcome back to another episode of the fertility suites podcast and joining us this week, we have the fantastic Claire Mooney and Claire is an embryologist and anthropologist. And she's also the founder of fertility solutions, which is a specialist, male fertility clinic based in Bekins field in Hartfordshire. So welcome, Claire, thanks for joining us. What a wonderful introduction. Rachel, thank you so much for that. Yes, it's an absolute pleasure to come on and speak to you and to all of your listeners. And, yes, I founded fertility solutions about 11 years ago. Now, I can't quite believe that sometimes. But I did. But I've actually been an embryologist and geologist for 30 years now, if you include my sort of my master's degree, another scary thought. But yes, so we specialise very much in fertility solutions in male fertility. And really, that's an area of medicine across the board that that has is very sort of poorly resourced, but very, very fundamental to people's well to patient's chances of conception, it takes an egg and a sperm to make a baby. And the sperm is incredibly fundamental in that process may be more fundamental than has ever been previously realised. I think so. That's our mission at fertility solutions, it really is to help the man ideally from the start, and to improve his sperm as much as possible. And to identify where there are problems for the man in his fertility that there are impacting on the couple. Not just from a sort of natural conception point of view, but also from an IVF success point of view. And sperm can be also a causative a causative factor for early miscarriage as well. So all in all, a very important area. And it's been art, it's been my passion for yes, the best, best, best part of my life. Now, now that I'm 50 I suppose most of my life, and your passion online through clay, your passion shines through screen? Well, it's one of those things that I think really, I mean, I started off, you know, many years ago, same sort of thing, not knowing what I wanted to do in life and did my degree. And then I went to Liverpool University and didn't fancy the dung beetle project option that I was offered in zoology. So very luckily, I found the Liverpool Women's Hospital Clinic which was run by an amazing man called you and Lewis Jones, a fan fabulous and geologist, he was like a beacon of just brilliant and he very kindly offered me a project on the motility of sperm. And then in return for that I was just supposed to just work out how to work this new sperm analysing machine, they had all the hops and sperm tracker. So kind of sperm found me rather than me finding sperm, but I've always found it fascinating. And the thing that I love the most about men's fertility is that unlike female, it's far more changeable than I mean eggs, other kind of eggs, the eggs, obviously, women need to make sure that they're healthy, good BMI. But ultimately, they're born with all of their eggs where a sperm is constantly made. So it's exciting to me to be able to be involved in something that I see massive change in from when the patient's first come to see me to when they leave. And for me, I loved I love being part of something that I can do something about. So So yes, I I obviously went into after did my degree and my master's degree which was also on sperm I project so it found me again, I kind of went into the embryology world for a long time. Loved it. I think that you know, I worked for some of the best IVF clinics in the UK and, and really met a lot of very dedicated very, you know, hardworking and passionate people, but I just couldn't get the sperm thing out of my head. And overall, men don't have the same journey from when they go to see their GP as women do. So women go to see their GP, and they have scans and blood tests and lifestyle questionnaires and and then they refer to a fertility clinic but men really just do one test. which is a semen analysis. So most people that come and see us have had this one first line basic test done. But what am I most people don't realise. And, you know, I don't think I would ever realise this, if I wasn't doing this is that up to 15% of men can have a normal semen analysis and being fertile. And that's something that never kind of left me as a statistic. And so a couple years ago now, 11 years ago, now I kind of, you know, left the IVF industry, as it were, and set up this clinic to predominantly focused on men's fertility. And I'm very lucky to work with a gentleman called Jonathan Ramsey, who's a very high profile neurologist in the UK, incredibly dedicated man with with the kind of experience that is unrivalled. And also worked with an amazing neurologist called Jazz Kelsey as well. So, yes, so we basically focus on we get a lot of patients that just come for a first line check. And then we do all of their semen analysis and discuss all of the results with them. A lot of the time, actually, Rachel, I spend most of my time a lot of my time reassuring people that actually, if you've got a bit of a funny shaped sperm, it's probably okay, if you haven't been trying to conceive for a long time. So I spend a lot of my time actually reassuring couples about their sperm results. Because overall, we're very reproductively inefficient species, it can take us up to a good year to get pregnant. So really, it's about sort of understanding from the sperm results initially, is there really a problem? And there are a few parameters that immediately are alarm bells for me, and that is usually white blood cells in the sample. A low ejaculate volume. And motility actually, obviously, sperm count, if it's very low is a worry. But overall, I would say that those are some of those for me some of the most sort of concerning factors. And then you obviously, take the results and listen to the couple listen to their history. And if they haven't been trying to conceive for a year, and everything's not looking, you know, looking moderate on the semen analysis font, try and help them to achieve a pregnancy naturally first. And then if not, kind of move on steadily as you would with a woman move on to other tests to start to investigate things in more detail. But ideally, do it from the beginning. Sorry. There's so many things, excuse me, you've brought up in that introduction that I just Yeah, I want to jump on. Like there's so many extra marks and so many things that are issues that need addressing, yes, the while you're doing exactly what you do. So today, I really want to talk about sperm DNA fragmentation and more depth issues with sperm, because like you've just said, you know, lots of men will have a basic semen analysis, and there's not particularly a lot wrong with it. But if you've been struggling to conceive, like a lot of our listeners, and perhaps they've had a semen analysis and being told everything's normal, and someone's mentioned the word, you need to look more in depth, or you need to look at sperm DNA fragmentation. So what is DNA fragmentation? And like, how might you know if you have it? And what are the potential impacts on fertility? Well, semen analysis looks at the sperm, we do a number of different tests to see whether there are maybe infections or obstructions. We do a number of different tests to make sure that there's no inflammatory antibodies. But ultimately, we are looking at sperm, we are observing it. And whilst you can do a very good morphological assessment of a sperm, if you stain the sperm and you do it to accredited standards, you can't look in it. The most important are very, very good professor actually told me once that sperm is DNA with a tail. And it really is it's, it's a package of a payload. Essentially, it's a, it's a DNA bus, if you like that's what it is, it gets the sperm from A to B from vagina to fallopian tube. But inside the sperm is the most important component, which is the DNA, the genetic material. Now, for years, obviously, we didn't have any ability to look inside the sperm. But now in the last 10 years, we do maybe sort of longer than 10, slightly longer than 10 years. So what DNA fragmentation testing looks at is it looks at the structure of the sperm structure of the DNA with inside the sperm head. So DNA is made of proteins held together by bonds twisted together in a double helix. And the DNA fragmentation test looks for breakages in those bonds. So essentially, it looks for damage within the DNA. And what we know is that damaging DNA is associated for a lot of men with unexplained infertility, infertility, a failure of IVF treatment, when there should really have been a pregnancy and early miscarriage as well. So it's very important to look at the fragmentation inside the sperm. To give you a better sense, I suppose, of whether you are suffering from an element of male infertility. The sperm also creating, is this what you were talking about when you said about 15% of men will have a normal new analysis. Yeah, exactly. So it's perfectly possible that you would have a normal semen analysis, but then a men would go on to have further issues with sperm that we can't see with the naked eye. Absolutely. And I would say that a lot of semen analysis, in my experience is interpreted sometimes incorrectly. Especially for things like I mentioned before the ejaculate volume, the the motility, and white blood cell presence. So having a DNA fragmentation test can be a very effective way of and I suppose uncovering an element of infertility within the man that exists, that hasn't been uncovered by a standard semen analysis, and certainly a GP. I mean, I'm very proud of our National Health Service overall. And the fact that we have health care for, you know, for a majority majority of people, but the GPs are not specialist in men's fertility interpretation of results. I would be a terrible general practitioner. So why would we expect general practitioners to be amazing sort of anthropologist neurologists. So I would really like to see a situation whereby men's fertility results are interpreted by a urologist, and an anthropologist, so that those results can be clearly given to the man, because not everybody needs a fragmentation test, Rachel, and it's expensive. There's not a lot we can do about that. And so sometimes, it's better to just just peel it back and say, do you actually need the test. So the ideal thing is to bring your semen analysis results to you, or to me to understand whether that's actually a requirement. But I think that you that elements of your fertility journey that may indicate that you have high fragmentation in sperm, probably include unexplained infertility for years, you've been told, we don't know what it is, your ovaries are looking at. So the woman's ovaries are looking lovely, and she's got a good ovarian reserve and her tubes are clear, and her uterus is fine. And the semen analysis looks fine. But then when you look at the finer detail of the genetic material of the sperm, you can see that there is damage there. So for those couples, that might be the case, also, if you've been through an IVF cycle that was going really well at point, so you were getting lots of eggs, good fertilisation, or maybe even poor fertilisation. And then the embryos were just not developing in the way that you would want them to. So maybe they were doing well for the first few days. And then you got a call from the lab to say, unfortunately, they're slowing down between day three and day five in the lab, it might be it could be a sperm issue, it could be that there could be a genetic anomaly within the sperm or or sperm quality issue that is causing the embryos to slow down. Because embryo development, up until the four to eight cell stage is very much determined by the female genes by the maternal genome. But after that, the male genome comes into play. So between the four to eight cell stage the embryonic genome activates, that will start a study done by a lovely lady called Kate Hardy from Hammersmith hospital. And then the embryo will see continues developing for another two days to the blastocyst stage until it's transferred in an IVF setting. Now, for a lot of those embryos, when they don't develop that could be a sperm issue. And it would be a good idea to have a fragmentation test at that point as well. And then, of course, there's the biochemical and early pregnancy losses, which before 12 weeks, a majority of miscarriage is caused by an abnormality within the embryo within the developing foetus and the sperm is obviously half of those genes. So if you're if your listeners are suffering from recurrent miscarriages of unexplained origin, then it's a good idea to have a fragmentation test. Because this is all about really eliminating factors here and just saying, well, it's not likely to be that it's not likely to be that and then it provides other healthcare users with information like yourself, recurrent miscarriage specialists, IVF clinicians to say, well, it's not looking like a male factor. So let's have a look at other factors as to why these these couple of suffering. Yeah, absolutely. It's so important with, you know, any medicine not just fertility, but to look at the patient or the couple in our cases and in your case and look at the bigger picture because yeah, what we're not saying is, in every case of IVF, or early miscarriage, that it's definitely a male factor issue. But if that's a recurring problem, or the time to pregnancy is much longer or things are unexplained in inverted commas. You know, it's Definitely worth considering looking more in depth at the sperm dependent on what the rest of the picture looks like. So, yeah, that's a key point here, right? I think there was a study that came out recently, correct me if I'm wrong, but it was to do with looking into the numbers of aneuploid. So abnormal embryos when egta tested, and there was a direct correlation between high DNA frag levels and increased numbers of aneuploidy embryos. So, you know, if you're going to spend the money on things like PGT, a testing and a cycle, you're probably worth, you know, doing a DNA frog first, right and seeing what you can change. I mean, I personally think that DNA fragmentation testing, it feels expensive at the very beginning of your journey. 400 pounds feels like a lot of money. Of course it is. But in terms of the actual expense of a cycle of IVF, if you're funding that privately, you're looking at maybe anything between five and 10,000 pounds. And also, if you're, if you're on the NHS, and they have said that they will fund one cycle of IVF, for you, it can be incredibly important to give yourself every chance of that cycle working. And so at that point, having a fragmentation test would also be very beneficial as well, to be able to say, look, let's just make sure that I'm healthy, you're healthy, the sperms healthy, and that we've done everything that we can to make sure that this has a good chance of actually working because the NHS are only able to fund one cycle of IVF. So I think overall, it's very, I mean, in an ideal world, Rachel, if I'm honest, I'd like the NHS to do this, to say to the man that comes into the clinic to say, my, my partner and I are struggling to have a baby, for the NHS to send him off for three tests. And we'll obviously get on to microbes in a moment. To just say, right, let's just make sure that this is likely to be a male factor. And although these three tests I mean, I'm not saying that all these tests exclude everything. I think that's another thing that's I really should make clear, I think, because a lot of people come to me and say, right, this is all normal, these three tests are all normal. So I must be good, right? And I always think, well, actually, because of the lack of complete data on all of this, it's actually really important to consider all of this in your own context as to what's normal for you. Because for some of my patients after Mr. Ramsay, Mr. Kelsey, and I review the results, we actually feel that actually, maybe a slightly high fragmentation for you is okay. Whereas for somebody else that's been on a completely different journey, it's not the issue. The issue here is that it's not one size fits all for fertility. I think the most, the most sort of successful fertility clinics are there like yours, you know, people that, you know, don't just say that, listen, and take everything as a first line and not apply just general strategies. So it's really important to bespoke everything that you're saying and doing. And natural fertility, like natural conception is always the aim of the game, right. And obviously, some people will have to have IVF. But if you're going to consider running a sperm DNA frag, before you have IVF, you may end up conceiving naturally if you can identify an issue. So it's always worth doing right. And yes, like you pointed out, you can have this test on privately before you undergo NHS IVF, as well. So there's definitely lots of benefits to doing it before an IVF cycle. Right? I would actually say that not only are you like, I mean, you've touched on an amazing topic there. Rachel, of course, that is the when you actually address men's fertility. So what do you do after you've had your fragmentation test, and it's abnormal, because of course, there's no point doing something unless you can do something. And that's the point, you can do something. So with the fragmentation levels are abnormal, it's like what I said at the beginning, sperm is constantly made. So unlike women, where you can't really change your egg quality completely, if you're if you're living a healthy lifestyle, normal BMI, you can change your sperm, but you can't, but you shouldn't think that you can change it on your own. So the neurologist then comes into this, because the neurologist is central and key to this because they are highly trained, highly skilled, and very good investigate, they're very best, much best place now, to investigate what's wrong when you have high fragmentation to say, well, what's the problem? Is it okay? Is it your lifestyle, because sometimes it is, but a lot of the time it isn't. Up to 40% of men that struggle with their fertility have structural abnormalities in their testicles such as Baraka seals and epidermal cysts that are not to do with their lifestyle. So it's really important for us because I I see a lot of patients that come to me and say, Well, I'm eating really well. I'm not drinking, I'm not smoking. I'm taking plenty of vitamins and I'm leading a really healthy lifestyle. And I say to them, well, that's great. And that perfectly illustrates the My point of a lot of people can have a very, very good life. So we see a lot of athletes actually, we see a lot of athletes, because sperm can be affected, not just by lifestyle, but by structural abnormalities and testicles. We saw a very prominent Olympic rower who I think I can't remember his name, but he went on record, as talking about it had a big Verica sale. And as he said to me at the time, I'm one of the fittest men alive, Claire, which he of course he was, and he still had a big varicose seal that was causing a low sperm count and high fragmentation levels. He had his Barraca seal embolized and they conceive naturally, this is always trying to educate clients about because I think when you feel like when you're having fertility problems, that first of all, you want to have loads of control and do as much as you can. But secondly, you often feel like it's partly your fault, like I'm not doing it. And that education around, sometimes you can be doing all of the right things on paper, you can be super fit and healthy. But if like you said there's something structural or physical, and we're gonna come on to talk more about other things, but you know, it needs treating from a Western medical perspective it needs treating often, yes. I couldn't agree with you more. I think that for so many men, they produce a semen sample in in a, you know, a little room. And then they are told some devastating news of you're not fertile, or your sperm numbers are very low. And it can send men into a real spiral of cause of depression, of anxiety. And it can be extremely stressful then for the man to go back and to review things. And yet, Rachel, for so many of these men, it's nothing to do with what they did or how they've living their life. It's more to do with a structural abnormality. I always always equate it actually to hearts. I don't know why but I do. If your heart was beating really fast, and you had tacky cardio, you'd go and see a cardiologist, who would then diagnose the problem and medicate you. The urology is the same. If something is wrong with your testicles, they are testicles, they are organs. And I appreciate that they are very associated with your images of man, and how you feel about yourself as a man. But ultimately, you don't have control over two organs in your body. You can't it's an autonomic function. You can't speed up your sperm production or slow it down, and you don't have control over it. So it's very important to be able to say that there's a problem. Now you go and see a urologist and now we treat it now we improve the sperm. Now your chances of conception improve naturally. And your chances of fertility treatment being successful improve as well. So we have to get our mindset out of what we're currently doing, which is blaming the man, you know, telling him he should be eating less burgers or not smoking and not drinking and don't get me wrong, those things are important, but they are not all encompassing. 40% of men with infertility problems have structural abnormalities in the testicle. jority Yeah, majority. That's almost half. Yeah. Yeah. My math is better than that. I can work out the 40% It's not good. So if it if say for example, it wasn't America sale, what are the other things apart from lifestyle America sale. So there are lots of other lots of other issues. So there are genetic issues. There are infective issues, and we'll move on to that as well. structural abnormalities, obstructions. lifestyle factors, of course, will play a part of this, but also your history as a man as well. So if you're born with undescended testicles, if you have mumps as a child, if you are taking anabolic steroids or consuming things like testosterone replacement therapies, please don't. And please if you are going to please do it under the supervision of an endocrinologist or neurologist. So there are lots of factors that go to affect your fertility, some of which you were born with, some of which you acquired in your life, and some of which are sort of happening in your body now. Now, men's fertility is not hugely investigated, but it should be because, of course, diabetes, undiagnosed diabetes associated with male fertility issues, not wishing to scare anybody, but testicular cancer is associated with fertility problems as well. So it's really important to look at the man from the from a whole sort of body aspect from from birth to now, in terms of his full medical clinical history. There are also medications that can affect sperm quality conditions. So if you if you've had, you know, if you've had cancer if you had cancer treatments, so there are so many different factors to this, Rachel, that everybody should just be viewed as the minute they come into your clinic and sit down as a completely blank canvas. Because some people might be doing a combination of these things as well, they might be taking some testosterone replacement therapy, they'll have a slight Barraca sale on the left hand side, they will have mumps as a child. So that's why the neurologists, the Andrew ologists, and the specialist, fertility consultants, like yourself are so important in this, because it's all about being collective in your approach to the patient. And looking at things in a bigger context, right. And I often say to patients, it would be great if we could look at your fertility as a couple big picture and pinpoint one thing that was causing the problem, treat it and you'd get pregnant. Often, it's a combination of, you know, a couple of things that need optimising, like you said, maybe there's some improvements to be made on the sperm health side of things, you know, maybe there's some structural issues with the female or coupled with low Hmh. You know, there's, it's never often just one sole thing. So it's about being able to go Do you know what? Yes, maybe there is an issue with the sperm that we need treating, and that will improve things by XML. But there's other things as well, why, what, how common is bacterial infection? Well, the answer to your question is in my clinic vary, but we don't know what the actual incidence of this is generally, and I would hypothesise it will be a lot higher than we think. And we don't know the mechanism. So there's a couple of bugs that we see quite commonly, Enterococcus faecalis, Klebsiella Ecoli in semen. Now, what we know is, again, it's an association. We know that when those bugs are in this theme, and there is an association of lower fertility, unexplained fertility, failure, IVF failure, the miscarriage clinic connection is less clear, I think, because really what happened in 1992, as a long came xe, where you inject sperm into eggs, and pretty much male fertility investigation just plummeted overnight, it stopped, you can almost you could plot it in the pub in the PubMed journals, you can see it did. Because what happened was, is that we felt that well, the profession assumed that male xe was the universal answer to male fertility problems, which it's not. So the problem that we have currently, Rachel is that we don't have a huge amount of investigation and it's happening more and more. We are doing lots of investigations here with associations with with the University of Kent and Imperial College. And through logics farmer who set up tests him obviously should be commended as well, of course, because they are also funding lots of research projects at the moment as well. So the answer is, is that I would hypothesise that the in the pathogens in semen is extremely prevalent in infertile couples. And we see a lot of men come to us with these problems, and we send them to your ologists they're treated, the bugs are cleared, and then natural conception chances massively increase, and IVF success increases as well. And we don't know entirely what the mechanisms are, but it's going to be likely to be the way that bacteria and pathogens affect sperm function. And that seminal plasma as well, because obviously, the bugs live in the seminal plasma, and how those bugs are transferred in, in an IVF. clinic, perhaps to, to, to those dishes. So it it's obviously very difficult at this stage to know because the research hasn't really been done. So I should make that clear that ultimately, we need to do a lot more research into the effects of pathogens on IVF success, and also on natural fertility chances as well. I think like you said, it's as with fertility, you know, all fertility is really fast moving areas of medicine, right. And it's hard to keep up. Sometimes it's constant new studies coming out, which is great. But it does, it does mean that there are still grey areas, and we don't have all the answers, I guess in terms of bacteria, like we know that when you have bacteria in the body, you will have inflammation, you'll have increased cytokines like and generally those things are not good for the body, right? They're not conducive to health and fertility. So it's just working out that pathway mechanism on a more in depth level, right? How is that actually affecting fertility? And how can we prove that? How does it fit into the patient's sort of history as well? So I do think that doing sort of cultures are as important and there's obviously a new test called the male microbiome that looks at every single kind of puck known to man It seems but the research is still in its infantile stages, very much so. So we have to kind of remember that and be mindful of it. The most important thing is to make sure that your results have been and interpreted by somebody with experience of these things experience of interpreting microbiome results, which isn't, I would say that there are probably under under 15 people that really can interpret microbiome results very effectively. So, for me, it's all about just looking at the entire picture. And sometimes, yes, bugs are important in this process, and we find them and then when they're cleared, when they're treated, then obviously, then we see improvements. But the answer to them, I want to say to you is not lots of antibiotics. Because even though your ologists will use antibiotics, it's really important that it's done under their care as it were. Because for one thing, we don't want to be shelling out antibiotics willy nilly, because of resistance. And for another, we don't know where these bugs are coming from. So it's really important that the neurologists can make sure that there are no enlargements in any of the accessory glands in the reproductive system. And also that they discuss with the partners, because it may be very important at that point to do a microbiome for the female partner as well, to make sure that these bugs are not being passed back and forth between them, obviously, as they're trying to conceive a child. So again, it's really important not to have a blanket treatment policy, because I'm seeing, I'm seeing a few sort of clinicians just saying, well, let's give them loads of antibiotics. I think the best thing to do the clinical gold standard is to say, go to see a urologist, the neurologists will prescribe what they need to prescribe, check, the bugs have gone, I see a lot of patients where the bugs, no one's checked to make sure they've gone. So. So they had the antibiotics. And then nobody said, well, let's do another culture test to make sure that's gone now, unlike other tests before they have fertility treatment. Sorry, I interrupted you. Yeah, like you said that there can be a lot of resistance with these bugs and antibiotics can't they're actually people will often say to me, Oh, well, I took some amoxicillin for a throat infection last month. So that would have sorted it out. Like it's really important to save a lot of these bacterias need targeted specific antibiotics, often more than, you know, one course if they're really resistant. And then like you said, it's looking at that root cause, you know, what is the rest of it? Yeah, excellent. That's the issue for me is that, you know, I'm sure that when they took amoxicillin for a throat infection, that throat infection was diagnosed by a GP that looked down into the throat, to actually see that there was inflammation in the throat. So there was a diagnostic factor there. So So tend to give a man antibiotics without actually sort of diagnosing anything or or even investigating is, I don't know, I don't like to use the word nebula to but it's just not good medicine. It's not it's not sort of effective medicine for the couple. Because ultimately, I don't actually believe in unexplained infertility. I think it's just on diet. It's unlikely, obviously, it's undiagnosed. Nobody would argue with me on that one. But I think we should do everything in our power to diagnose what the problems are, for men and for women, before we put them through a technology that best has a one in three chance of achieving a child. I mean, obviously, sometimes it's better in other clinics. But ultimately, IVF treatment is, you know, if it was the universal answer to men's fertility, we wouldn't be having this chat. Now, it's still, you know, there will be 80 90% successful for couples with no female factor at all, where the woman had had, you know, multiple children already was quite young, you know, and, and the man's sperm was poor, we know that the XC does not universally create a child only does so in one in every three occasions. And like going back to what you said about you know, unexplained or undiagnosed? You know, it's not, it's a bit sloppy nowadays, to say that it's unexplained because we've got the vast array of tests and investigators, the tools available, it really nailed down where the issue is, you know, and I think we'll hopefully start to see this unexplained infertility term used less and less, because we are able to explain things. Yeah. And I think, I think that, obviously, when you have a national health service that is wholly not funded to the extent that it needs to be for fertility, and we know that that's the case, the postcode lottery has existed for 20 years, we know that your neighbour might get three cycles of IVF, and you may get nothing. So we absolutely know without argument that the NHS is poorly funded from a fertility point of view. So in that, in that respect, unfortunately, they can't afford to do all of the tests. I feel sometimes that unnecessary. And yet I could actually argue that they can't afford not to as well. Because if they're going to give someone an IVF cycle and fund it and spend five to 10,000 pounds, funding it, then far better to have done to have maybe spent 1000 pounds at the beginning, doing a fragmentation or full clinical work. Can't esteem and culture refer to urology, and then actually help a couple to conceive naturally over and over again. So that's the dream. That will I mean, I think that when it becomes, I think, actually, Rachel that obviously, I've been doing this for 30 years, and I'll probably retire and what another, never, maybe never, you'll never know, whatever. But, but I do think that there is a huge logic to this, and that people like Mr. Ramsey, yourself, all the holistic therapists that are out there doing a while in pursuit, nutrition, reflexology, acupuncture, and are spreading the word so effectively. And we've done a couple of TV programmes as well, with Channel Four and BBC One, I actually think I'm feeling very optimistic, actually, at the moment, that things will change, because the amount of information and social media, as much as my 50 year old brain can't get rounded at times or can't get my head around it, it's been very effective in spreading the word to lots of different people. So I actually think that eventually the NHS will, will realise that there is a huge power in this and just really, really good comprehensive, thorough investigations, before fertility treatment becomes necessary. And if we can look into the data, which we are, so excitingly, we are looking more and more now into the data, to be able to show people that when you do investigate things, you find bugs in sperm, you treat them, the patient has good nutritional support, acupuncture, reflexology, and a whole holistic overall body approach. And you do see a lot more pregnancies that way. I mean, you know, yourself, right, you know, you know yourself from how many patients that get pregnant with the fertility suite, how many how when you actually look at things from all angles, and you apply sort of your knowledge and technology to all different aspects of their for to have a couple's fertility, then suddenly, they have a much better chance of conceiving, because, you know, female and male sort of organs and reproduction is quite complex. I mean, we kind of think of it as are clear tubes and good get good egg and good uterus and lovely sperm. But really, it's far more intricate than that, and undiagnosed than that. Acupuncture has been being done now for 2000 years. Yeah, it's a pain reliever. It was obviously originally. And it works. And sometimes we don't know entirely why it works. But we know that it does. Yeah, there's lots of things we don't know the wise, but we know, we know that they work right? So we talked a bit about like fertility you ologists. So obviously, you have Jonathan and just Kelsey, in your clinic. So if people are listening to this, and they're thinking, well, I now have just realised the significance, or maybe I'm struggling with weight loss or unsuccessful IVF. And I want to dig a little bit deeper into the mail side of things. How are they best to get in touch with you? Or what is the process for people to find you? Well, I feel that there is a massive gap between NHS provision and private and I now offer for probably for the foreseeable future consultations with patients online, or over the phone for 55 pounds, we decided to charge two to five pounds actually just to make sure that people were there at the end of the phone. But and then we review everything. So we have a look at everything, all the previous test results. Make sure that see if there's anything obvious that we can see. And then we'll go through those results with you explain what we feel you need to do advise you on aspects that you can take including the NHS as well. And sort of make a sort of bespoke treatment plan with you because as I say, it's very much about saying this, this is not right, right, this is not right. And so therefore together, this might be the cause. So we review everything, discuss it with you carefully over 40 minutes. And you know, really try and get to the bottom of what's going on. And then refer you to you know, two specialists that can can assist can help people that can actually help you perfect okay, and for anyone listening, I'm going to pop the details of how to contact Claire and fertility solutions in the Episode Notes. So if you are thinking you want to get in touch then have a look in the episode you can book a consult with me now on the website, I have actually moved into the 21st century. Now you can book a consultation with me I kind of update my diary regularly on there. So you can actually book an evening or a weekend appointment so that we can actually go through these things carefully. If you do, please make sure that ideally you're both on the call if it if it's affecting both of you. And part time make sure that you kind of have good 40 minutes, no distractions, and you can be together ideally. And for anyone listening I have certainly refer had quite a fair few of my clients over the last few years to Claire. And you know, we have had really good clinical outcomes, really amazing stories to tell. I could talk all day about it. But if you do have male fertility issues or you're thinking about digging deeper in this area, then fertility solutions really is well, in my opinion, the best if not one of the best places in the country to go and do that. So, Claire, thank you so much. It's been amazing. As always, I will speak to you soon. Okay. Thanks, Rachel. So much.