You're listening to the fertility dots, uncensored podcast, featuring insight on all things, fertility from some of the top rated doctors around America, whether you're struggling to conceive or just planning for your future family, we are here to guide you every step of the way
Speaker 2Today's podcast is brought to you by ovation fertility, a leader in the field of IVF lab services, ovation partners with some of America's leading fertility specialists to provide a range of services to support fertility treatment, including fertility testing, IVF, egg donation, surrogacy, genetic testing, and long term storage of reproductive material. You can learn more about ovation at ovation, fertility.com. This is Dr. Susan Hudson from Texas fertility center with another episode of fertility docs, uncensored, and I am joined today with my amazing co-host Dr. Abby Elin from Nashville for fertility center. Hi everybody and Dr. Care beedi from fertility of Las Vegas. And we have a special guest today. We are so excited to have Dr. Mark Ratner with us. Hey mark .
Speaker 3Hello. How you guys doing? Fabulous.
Speaker 2Good, good. So mark is a urologist and he is also the chief science officer of a company called theologic . So we're gonna learn all about the logics and learn a bit about vitamins and, and all that kind of good stuff. But Hey mark, you were mentioning that you are delving into some sort of ancestry research.
Speaker 3Yeah, I it's , uh , it's kind of funny because it it's an area that my background in genetics and fertility sort of led me into . I had been for many years doing sort of typical, you know, like sort of standard genealogy work where you, you know, you're online and you're looking at things like census records and chips , passenger lists and stuff like that. They're very hard to read aren't they <laugh> oh yeah. The old handwriting can be calendared , but you know, all that stuff is online. And so it's been , uh , sort of a hobby of mine for a number of years, but then more recently there's been an explosion in what's called genetic genealogy. Mm-hmm <affirmative>, mm-hmm , <affirmative> , there's been a lot of publicity lately, a lot of media , uh , attention to old crimes that are actually being solved because of genetic genealogy. And what, with the ability for , you know, you can go on 23 and me , you can go on ancestry DNA, you can go on my heritage. There's about five or six different companies that hold for, you know, 70 or $80 they'll sequence your DNA. And then a few weeks later, you get a long list of all of these people who you are theoretically related to . And you know, when that list first comes in, you look at it and you say, who are all these people? <laugh> , uh , because the names aren't always gonna be familiar to you, most of them won't be, but they're all typically gonna be second cousins, third cousins, fourth cousins, where you share potentially a set of great grandparents or great, great grandparents. So it's really fascinating stuff. And what got me into the genetic genealogy of it was that I , I have a daughter who she's actually now a , a doc and we were having dinner one night, about three or four years ago. And her phone rang and it was a Genea researcher through ancestry DNA. She had gotten her DNA done and on the phone was a genealogy researcher who basically unloaded some information on our family, which was like completely outta left field. This woman had a client was a 70 year old woman who was trying to find her birth parents. She had been adopted , did at birth. And she was looking for her birth parents and she had her DNA done. And my daughter who had her DNA had been done like a year earlier, came up as a match saying that they were like third cousins. Wow, wow. And nobody in my family, actually, it turned out to be on my wife's side of the family, but nobody in the family had any idea that there was a child that had been born and given up for adoption in the 1930s. So it was wild and it took a , it took several weeks to figure out what was going on, whose child this had actually had been. Yeah, it was crazy, but it really got me very interested in, in sort of understanding how genealogy can be done using genetic.
Speaker 2Yeah . That is so exciting. My mom has been doing a lot of genealogy and she's been doing some of this with her DNA and that type of thing. And my mom was born in Germany because that's where my grandparents happened to be after the war. They're from Lithuania. My two older aunts were born in Lithuania. My mom grew up not knowing anybody cuz they over to the United States and they really had no contact with the relations cuz it was so far away. Yeah. Well it was behind the Soviet wall <laugh> oh yeah, yeah, yeah. You know, and so there was very little interaction, only letters from limited people and things like this. And so my mom has gotten, I mean she's in her seventies and she met like cousins and spouses of like other family members through this type of thing. And she's been working on like just the handwritten ancestry stuff. We found out that we're related to Helen Keller through my dad's side of the family, which was like super cool. Wow. My kids thought that is fantastic. And it really makes, you know how small a world it, yeah, absolutely. It's an amazing gift, but you always have to be prepared for those phone calls. Just like you mentioned because you , you never know what's gonna be around the corner and
Speaker 3When you do your DNA and they send you those lists there's now they provide a disclaimer basically saying <laugh> you never know what you're gonna find out you . Exactly, exactly. And sort of like be prepared and you know, be , be aware that you may discover something that you're not entirely happy to learn. Okay. Um , yeah . And this somewhere in the three to 5% range of mistaken fraternity where, you know, you thought so and so was your dad and it turns out he wasn't <laugh>
Speaker 4I was telling our ladies on the podcast, I read this book called inheritance and it was , oh, great book, have you read that? But that is such a good book. I think it , it was so eye opening to , you know , cuz for many, many years we've talked to couples about using donor sperm and donor eggs and donor embryo. And I mean, you do think about it from the child's perspective, but we always said, you know, it's really important to let your child know because you know, secrets can get out. Of course, back when I started out 20 years ago, we never knew that things like ancestry.com and 23 and me would even exist. And so yeah, it's, it's amazing that the secrets and things that, that patients can find out. But I have a question for you, you , since you're an expert in this area, I've also done mitochondrial DNA, which really, I , it hasn't really given me any revelations about anything. It's just kind of , do you know much about that at all? Or
Speaker 3Yeah. So the main tests , the ones that you would get through 23 and me or ancestry, those are autosomal, right? They basically look at SNPs, you know, single nuclide polymorphism in the autosomal DNA, but you can also have Y chromosome men can have their Y chromosome sequenced. Okay. Uh, and anybody can have their mitochondrial DNA. Okay. The problem is that mitochondrial DNA is much harder to use because both men and women have mitochondrial DNA, right? Why DNA? Why chromosome DNA is a perfect indicator of patch, what they call patch lenal descent . In other words, I just, it's interesting. I just had a , uh, my family , uh, is on my father's side from Belarus mm-hmm <affirmative> and I just had been in touch with a , a researcher in Southern California who hap was doing , have done. She actually paid researchers in Bero to go to the archives there and dig through material on my last name, Ratner , you know, the Ratner family. And she has this amazing family tree that she just shared with me. Wow. And my first reaction to it was did he show you all of the documentation for this? He was like ,
Speaker 4So they just came up with it. Yeah.
Speaker 3Here here's a family tree. And now you, you know, pay me the thousands of dollars, you know , that I've negotiated with you. And what we're talking about is the fact that if we can find some other people with my same last name, men who have my same, last name who are alive today, and we can do DNA on our Y chromosomes from that same tree, my Y chromosome should be identical to that other guys. Oh, interesting. Because my Y chromosome, there's no recombination on Y chromosomes. Oh. And there's no recombination on mitochondrial DNA either. But the problem is that it's both men and women, in other words, all of mitochondria in and embryo come from the egg. Right. Yeah. Yeah . And that , that gets back to a whole thing about energetics and co turn . But we'll talk about that.
Speaker 4So one last question while you're on that topic. So if you descended from the same grandfather or great-grandfather, you would have the same Y chromosome that somebody else would unchanged.
Speaker 3I didn't know that my Y chromosome is identical to my father's. Okay. And his father's and his fathers. Right. It just goes back. And so the only changes that occur in the Y chromosome are due to mutation mm-hmm <affirmative> , mm-hmm , <affirmative> not recombination the autosomes, they cross over the Novo mutation and they also have mutation, but the crossover is really what makes the autosomal DNA vary from one generation to the next mm-hmm <affirmative> with Y chromosomes. What they had done is they basically mapped the mutations, which are SNPs also. Okay. They're , they're basically single nucleotide polymorphisms, but they mapped those and they develop what they call haplotype. And so if you can go back far enough, you can use the white chromosomes to basically build a family tree that goes back hundreds and done hundreds of years. Wow. That's cool. Yeah, because they don't recombine. I didn't
Speaker 4Realize that. Well, very good. That was interesting. I learned some things <laugh> that's great
Speaker 3Stuff. I love it. Yeah.
Speaker 2Let's do our question of the day before we kind of into some vitamin stuff. Um, our question is how does or can being Ana positive effect , fertility trying to conceive for over a year after successful pregnancy diagnosed with Unicorny uterus and Ana positive one to 320 ti speckled pattern after birth of sun .
Speaker 4So, and people talk about auto immunity. I tend to think more about women who have recurrent pregnancy loss. And I think this patient has sort of two potential issues when it comes to recurrent pregnancy loss, not so much fertility, but recurrent pregnancy loss. So, you know, we know if there's high titers of lupus , anticoagulant, anti Carly antibodies, we know that that's particularly in a per person , who's had recurrent pregnancy loss. We know that that's the one condition where those patients would really benefit from a blood thinner. We used to use heparin more commonly, but now we tend to use ox cuz it's a safer medication and it tends to improve outcomes since traditionally have more problems with delivering babies, early pregnancy loss, second trimester loss. Ocre uterus is sort of a confounding factor because generally if there's a uterine abnormality, we tend to believe that it's more related to , um , a second trimester loss. So it's interesting that this listener is asking this after the birth of her child. Does she give any information about that or
Speaker 2No , it was just exactly what
Speaker 4I put. Okay. So with the unicorn uterus, the other point to point or other thing to say is that , um, just with any mul abnormality, meaning, you know, the two tubes have to go together, the mul tubes, they fuse in the midline to form the uterus. And clearly in this situation, if they have a unicorned uterus, only one of the tubes was present. So there's only one tube, there's two ovaries, but one tube and one uterus. And we know that it can make it more likely the , if that person can miscarry for some reason, no matter what the uterine malformation is, that uterus is weaker and it just doesn't hold the pregnancy as long in some situations. And so certainly if you have unicorn at uterus, your doctor's gonna wanna check your cervix early on before you get too far along, just to make sure there's not early dilatation. And then just continue to check it by measuring it, you know, when she does ultrasounds, but it sounds like you've had a child. So that's a good thing. <laugh> , you've proven that you know, that both of those two things can be overcome. So
Speaker 5That's great news. The other thing that we oftentimes see is that when someone is just looking for a double stranded DNA is a screening test of the lightest order in the sense that if that comes back positive, oftentimes the next thing that the rheumatologist will do is they'll order a more comprehensive panel and the rheumatologists are some of the Queens of an amazing number of lab tests. And so, and all of these antibodies. And so they will dive into it further and look and see, you know , are there SSA and SSB antibodies, are there all of these different types of antibodies that could indicate, is this a double stranded DNA that is related to a specific disorder or not? And so I'm kind of curious about what the underlying reason is and why they order the test in the first place. And I'm guessing there's some occur or pregnancy loss component to it just because that is usually what's related to it. You know, there may be a really strong family history of autoimmune diseases, but it's a , it's a very nonspecific test. And so that by itself, I don't think means a whole lot in terms of taking action and in doing something specific, I, it's more of a, well, let's look into this further and see if any of this autoimmune panel comes up positive. And unfortunately in the absence of symptoms, it's really hard to pin some of this down because the lab work goes positive and negative and can vary. I mean, there's a reason that the rheumatologists are exist, right. Booked out forever and ever on men and they exist because they are, or like it's a , it is a tough field. That's very intricate with all of the different tests that you can do and how to interpret symptoms in combination with the tests done over time. It's not a one and done thing it's usually takes several months kind of thing to figure out.
Speaker 2Yeah. I would agree that when I see a positive a and a by itself, I'm assuming all the other things have been done as, you know, you guys talked about, but in the absence of the other things being positive, it really is so nonspecific that it really, I mean, I don't think has any tangible evidence to make us really concerned about something, you know, there's , there are the inherent risks of a unicorn uterus, but it sounds like you've already delivered a baby there, but if you've been trying for a year and in light of those things, you know, definitely be visiting with your reproductive endocrinologists. Now you're the person we definitely don't want pregnant with multiples. <laugh>
Speaker 5Amen to that.
Speaker 2So that's gonna play a part in the decision making tree of, you know, what types of treatments might be best suited for you. But, you know, at , at this point I think things have pretty good . So , all right , well, let's kinda dive into tell us a little bit about their logics and we're gonna kinda focus on things like co Q 10 today, but , um , kind of give us a little bit of background of who you guys are. Sure.
Speaker 3So the logics is based in the Washington DC area and actually the Maryland suburbs right outside. We started the company about 20 years ago and it was started by , uh , a group of physicians. Our initial focus was really on urology and men's health. And the background was that at the point that we started of the company, there was a ton of research being published about the impact of specific nutrients on prostate cancer risk. And so we got together a bunch of docs from some of the teaching programs in the Mid-Atlantic here, and a couple of community physicians and said, you know, really interesting science, that's kind of evolving here. Unfortunately, the supplement world, the dietary supplement world is sort of filled with a lot of questionable players as it still is now. <laugh> yeah, no for sure. And, and so we said, you know, we , we talked to these guys from the academic programs and said, would you be willing to work with us if we created a company that would sort of vet the science carefully? And then the other thing that we, that we would do , uh , at the outset is have any products that we were going to develop the independently third party content certified, which is another thing that doesn't happen in the vast majority of supplement industry. So we started this company and initially we focused on prostate health. We recruited a medical advisory board, which included a couple of department chairman from teaching programs in the Mid-Atlantic. And then within a few years, it , we became, you know, pretty successful initially. And then within a few years we developed a male fertility product based on science that was really kind of being published about the impact of certain antioxidants on improving , uh , DNA for, and sperm and , and similar things. And so then from male fertility, we sort of started expanding into the world of , uh , female fertility. And now the company really has, I would say five different specialties that we kind of work pretty closely with urology, reproductive endocrinology, meaning the fertility world, rheumatology pain management, then standard OB GYN . So we do a really robust line of different prenatal vitamins. We're actually now getting into the cannabinoid space. There's some very interesting data on non-cannabis derived cannabinoids. <laugh>
Speaker 5Where do you find cannabinoids? Not from cannabis.
Speaker 3Okay . So , uh , this , this is gonna to be a little parenthetical. We're gonna go off on this tangent, but I , I love the topic, so I'm happy to, to get into it. Um , curious , is this a
Speaker 5Personal question or is this for our , our listeners? I'm just curious. I mean, I do live in Vegas and you know, I , uh, I see all of the things. And so knowing about alternatives to the isn't there
Speaker 3Like a big cannabis museum in Vegas , something , I
Speaker 5Think I've read that there's a museum for everything in Vegas. Like there's a museum of erotic art history. There's a museum of just about everything. So
Speaker 3I'll give you what we call the cliff notes version very quickly. It turns out, okay . The reason why cannabis has any effect on the human body is because we have receptors in our tissues, which are called cannabinoid receptors. And it's what THC and C B D . Those are the two primary chemicals that are in cannabis. That's what they bind to. So the question then became, you know, years ago, maybe about 40, 50 years ago, why do we have those receptors for chemicals that are just found in this one particular plant <laugh> ? And it , it turns out that the reason we have those receptors is because we make our own cannabinoid ligands. In other words, we make our own signaling molecules in our tissue that are designed to bind to those receptors that we have. And those, the two primary cannabinoid ligands were discovered by an Israeli scientist in the early nineties. One is called anandamide and Anand is the Sanskrit word for BLIS, no
Speaker 4Coincidence there, I'm guessing <laugh>
Speaker 3He named it that because it binds to CD one receptors, which are in the brain. The other ligand is called two ag . They're both derived from Adon acid, which is a , uh , it's a fatty acid in our tissues. Well, it turns out that there's a third one, which is called P it's a fatty acid MI that's derived from P acid. We make this in our own tissues. It functions in our tissues as an antiinflammatory and analgesic. Okay . It was discovered back in the 1960s, but nobody really understood the mechanism of action. There were so much other
Speaker 4Better things in the sixties. Why would you focus on just pot when all the other alternatives
Speaker 3Out there ? POID Eide, this is that third endogenous cannabinoid. This is a cannabinoid that we make in our tissues. So it's an endo cannabinoid li Gant . In other words, it's not in cannabis. The reason that we can create it as a supplement though, is because pea is also found in soy eggs in peanuts. And because it's all also found in certain foods, it's the only substance that we know of. That's both an endogenous cannabinoid, sinking molecule, and it's also found exogenously. And so P uh , has been very widely used in Europe for about 20 years. There's a ton of data. I'm talking about randomized placebo controlled trial, published , looking at endpoints like arthritis, sciatica, TMJ , uh , endometriosis. Oh, wow. Yeah. I mean, so there's a ton of pea , uh , works by it basically downregulates mass cell activity. It binds to cannabinoid receptors, which are on mass cells and , and it prevents the mass cells from de granulating. And so you don't get the release of all of these inflammatory compounds that you normally would get when mass cells are
Speaker 4Activated. So mark, what you're saying for people that don't understand all the signs of it , this P is a good anti-inflammatory and it's also good for pain, right? Is that what you're saying? Yep , absolutely . And it , but it's not, but it doesn't specifically come from
Speaker 3Marijuana. Yeah. You can't find it in marijuana. It's not in, it's not in cannabis. Exactly. Gotcha. Okay. Hmm . So that's, you know , so we've gotten into the cannabinoids as well, and the rheumatologists love that product because it's got terrific data , uh , for like osteoarthritis of the knee. Uh, there was a very big Australian study published about three years ago with that. And , uh, yeah, so the logics basically is we , we've got a lot of different things that we do. So
Speaker 4Do you have a supplement purely that has that in it, or is that a combination of some other supplement that you have?
Speaker 3No. No. That we have a supplement that , uh, we launched , uh , it's called Canbra and Canbra is POID Eide , uh , pea. And it is 300 milligrams in a , in a capsule. Most of the studies that have been done with pea have used 600 milligrams a day. Okay. So Canbra has taken like one capsule, B I D the one thing that is sort of important for the rheumatologist to understand this, but it is not a fast acting . It's just not a rapid onset analgesic. This is not like taking ibuprofen or an NSAID or, you know, God forbid an opioid. Okay. Yeah. This takes a while to build up tissue levels. And so the studies that have been done depending on the endpoint maximum benefit is gonna take anywhere from two weeks to two months. Okay. For adequate tissue levels to build up. But yeah, no. So we're into cannabinoids a bit and , um, yeah, we do a lot of interesting stuff for husband with rheumatoid
Speaker 4Arthritis. I'm gonna go out in <laugh> .
Speaker 5So how did everything come about to cuz you said you started off in the, the fertility space. So how did you go from all of the male? Um, I don't wanna say enhanced supplements, executive entirely supplements , supplements. Thank you. That is a much better word. Um, but how, like how did you guys transitioned into Coq 10 and thinking about, all right , how does this impact women's fertility
Speaker 3From a , a business development perspective? What happened was we had built out our urology product line over the first say five or six years that we were in existence and that line included a male fertility product. And I had begun at that point working with a large fertility practice in the Washington DC area. And we were using the male fertility product with them . And in my conversations , uh, I mean I was treating men, male fertility issues. And so in my conversations with the Reiss that I worked with, I just started hearing more and more about data on things like vitamin D in women, the Coq 10 story, D H E a . And so that sort of triggered us to sort of start looking at that science and deciding whether there was enough support for expanding our product line into that area. We expanded our medical advisory board to include reproductive endocrinologists. And at this point, our medical advisory board is 15 physicians and scientists from, I think it's 11 different medical school faculties. Every one of our products goes through the board process. We don't produce a product unless the board signs off on formulation. And then the other thing is that every one of our products goes through independent content certification through a nonprofit program, which is up in Ann Arbor, Michigan, it's called NSF international. NSF used to be part of the university of Michigan, and it's now a freestanding nonprofit . And so, especially in a reproductive timeframe, you wanna know that if you're taking an over the counter of supplement, that what you think is in that pill is actually what's in that pill . So to
Speaker 4That end, what should people look for when they're looking for a supplement is to know that, to know that very information that they're really getting what they
Speaker 3Think they're getting. So there are two programs in the United States, which are nonprofit , independent certification programs. And if a company will wants to go into those programs, it's a , it's a , you know, you have to sort of be very serious because that they're not only going to test your product for content, accuracy and purity, but they're gonna come and inspect your manufacturing facilities for what's called GMP compliance, good manufacturing practices, compliance NSF program, which is, is the one that we're part of also reviews all of our marketing materials. Hmm . To make sure that we are within regulatory compliance, that we're not making the kinds of crazy health claims that you're not supposed to make overblown
Speaker 4Claims. Yeah. You mean just because it's on the internet, doesn't mean it's real. <laugh> not everything on the internet was true. You
Speaker 3Know, unfortunately the FDA is completely outgunned by the supplement industry. They just cannot police it adequately. So I mentioned NSF , that's one program. What
Speaker 4Does that stand for? Sorry, I'm putting you on the spot here. I always think about national science foundation,
Speaker 3Right ? No, it is not that , um , NSF used to be part of the university of , and then it was spun off as a freestanding nonprofit , I think like 40 or 50 years ago. And it's called NSF international. And I think historically like 50 or 60 years ago, it might have stood for the national sanitation foundation or something crazy like that. But they don't , it's just called NSF at this point. And in fact, NSF has a program which is called certified for sport, which is the only supplement certification program that's accepted by the , uh , us anti-doping agency, the us ADA. Huh. Interesting. Wow. Which oversees all the Olympic testing and everything like that. So I was mentioning that there's two programs. One is NSF internet national . And if you go to a store and a particular product is NSF certified, you'll see the NSF logo on the label. The other program is USP . Oh yeah . Which is us Pharmacopia and those are both nonprofit programs. And so if you're looking for a supplement that you want to be able to trust the content, look for either one of those two logos on the bottle. So mark ,
Speaker 4Tell us about coenzyme Q 10 . I am so excited to hear about it because I really, I recommend Zyme Q 10 to my lot of a lot of my patients, but I always say, well, there's not a lot of random us perspective data. This is the way we think it may work, but we really don't know if it really works in this way, but it, it's not gonna hurt to take it. So tell me what your thoughts are. Tell me your details that, you know,
Speaker 3Okay . So the first thing that , and I think this is a , a factor that is, in some ways it's important to understand about many of the supplements that are out there and be being touted for, you know, potential benefit in the fertility space. But one thing about dietary supplements is that you don't need a prescription to get them. Right. Right. Yeah. And so you made the very valid observation that there aren't a lot of randomized placebo control trials for some of these interventions. And the re reason why that is the case is because it's notoriously difficult to get couples who are going through fertility treatment randomized
Speaker 4To placebo
Speaker 3To accept a placebo arm of a , of a , of an intervention that they can buy down the street. Okay. So if you give them an informed consent and it basically says, we think that coan on Q1 may have some real benefit in improving your egg quality, and
Speaker 4We may or may not
Speaker 3Give it to you. <laugh> right. Exactly. Most couples say, Hey, thank you for this information. I'll go by my own. Right, exactly. So that is why it's very difficult to do these clinical trials. So what happened with co Q 10 is this, we know that one of the most important factors in terms of the quality of an egg is how much energy it can produce during what's called myosis. Okay. And what happens when an egg is formed , uh, is that the number of chromosomes have to be cut in half and the process by which the chromosomes, maybe we have 46 chromosomes, right? And that's actually 23 pairs of chromosomes. So you have a pair of chromosome, one and a pair of chromosome two. And what happens when an egg is formed is those pairs split. Okay. And the egg ends up with only , only one copy of each pair. Then the sperm comes along with its own copy of that pair. And you end up with an embryo, that's got 46, whereas the sperm and the egg each have 23 , right? The process by which the egg divides the pair . So that there's only gonna be copy of it, left in the egg, requires a huge amount of cellular energy. That energy is produced in the mitochondria of the egg. And there's a compound in the mitochondria called coenzyme Q 10 . We make our own coenzyme Q 10 . It's a substance that's found in every cell in our body. And what happens is, as a woman gets older, the amount of ZY Q 10 , that her eggs have decreases. And therefore the amount of energy that, that egg can and produce decreases. And therefore the ability to split that chromosome pair and end up with only 23 chromosomes in the egg starts to go down. And when, when that happens, mistakes are made and an egg production and an egg might be ovulated where instead of 23 chromosomes, it has an extra 1 24, maybe one of those pairs, the there wasn't enough energy to pull the two apart, the , the pair apart. And so the egg ended up with an extra chromosome, maybe an extra copy of chromosome 21 . Okay . Which is then if that gets fertilized, it's a risk of down syndrome, right? Mm-hmm <affirmative> , that's you end up with the sperm brings along a 21 chromosome. The egg has two by mistake. And now you end up with three, which is what we call trisomy 21 . So the point is that an egg that doesn't have enough energy could end up with one chromosome, too many or one chromosome, too few. It could have 22 instead of 23. And that condition is called Aloy . An OID egg is an egg that doesn't have the right number of chromosomes. If it's the 21st chromosome that egg can fertilize and you'll end up with a baby that has down syndrome. But for most of the other chromosomes, almost all the other chromosomes, the egg just won't fertilize. And so th this is the most common cause of infertility, correct me if I'm, I'm I'm wrong in , in any of <laugh> . No, it's a big part of what we talk about for sure. Okay . It's the most common cause of infertility in women as they're getting into their late thirties and early forties. It's not that they're not making eggs. It's that the, of the egg genetically is not correct. It's not there. And so there was a doctor up in Toronto , uh , a reproductive endocrinologist who figured out that maybe if he supplemented cos on Q1, he could improve egg quality in women who were at risk of not having enough energy , uh, in their eggs to produce a good quality egg . So this doctor whose name was Casper, Dr . Robert Casper, he started off working with mice and it turns out that mice, I guess mice only lived to be about two. Okay . That's like an old , so an old mouse , an old mouse is a mouse . That's like one , okay . If a mouse is like a year old, they have the same problem with their eggs being Aloy. And so his first work was to supplement old mice. That means they were a Euro with Coen on Q 10 to try and help improve the amount of energy that the mouse eggs could make. And he basically restored the egg quality of old mice to look exactly like the eggs of young
Speaker 5Mice. So did those mice, after he gave them the, the supplement, did they have fewer OID babies? Did they have more pregnancies? Like yes , yes . To all of that and to , to what magnitude? Cause you can have , I mean, you know, this as well as we do, you can have statistically significant data, meaning it shows that there's a difference, but if you have,
Speaker 3But, but not clinically significant, but
Speaker 5Not clinically significant. Right . And so nobody cares if it's a 0.1% chance , uh , you know, if it's zero to 0.1, whatever, if it's one , you know, if it's zero to three, a huge difference.
Speaker 3And the way it was described , uh, in the paper was that they basically restored these mice to having the same fertility as they did, if they were three or four months old. Um, the quality , the , you know, the pregnancy rate and the, and the birth rate was essentially indistinguishable from a mouse that was only three or four months old instead of being a Euro .
Speaker 5How long had they been on the Coq 10 to get at that kind of effect? Couldn't have been that long. They don't
Speaker 3Live that long. <laugh> right. No, I , I , I think it was about 60 days and I, and I think they gave the mice , the Coq 10 by injection. They actually injected it intra parent knee . Woo . So Bob, Dr . Casper then decided, okay, I'm gonna do a clinical trial with Coq 10 and women . Right. Um, and I think they had, this is a get up in Canada. They, they, I think they had four sites and their goal was to enroll 50 couples in this clinical trial. And after two years, four sites, they were only able to enroll 20 couples. Wow. And so they , uh, discontinued the study, but at that point point , the couples, and I think it was placebo versus Coq 10 , the couples that had gotten the Coq 10 showed a 35% reduction in Aloy in the eggs, but it did not be statistical significance. What
Speaker 4Dosing did they use? Do you remember in that study? Cuz that's always a question. I get 200, 400, 600 . What's our, what's our dose of co
Speaker 3Q1 . The most widely kind of thought of dose is 600 milligrams a day. Kinda a lot though. <laugh> well, the , the reason that number got into sort of the medical mind is that that's what Casper used in his clinical trial. And how did Casper get it? He extra , he tried to extrapolate from what he injected into the mice into a dose for people the, with co Q 10 is that it is a very large fat soluble molecule and absorption from the gut is really poor. And so what we say is what's important is not what youngest, but what you absorb. Okay . So what we've done with our co Q 10 and I'll tell you, there are other companies that have , uh , similar things we've used in emulsification technology. It's, what's called a sets , S E D D S a self emulsifying drug delivery system. It's from a Swiss pharmaceutical company. And it's essentially what, what it is, is sort of, it's like adding biosalts , you know, when we have to absorb fat from our diet, the body emulsifies, the fat in our stomach, the gallbladder secretes biosalts, and those biosalts emulsify the fat and make it absorbable. And so occasionally you'll see a Coq 10 product. That's actually a tablet or a capsule with a dry powder in it. The absorption in that form is gonna be on the order of one to 2% . You'll see Coq tens that are just an oil based soft gel. In other words, where it's like rice brand oil or olive oil as the carrier inside the soft gel absorption then is gonna be somewhere between two and 4%. So what we were focused on is trying to increase absorption and we use this it's called VESO sob . It's from a Swiss company called VE fact , which is a self emulsifying drug delivery system. It increases absorption 15 to 17%, which is still pretty low, but it's still like five to six times better than what you otherwise get. Yeah. So for our product, a typical dose is , is 125 milligrams twice a day or 250 milligram . And that's, what's actually on your bottle. Yeah. Each of our soft gels is 125 milligrams. Okay. And that might sound like a very random sort of amount. Like why not just a hundred ? Why not 200 . How did we get to 125 ? But the reason is because whenever you're developing a product you're forced and make a series of compromises. You want to have a product that follows the science. It can't be too big, right? Nobody wants to swallow huge pills. Nobody wants a product. That's gonna make them feel sick to their stomach. You could formulate the best product in the world, but if people can't tolerate it, what good is it? Right? Mm-hmm <affirmative>. And so the 125 milligram soft gel is because that's the largest soft gel that we felt was reasonably sized. That's the most we could get of the Coq 10 plus the emulsification agent , uh , into a reasonably sized soft gel. Hmm . And so that's, it's still a , a fairly small, soft gel it's , uh , nicely tolerable. And you
Speaker 4Have that as a standalone product. Do you, have you probably have other products with cones on Q1 mixed
Speaker 3In or, well, we have it as a standalone product. Yes. It's called Neo Q1 . And then we also have a prenatal vitamin, which is called Ovide . And what Ovide is, it's a prenatal of vitamin that's sort of intended for women where egg quality is potentially a concern. So we, we always are try to be, be very careful about naming a particular age. <laugh>
Speaker 4That's a smart thing. Mark smart thing.
Speaker 3Yes <laugh> . Yeah. Um , and so, but you know, if, if an ploy is a concern, supplementing Coq 10 is potentially going to improve at quality. And so the , I was gonna say, OVI is a tablet, which has a, so it's three pills a day. It's a standard prenatal tablet with high dose vitamin D methylated, folate, all the things that you would want precon, conceptually plus two soft gels of the Neo Q 10 . And so you get 250 milligrams of high absorption, Coq 10 and , uh , a standard prenatal tablet as well. Yeah .
Speaker 4So with your urology background, I have a question for you. We always say, tell women, you know, you're born with all the eggs that you'll ever have and you know, they sit in your body for this period of time and all of a sudden they have to wake up and divide and you know, that's kind of the problem. Well, so with men, we always say, well, you know , you makes sperm every 72 days or whatever it is, and you have young, new sperm, but the young, new sperm still comes from old guys. So <laugh> in theory. So why do you think there's not as big of an issue with things like ZY Q1 in an older guy? Or is there, I mean, is there a reason for somebody's husband to be taking co enzyme Q 10 ? There is
Speaker 3Actually pretty good data to on Coq 10 and male fertility from two perspectives. One is energy production. Okay . What sperm have to do is swim <laugh> okay . And they have , and they have , and they have to swim effectively and, and , um , and reach the egg, obviously, of course, in those situations where they're getting help. Okay. Whether it's, you know, with IIE where the sperms gonna be injected into the egg , you know, and it doesn't have to really swim too far. It may not be that important. But the other feature that co Q 10 has is it not only is important for energy production in the egg and in sperm, but it's also an antioxidant and it's a very potent antioxidant. One of the sources of confusion about Coq 10 is that Coq 10 comes in two different forms. One form is called UBI known . Yeah. The other form's called UBI ol . And it turns out that that's the same molecule, except one is the oxidized form. And one is the reduced form. And there's a lot of marketing nonsense, a lot of marketing hype out there that, oh, this form's better than that form . You should use this. You should use that. Uh, it turns out that the body converts back and forth between ubiquinone and ubiquinol constantly they're , they're what we call a , a redox pair , R E D O X , a redox pair , red reduction and an oxidation. And what happens is in the mitochondria ZY Q 10 transfers an electron, right. That's down the electron transfer chain. That's how energy is being produced,
Speaker 4Man. I feel like we're talking about biochemistry here, mark . I'm having
Speaker 3Bad flashbacks here though , to college or organic chemistry. No . So, so , so it goes from an oxidized date to a reduced state and then back to an oxidized state to a reduced date as it transfers that electron. So it's constantly going back and forth between those two forms ubiquinol and ubiquinone but do they matter? No, it does not matter. Doesn't matter which form you take,
Speaker 4So don't pay more money for the ubiquinone as , as opposed to the ubiquinol then.
Speaker 3Right. Well, typically ubiquinol is more, are expensive because it's the one that is more, has been more recently developed and it's the one that they'll , they'll call themselves body ready . Yeah . Which is , uh , it's kind of just marketing stuff. And actually the vast majority of clinical trials that have been done with ZY Q 10 have used ubiquinone. Okay . I mean, if you wanna get a good sense of how potentially beneficial co Q1 is, there was a clinical trial that was huge clinical trial that was published about seven years ago in patients with congestive heart failure. And they were supplemented with either co Q 10 or placebo. And the cosign Q 10 group had statistically and clinically significant benefits in terms of less hospitalization, less death , better function in terms of their ability to exercise. Um, and so co Q 10 helps with heart muscle energetics the same way that it , it helps with sperm and egg energetics as well.
Speaker 4I had just an anecdotal story. I had a patient one time who never had normal blood pressure. She couldn't tolerate any blood pressure medicine that she was on. She was gonna do IVF. And so, and she was 40 ish, 38, 40, somewhere in that rain . And , and so I put her on co enzyme , Q 10 , about six weeks later, I get a call from her family practice doctor. And he's like, tell me about the, as coenzyme, Q 10 . She walked in and her blood pressure was one 20 or 80. And I have never, in my career are never in the time we've been together, seen her with a normal blood pressure. And you know, who knows if it was all that. But I mean, he that's, the only thing she had changed was she had started taking 600 of coenzyme, Q 10 and, and it apparently has some issues with vascular reactivity. It helps vascular re and people with high blood
Speaker 3Pressure. I , I think that's true. Yeah. Um, and , and so, yeah, so co enzyme Q1 is a , it's a , it's a really interesting compound. One other thing I'll mention, and that is anybody who's taking a statin cholesterol medication like Lipitor Zocore , Provo , which are, they're all like now generic, but those drugs, the enzyme that they block it's called HMG COA reductase. That enzyme is the enzyme that produces cholesterol in our bodies. And so by blocking that enzyme, it lowers cholesterol, but that same enzyme, HMG, COA reductase is what produces co-enzyme Q 10 in our bodies. And so anybody who's taking a higher dose instead . So if you're taking 10 milligrams a day, it's probably not a big issue.
Speaker 2I think my husband needs to start taking some good 10
Speaker 3<laugh> . Yeah. So, so people , well , people who are taking 20, 30, 40 , you know, 20, 40 , or even higher doses of say Lipitor , um, their cos on Q 10 levels in their tissues are significantly lower. Um, so yeah, it it's something that you should consider supplementing. Yeah.
Speaker 4That might be a good thing for husbands, most women that we see, they're trying to get pregnant. We want, we try and get 'em off statins, but certainly for partners, that's an important thing to know for sure. Yeah. Well,
Speaker 2This has been an amazing discussion. I've learned so much about vitamins, about Coke , U 10 , about all kinds of stuff . I mean, this is , this is amazing. We, we really, really appreciate you mark for coming and joining us today and, and we hope you'll come and see us again.
Speaker 3Sure. No, absolutely. It's been my pleasure , uh , ton of stuff. We can talk about everything from , uh, cannabinoids to , uh, you know, P
Speaker 2C O S stuff, whatever you like. Absolutely. Absolutely well to our audience. Thank you so much for listening and be sure to tune into us next week for more also be sure to subscribe and leave us a review in iTunes. We'd love to hear from you. We are also on Instagram and Facebook. So please hop on and leave us a like , or a follow and say hello.
Speaker 4And you can also visit us on fertility.com to submit specific questions. All questions will be answered on the podcast anonymously for ask the doctor segment. So don't
Speaker 5Hold back as always. This podcast is intended for entertainment and is not a substitute for medical advice from your own physician. All right , guys, we'll talk to you soon and we'll see you next week. Have a wonderful week. Bye
Speaker 4Bye . Everybody.
Speaker 5We want to thank ovation fertility for sponsoring today's podcast on the road to parenthood. Many of our listeners find themselves in need of fertility testing, IVF and other related services, such as egg donation, genetic testing or gestational surrogacy ovation is a one stop shop for services that many people may need as they go through fertility care. You can learn more about ovation services for hopeful parents at ovation, fertility.com .