Male Fertility Explained: What Every Couple Needs to Know About Sperm Health with Dr.Mark Ratner

Lorne Brown 

Most of the people that come into the clinics are the women. Even when they know there’s a male factor issue, it’s the woman that comes into the clinic. So do you have an idea of what’s wrong with us?

Lorne Brown 

By listening to the Coherence Code Podcast, you agree to not use this podcast’s medical advice to treat any medical condition, either in yourself or others. Consult your own physician or healthcare provider for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast. Welcome to the Coherence Code Podcast, where we explore how the mind and body work together so you can move from stress and inner conflict to clarity, calm, and alignment. My name is Lorne Brown. I’m a doctor of traditional Chinese medicine and a clinical therapist. And through my work, I’ve seen that healing happens when we remove what gets in the way and allow the body and the nervous system to do what they’re designed to do to heal. Welcome to the Coherence Code Podcast.

Lorne Brown 

We are back for part two with Dr. Mark Ratner. Now, I was saying on part one, we talked about PMOS, previously known as PCOS. So polycystic ovarian syndrome has a new name and it’s now called Polyendocrine Metabolic Ovary Syndrome. So there’s a new name. And so that’s the episode before. We just had a discussion on that and I was saying how he’s my first three-timer, Dr. Mark Ratner on the Coherence Code Podcast. Mark, we’re counting this still as a third one because it’s in one recording. No, no, we’ve released it as two parts. I don’t think it’s fair to call this episode four. So you don’t get your green jacket for five yet, but we’re getting closer. We’ll have you back. All right.

So this one, we’re going to talk about sperm and semen because it takes two to make a baby. It takes an egg and a sperm to make an embryo, which turns into a baby. And everything majority of discussions is around the egg and 50% of fertility issues are related to the sperm. So I thought it’d be important to have this discussion. For those that don’t know Mark, Dr. Mark Ratner is a board certified urologist, so he’s our expert when it comes to sperm. And he’s also the chief science officer of Theralogix, which markets micronutrient supplements with a focus on reproductive health. Dr. Ratner did his undergraduate and graduate studies in nutrition at Cornell University. He received his MD in residency training at Tulane University School of Medicine. And he was also at the Integrated Fertility Symposium that I had the privilege to chair and spoke there.

Want to give shout out to his previous episodes. Episode 142, Fertility, Fueling Fertility, NAD, episode number 142. So we had a real interesting discussion on their precursors of NAD and the Theralogix NAD supplement, or I call it NAD supporting supplement because it’s not actually NAD, but it supports NAD. And then episode 143 was on resveratrol at IVF. That was also great. That was a fun conversation we had. And then we just did part one on PCOS PMOS, and now we’re on part two on male fertility. Mark, welcome back to the Coherence Code Podcast.

Mark Ratner

Thank you, Lorne. Thank you. We’re all over the map for sure

Lorne Brown

Yes, we are.

You’re a wealth of information and I enjoy our conversations. So in the intro here, I shared guys are half the equation. First of all, why are they dismissed? Why is it that when I survey my colleagues informally, most of the people that come into the clinics are the women. Even when they know there’s a male factor issue, it’s the woman that comes into the clinic. So do you have an idea of what’s wrong with us? Lots, hey?

Mark Ratner

Well, look, for about 15 years, I was the director of male reproductive medicine at what at the time was the largest IVF practice in the United States. So I saw lots and lots and lots of couples where there was a male factor, there was a male fertility issue identified. The evaluation of a couple who comes in with infertility is a bit more complicated for the woman than it is for the man. For the man, okay, it’s basically give us a specimen. You basically provide a semen analysis. If the evaluations being done in a thorough and thoughtful way, it’ll be two semen analyses and you want to do those a couple of weeks apart. But back in the old days for a lot of guys, that was a somewhat, I don’t want to say traumatic, that’s probably overstating the case, but nobody liked going into

Lorne Brown 

I got to highlight something. First of all, a boo-hoo for the guy, he gets to masturbate at a cup. The women come in, their legs go up in stirrups. A male doctor comes in, is checking around vaginally, looking at things, probes, using terms like failure, advanced maternal age, poor quality, boo-hoo for us guys. But anyways, outside of that, you did say something that I wanted to highlight. You can comment on that, but I would love for you to highlight the two semen analysis. A lot of people do one and they think that’s the verdict. Can you just touch on that?

Mark Ratner 

Sure. So the sperm that are present in a particular specimen that a guy gives for analysis, it took the body somewhere between 50 and 70 days to make those sperm. And so anything that might’ve happened to him during that period of time that those sperm were being produced, being formed, could impact the results of that particular semen analysis. So if he had the flu and he ran 103 fever for three days in a row, if he went to Acapulco and sat in a hot tub for an hour and basically cooked his testicles, that’s going to impact a semen analysis, not permanently, but the point is that from one specimen to the next, there can be significant variation. So you never want to look at just one semen analysis and say, okay, we know exactly where this guy is. Now arguably, if the first one is perfect, perfect, there’s less

Lorne Brown 

Yeah. If the first one’s not good, you probably want to do a second one. If the first one is good, you don’t need a second one. And I do want to go back to my boo-hoo poor guy because relatively what the guy goes through is nothing what the woman goes through when it comes to diagnosis. However, I’m aware that there are IVF cycles that did not happen because the guy could not perform to give the sample on the day of insemination when the woman had the retrieval.

Mark Ratner

Oh, I used to see that several times a year.

Lorne Brown 

So I said boohoo, and that was for my women because that’s the majority of our listeners. I just want to say, because you guys are like, “Are you kidding me?” So I get it. And then for the guys, there are some people where whatever you’re social, religious, or however you are, that this is, as you said, traumatic for them. And so for whatever the reason, it is traumatic and they can’t give a sample and it’s the most uncomfortable thing they’ve ever done. So I do realize that is the case when I look at you as an individual. I just had to do a little something for the female because I know what they go through.

Mark Ratner

So I can tell you more and more of the IVF practices here in the days are using, there’s a couple of companies out there that will do mail-in semen analyses where you produce a specimen at home and you put it in a special container with preservatives and you send it through the mail. And the results have been validated as being pretty reliable. So some of that onus, some of that discomfiture is probably being relieved with that. But I saw many, many couples over the years where it was clear after his evaluation that the guy had a problem with his semen analyses. And for some men, it feels like it’s impacting their masculinity. And so there’s that psychological overlay of guys feel like this is sort of threatening their sense of manliness, that they don’t have enough sperm or their sperm are not swimming adequately or they’re misshapen any of the abnormalities that we would see potentially on a semen analysis.

 
So yeah, there’s a whole bunch of complicated

Lorne Brown 

They don’t like to come to doctors for whatever reason. They don’t. So it’s just a cultural thing. And for guys, I’m curious because you did this for so many years. When I ask the guy when I do see a man in front of me, and it’s so much better, I started in 2000, it’s 2026, we’re recording this. The number of men that are involved and come are much more, still nothing compared to how many women from 26 years ago. But pretty much when I asked the guy, “So why are you here?” They say, “My wife sent me.”

Mark Ratner 

Yes. No, I mean I lost track of how many couples I saw where the husband would be sitting in the chair with sort of a deer in the headlights kind of look in his face and the wife would have a legal pad and just be taking notes furiously. And we used to joke that you could tell the guy you’re going to have to stand in the corner on your head for 20 minutes every night if you want your semen analysis to improve. And the wife would say, “No problem. He’s going to do it.” They do it.

Lorne Brown 

So let’s set the stage here because we want to talk about male fertility and sperm quality. Our audience who’s probably listening are the women.

So we’re talking to them and then if they like this, they’re going to see if they can get their guy to sit with them and listen to it as well. And if you’re a guy listening to this on your own, awesome. You get started. So you said something about the heat insult. So when there’s heat insult, it can affect the motility or even the count. So because spermatogenesis is somewhere like that 72 to 90 days, if somebody did a hot tub or they had a bad flu, is it’s going to take 72 to 90 days before you see better sperm? Or is it 72 to 90 days there’s bad sperm? How does it work with the heat

Mark Ratner

Flow? It’s a question that has never really been tested out. Is there a specific part of that roughly 70-day timeline where it’s more sensitive to heat? In a sense, the scrotum, the scrotal sac is sort of a temperature regulating mechanism. For sperm production to be optimal, the testicle should be a couple of degrees cooler than the body’s core temperature. And so that’s why you’re really, really warm. Scrotal skin relaxes, the testicles are further from the body. It’s sort of a cooling mechanism. When you’re really, really cold, you jump in a swimming pool. As George Costanza said, you have 

Lorne Brown

I was just going to say the Seinfeld episode, it’s shrinkage, it’s the cold, the pool.

Mark Ratner 

Right. It’s the cold that basically cools everything up and makes it shrink. And that’s to keep things warmer. Yeah. So we don’t really know the answer of, but we know that doing them a couple of weeks apart, and this is especially important in clinical trials. There have been clinical trials where they enrolled men for male infertility or abnormal semen analyses, and they enrolled them based on one semen analysis and the results are invariably going to be almost impossible to interpret. That’s a whole other story. But nevertheless, two is really the best approach.

Lorne Brown 

Okay. And now there’s some at-home testing that’s getting better, which is great to hear. And then let’s go through causes and testing and then what’s available for the guy. So there’s a semen analysis. DNA fragmentation seems to becoming definitely in Europe, but even United States and Canada seems to becoming more popular. Do you subscribe to the idea that the semen analysis is kind of rudimentary? It’s been around for a while. Look at the shape, morphology, look at the count and motility, but it’s looking at the contents of the book without really reading the book. So you don’t really get a good read as if you read the whole book. And now we’re having more testing like DNA fragmentation, which may give us a better idea of the sperm quality. This is your wheelhouse. Can you tell me a bit about that?

Mark Ratner 

Sure. So DNA fragmentation has been around and proposed for use as a clinical test, I’m going to say for almost 20 years, maybe more. And point is that the head of the sperm, the sperm has got an oval head and then it’s got a little what we call a midpiece, which is like a little collar, and then it’s tail and the tail is what wiggles and makes the sperm swim along. But the DNA is in the head of the sperm. And so a test was devised. It was called the SCSA, Sperm Chromatin Structure Assay. That was the first one. And it was actually invented by a veterinarian. They used it to look at bull semen and everything. And essentially what it was doing, it was measuring whether or not there were breaks in the DNA in the sperm head. And they would say, what percentage of the DNA is fragmented, broken?

And when they first published their results, they said they tested this on a bunch of men when they realized it would have some applicability in male fertility and couples. And they said, if the fragmentation rate was 30% or higher, no couple ever got pregnant using those sperm. That was an absolute cutoff that if you had a DNA fragmentation rate, don’t even bother doing IVF. And the IVF world, understandably, they kind of freaked out a little bit about that data because it assessed it meant, okay, you should be doing this test. If that was true, it meant you should be doing this DNA fragmentation test on every guy who’s coming into a fertility clinic with his wife or partner and anybody who is at a certain point or higher, if they have too much fragmentation, just send them away. Nothing you can do for them. And then within a year or two, several other studies were published which said, no, that’s not right.

That’s not right at all. Here’s couples with fragmentation rates of 40% where they had babies. And so it’s not an absolute, but it has been shown that there’s a correlation. It’s not an absolute cutoff, but there is a correlation. The more damage there is to the DNA in the head of the sperm, the less likelihood a pregnancy is going to result. And that relates not only to natural conception, but it relates to IVF. And so typically sperm DNA fragmentation testing is not done as part of a screen because every IVF practice has had many, many cases where the parameters on the semen analysis that you were describing a second ago, the count, the shape, the motility, whether they’re swimming or not, they could have significant abnormalities there. But you can do a sperm injection, what we call ICSI, where you inject the egg with one sperm.

And even if that sperm doesn’t look particularly normal or doesn’t swim well at all, you can still get a pregnancy. So what we know is that those parameters that you were mentioning, the ones that are typically reported in a standard semen analysis, they’re not absolutes, especially in the IVF setting. You can use sperm that are what we call morphologically abnormal, meaning you look at them under the microscope in the head instead of being an oval head, it may be round or it may be tapered or it could be all crinkled. It can have abnormal shape. We call that abnormal morphology. That sperm can still fertilize an egg and make the baby. It’s not an absolute. But when you have a couple that maybe has gone through one, two, three IVF cycles and they haven’t succeeded, that’s when they typically will start ordering a DNA fragmentation test to see whether or not there’s a hidden problem with the DNA.

They’ll also order what’s called a karyotype. A karyotype is sort of a snapshot of the chromosomes.

Humans, people have 23 pairs of chromosomes, 22 pairs of somatic chromosomes, and then one pair of sex chromosomes, total of 46 chromosomes, 23 pairs. And there are actually instances where a man can have an abnormality in the total number of chromosomes, can have an abnormality in the shape of one of the chromosomes where he is missing a chunk of it. And that can be shown up on a test called a karyotype, which is a simple blood test. So it starts, the evaluation of a guy starts with a standard semen analysis. And like I said, it should be two at least a couple of weeks apart. If there are significant abnormalities, and there are some guys who come in and they end up having almost zero sperm or absolutely no sperm. And that’s what we would call severe male factor where production is dramatically lower in the testicles.

It’s almost shut off. Usually it can be shut off completely, but maybe sometimes there’ll be a few sperm there, but those can be used for IVF. But in those instances, there’s a much higher risk that there’s some sort of a genetic abnormality that’s underlying that severe abnormality in the semen analysis. And so you might do the karyotype blood test and the DNA fragmentation on those guys. So it starts with a semen analysis and oftentimes that’s all that’s going to be necessary for the guy.

Lorne Brown 

And I’m not sure if you’re familiar, there’s a study on DNA frag and IVF and it seemed like women over 40, then there was an issue with the IVF success, but if they were under 40, not. So again, it seems like if the egg is not as youthful, then it can’t repair because we’re aware that the egg does some repairing, right? Yeah.

Mark Ratner 

Yeah.

Lorne Brown 

Just like in life. When somebody marries us, they see us as a make work project. I’ll change him. So it starts with the insemination with fertilization. The eggs like, I can improve this. And they fix it, right? They fix the embryo.

Mark Ratner

No, exactly, exactly. They can basically edit the DNA where there’s a mistake and sort of correct. If the guy shows up with crappy DNA from that sperm that fertilized that egg, the egg can say, “All right, hang on, got some work to do here and correct things. 

Lorne Brown 

I’m not saying this is what’s to be done, but if somebody gets in their late 30s or 40s at least, then maybe the sperm DNA fragmentation is a valuable test since the IVF outcome becomes much lower if there’s a DNA fragmentation issue. 

Mark Ratner

That’s an interesting point. Yeah, I’m not aware.

Lorne Brown 

I’m thinking, just thinking. 

Mark Ratner 

Yeah, no, it’s logical

Lorne Brown 

Because an IVF is like here it’s about $25,000. If somebody’s in their forties with the amount of drugs and stuff, you guys got to check with your fertility clinics, but that’s what’s running through my head. And the DNA frag is about 600 Canadian here at our local clinic. So to me, maybe worthwhile. And then you know sometimes antioxidant therapy staying away from smoking and drugs and excessive alcohol may impact that where either the IVF becomes more successful or you don’t need the IVF because the sperm has been corrected.

Mark Ratner 

Yeah. And then one of the other things that has been shown is that if you have high DNA fragmentation in an ejaculate specimen, in other words, a semen specimen that’s produced, if you can retrieve sperm from further up the production line back towards… In other words, the sperm are produced first in the testicle. Once they leave the testicle, they go to a place called the epididymis, which is a duct that’s kind of behind the testicle where they hang out for a few weeks and they gain motility and then they go up the vas deferens, which is the tube that gets cut when a guy has a vasectomy. And that links the epididymis to what’s called the ejaculatory duct, which is right behind the prostate. And so then the sperm are in the ejaculatory duct for a while until they come to the outside. So it’s been very clearly shown that a guy who has DNA fragmentation in his ejaculate specimen, if you extract sperm directly from the epididymis, they will be lower in DNA fragmentation.

And if you go even further back and you extract sperm directly from the testicle, even lower, even healthier. So that’s another option. It’s a little bit more invasive obviously.

Lorne Brown 

Better sperm, maybe better embryo. So I just think the guys are listening here are very upset with this because their wives are like, “I don’t need him to do a sperm sample. Put them under, take it out, do the surgery, get the extraction.” What are some of the things then that can impact sperm quality? You talked about heat, viruses and flus if you get a lot of heat. I think COVID they saw in some of the sperm analysis. But what about SSRIs? Because a lot of people are on those. What about cannabis? What about you want to work out testosterone supplements? What about prescriptions for your hair? Can you share with some of the… There’s certain cardiovascular drugs too that can impact sperm from penetrating the egg. So just so people are like, “Oh crap, my doctor forgot to ask me if I’m on these or I’m taking these and they’re trying to get pregnant, how this could negatively impact.”

Mark Ratner 

Yeah. So I would say the two things that were most common for me to see in my practice that were impacting sperm quality were guys who were significantly obese. And then several times a year a guy would come in, built obviously a gym rat bursting out of his T-shirt and with no sperm at all. And it was pretty clear that he was taking anabolic steroids, testosterone supplementation, basically androgens will shut down your sperm production completely. And the reason that that happens is because sperm and testosterone are both produced in the testicles. They are produced in response to hormones that are released from the pituitary gland. There’s one

Lorne Brown 

From the brain.

Mark Ratner

From the brain, part of the brain. One hormone that’s called LH stands for luteinizing hormone. The other one is called FSH, follicle stimulating hormone. LH and FSH, they come from the same part of the pituitary and they kind of travel together. Sort of what happens to one happens to the other. So when your testosterone level in your blood goes super, super high, there is negative feedback inhibition on the pituitary. So it stops producing luteinizing hormone. Basically what the pituitary does is it says, okay, there’s a lot of testosterone in the blood right now. We don’t need any more luteinizing hormone. The testicles don’t need to make any more testosterone. We can slow down this LH production. That’s what happens to guys who take anabolic steroids or who take testosterone replacement therapy, which is extremely popular these days. There are companies online that’ll sell you testosterone you can inject yourself at home with.

You’ll get a doctor’s prescription with a 10-minute phone Zoom meeting with a doctor from the company and you can start, but it’s going to shut off your sperm production because it shuts off LH and FSH production in the pituitary. So as a result, your testicles don’t make any of the testosterone on their own and they won’t make any sperm either because the FSH is what makes the testicles produce sperm. So if you shut off LH and FSH by taking testosterone from the outside, you have no sperm production and you have no testosterone production on your own. So I used to see that several times a year.

Lorne Brown 

You said there’s two things. What’s the other one?

Mark Ratner 

Obesity.

Lorne Brown

Obesity. Oh the weight.

Mark Ratner 

And the reason that obesity is a significant issue is because there’s an enzyme that we have in our bodies, which is called aromatase. Aromatase is a natural enzyme that everybody has. And what it does is it converts testosterone into estrogen. So everybody knows testosterone is the male hormone, estrogen is the female hormone. Except men, they have lots of testosterone normally, but they also have a little bit of estrogen. That’s natural. They’re supposed to have that there. Women on the other hand, they have lots of estrogen, but they should have a little bit of testosterone as well. In an obese male, in a man who’s significantly obese, what happens is the fat cells contain a lot more aromatase, this enzyme, which converts testosterone into estrogen. And so those guys, instead of having a high testosterone and a little bit of estrogen, the ratio is out of whack.

Their testosterone gets lowered, their estrogen gets made higher because of that excess aromatization. The aromatase enzyme converts the testosterone into estrogen and that will impact sperm production. You can treat that with a drug.

Lorne Brown 

And fat tissue also just has inflammatory chemicals as well.

Mark Ratner 

No question

Lorne Brown 

Lots of bad. For the women, if they have a high BMI, does that mean they make more estrogen or how does that work for, does it the same?

Mark Ratner 

In theory it would. So here’s the point. In a high BMI patient with PMOS, formerly PCOS, be sure to watch part one if you haven’t, where we talked all about that. Yes, there’s excess testosterone, but it’s still nowhere near as much testosterone as a man would have.

Lorne Brown 

But it’s not because of the weight because you’re saying it aromatizes into estrogen. This is on an ovary level. Okay. Let’s go back to the guys. So you said there is a treatment for this.

Mark Ratner 

Yeah. Well, so obviously the best thing is lose the weight. And with the GLP-1s now, to be clear, I’ve been out of practice. I haven’t seen patients for several years now. I’m full-time as the chief science officer at Theralogix, but GLP-1s have become part of the landscape. It used to just be that they were for diabetes, now they’re for weight loss, and now we realize they’re good for reducing heart disease risk and they’re good for reducing cancer risk. I mean, it’s unbelievable, but they’re starting to get used in fertility clinics a lot. I know with women significantly, there’s been a controversial policy amongst a lot of IVF practices that they have a cutoff, a BMI cutoff for women. If a woman’s BMI is above X, I don’t know what X would be, but if it’s over 32 or 34, sorry, we won’t treat you. So now with the GLP-1s, they’re certainly putting those to use in that situation.

Whether they’re doing it with men who are obese is a different story. I mean, one of the things that I quickly learned when I started working with IVF practices is that most IVF doctors think, “Just give us a few sperm. We’re fine. Okay, that’s all we need. We’ll do IVF with ICSI, meaning we can… ” It used to be back in the old days when they did IVF, you would extract the eggs from the woman and those eggs would be put into a dish floating in fluid. And let’s say you got 15 eggs and you put them all floating in that dish, and then you would pour the sperm into the dish, and then you would put that in an incubator and come back 24 hours later and the sperm would’ve found the eggs and fertilized the eggs. And typically you would get about 70% of the eggs to fertilize that way.

That’s what we would today call conventional IVF. But the problem was that in order for that to work, you needed to pour into that dish. And At least a million swimming sperm. So if you had a guy who had severe male factor, meaning his sperm count was only a thousand or even just a hundred, they were out of luck. You needed a million in that dish for it to work. Then 25 years ago, they invented this technique called ICSI, intracytoplasmic sperm injection, where what they do is they literally take each egg under the microscope and they inject that egg with one sperm. So if you extracted 15 eggs from that woman during the IVF cycle, you literally just needed 15 sperm. There’s a tendency for men who have really, really low sperm counts to not even get a full evaluation in an IVF setting because the IVF doctors, they say, “We’ll get you pregnant.

And as long as we got a few hundred sperm to pick from, we’re good.” And they won’t necessarily take the time to send that guy to a urologist for a thorough evaluation. I would say that’s still not always the… By no means is that I would say it’s occasionally the case these days. More often now I think they will say, “Okay, we should touch every base. Let’s make sure there’s not something else going on with this guy that might even impact the outcome of IVF as long as they’ve got 100 or 200 sperm.” So the point is that there’s lots of things that can impact sperm production. There are genetic abnormalities, there’s diet and lifestyle things. There’s guys who take, they don’t even realize that they’re taking a supplement that’s got anabolic steroids. They just took something that somebody gave them at the gym. Yeah, I bought this at the gym and my friend told me it was really good for building muscle, and he had no idea.

I saw that part

Lorne Brown 

No concerns with creatine? That’s the most common thing that guys are using at the gym, creatine.

Mark Ratner

Creatine, no evidence that I see that it causes abnormalities with fertility

Lorne Brown 

Cannabis. I just going to list some things because this is what’s common, right? Cannabis is legal in most provinces and states. What about that as an issue for sperm production and quality?

Mark Ratner 

I don’t know what the latest data on that shows because cannabis today is very different than cannabis was 15 years ago, 20 years ago. Much higher content of cannabinoids.

Lorne Brown 

RDIs for now, here they say stay off of it. I mean, again, new studies will keep coming up, but currently they’re like, A, you don’t want to smoke anything smoking in general. But cannabis here, they still say we’re looking to improve sperm quality off of that. Are there certain prescription drugs for hair that can impact?

Mark Ratner

Finasteride.

Okay, so finasteride is a drug that was first released for prostate enlargement. Testosterone is the main male hormone, but there’s a subtype of male hormone called dihydrotestosterone. So we call testosterone T, let’s say, oh, so – and-so has low T, right? Well, dihydrotestosterone we call DHT. And again, there’s an enzyme that converts T into DHT. That enzyme is if you have a lot of DHT, it causes male pattern baldness and prostate enlargement. Those two things are caused by DHT, not T. So if you can block the formation of DHT, block the enzyme that converts T into DHT, you can slow the loss of hair in male pattern baldness and you can shrink down an enlarged prostate in an older guy. And so that’s what the drug is, finasteride. It was released originally for the prostate as proscar. And that’s a five milligram dose of finasteride. And then they realize, well, a lower dose will help with hair loss.

And so that’s propecia. It’s marketed as propecia, although it may be generic even in the one milligram dose. It’s only one milligram compared to the five, but those can impact sperm production. It’s not consistent. You’ll read studies that say it doesn’t have an impact. And then there’s other studies that say it does. I think the safe message is stop it if you can.

Lorne Brown 

Yeah, if you’re trying to conceive. Got it. And then any SSRIs?

Mark Ratner

I’m not familiar with that literature. I really am not.

Lorne Brown 

Then let’s go to things that the guy can do or their partner can influence them to do. So always the fundamentals, throw some steel around. So exercise, healthy weight, anti-inflammatory low-glycemic index diet. Again, we have a free book on the, it’s called the Acubalance Fertility Diet at acubalance.ca. Stress Reduction: Good Sleep. There’s the pillars of all health. And then scientific officer of Theralogix. What data research is out there to support sperm quality when it comes to supplements and diet?

Mark Ratner 

There’s several ways that supplements can impact sperm quality. The first is you want to use certain antioxidants because the antioxidants protect DNA quality. And that’s important for maintaining the morphology, the shape of the sperm, as well as the integrity of the DNA, which ultimately has to be intact enough to fertilize the egg and produce a viable embryo. So antioxidants are important. What are the antioxidants? Vitamin C, vitamin E, lycopene, very important. Selenium and zinc are both co-factors for enzymatic antioxidants in the body, so it’s important to keep those levels up. Our approach has always been that in developing male factor supplements, we have avoided using products or substances that are not naturally found in the body. So there’s something called pycnogenol, which is a very potent antioxidant that comes from pine bark, and it’s sold as a supplement. And there are a couple of studies that seem to show it might improve sperm production or sperm quality.

That’s the type of thing that because it’s not naturally found in our tissues, our medical advisory board has basically said, “No, we’re not going to include that.” So you’ve got the antioxidants. You’ve got what we call methyl donors. Methyl donors are something else to help with DNA quality. Those are typically going to be vitamin B12 and folic acid. And finally, you’ve got nutrients that can improve motility. Motility requires energy production in the sperm. For that tail to wiggle and make the sperm swim, you need a lot of energy production in the sperm and that comes from the mitochondria. So there’s really two primary nutrients that are very clearly able to do that to improve sperm motility. One is L-carnitine and the other is CoQ10. Both of those work at the level of the mitochondria to improve sperm energetics. You might say, well, what about NAD?

Lorne Brown 

I was thinking what about you have an NAD product? That’s good to know. So Mark, what about your NAD product?

Mark Ratner 

So the question is, if NAD can improve energetics in the egg mitochondria, and it’s been very clearly shown to do that, wouldn’t it do the same thing as sperm? So we looked at that. There’s a couple of studies out there, and one of them actually showed that they looked at men who were not necessarily being treated for infertility, but they just came in and had normal semen analyses and they correlated sperm count. The higher the sperm count, the lower the NAD content. And the guys who had the lower sperm count had higher NAD content, which would seem to indicate that increasing NAD levels in the semen might make your sperm count lower. So it stopped us in our tracks. I mean, there’s more data need. The studies haven’t been done. I mean one person said, “Well, maybe it’s a testicular response. Sperm production is under stress.

And so other things are driving sperm production down. And so NAD production goes up to try and compensate. Who knows? So that question hasn’t been answered yet.

Lorne Brown

And again, that’s because correlation doesn’t mean causation. So lower sperm count, you saw higher NAD, but there’s been not a study giving people NAD precursors to –

Mark Ratner 

Exactly.

Lorne Brown 

Okay.

Mark Ratner 

Exactly.

If there was, I can tell you right now, our product for women is called OvaNAD+. If there was data for men, we were going to call the product Go NAD+ or GoNAD.

Lorne Brown 

Love it.

Mark Ratner 

So it could be used for men or women.

Lorne Brown 

But that reminds 

Mark Ratner

It’s an inside joke for you.

Lorne Brown 

Right, I get it. But it’s kind of like when we did the episode on resveratrol where somebody saw, oh my God, resveratrol and implantation, and then you went to see it bad study and all the people stopped it. So to me, I bet based on how I understand my cellular biology at this point, that we’ll find that precursors and improved mitochondrial function, including the NAD will probably help. But I get why you’re waiting because how you guys run things until we see other stuff, we’re just going to wait because now somebody’s inserted doubt in our mind. So now that we’re aware of it, we have to take that into consideration. So here’s what I have so far, and then I have a couple questions. With the motility, you talked about CoQ10 L-carnitine. I’ve seen dosages for L-carnitine to be helpful for exercise and muscle strength and even fertility in that 3000 milligrams kind of dosage.

So I’m curious your thoughts on, you can have all the right ingredients in the product, but not at a therapeutic dosage. So I’m curious what you guys have done, but what do you guys are doing at Theralogix then for Male Factor?

Mark Ratner 

So we have two products and they’re both called Conception XR. One is called Conception XR Reproductive Health. The other one is called Conception XR Motility Support. The difference between the two, they both contain the same antioxidants, the same methyl donors, B12 and folic acid. They both contain lycopene. The difference is that motility support formulation contains L-carnitine and high-dose vitamin D because –

Lorne Brown 

Wait, you have vitamin D in there. Good.

Mark Ratner

Oh yeah, yeah, yeah. Yeah, for sure. Because those have been shown to improve sperm motility. Now, not every couple… Again, we designed these products because we knew how fertility practices would put them to use. A couple that’s doing IVF or IVF with ICSI with a sperm are being injected, those sperm don’t have to swim. They need to be alive, but they don’t need to be necessarily good swimmers because

Lorne Brown 

They’re going to be injected. This is where I see it differently. I understand why you’ll continue this, but I again think holistically. If the sperm isn’t a good swimmer, I just question there’s things that we’re missing that could be impacting the head, the DNA. We don’t know. The fact that this sperm doesn’t swim well holistically, why is it not swimming well? What else versus independence? That’s how I think. And your urologist, please use your scientific brain to think with my thinking.

Mark Ratner 

When they put the sperm and the egg together in the IVF lab.

Lorne Brown 

They take off the tail.

Mark Ratner 

Right. The person who does that, the embryologist who actually working under the microscope to inject that sperm, they do exactly what you said. They knock the tail off. They take the tail off the sperm or they crush the tail so it stops swimming. They will always pick when they’re going to decide which sperm am I going to use to inject this egg? They’re always going to pick the healthiest looking sperm. They’re always going to pick one that’s got motility. But here’s the thing, if normal fertility requires 50%… I’m sorry, if normal fertility requires 50% motility, meaning that at least 50% of the sperm are swimmers, but you’ve only got 10% motility and you want to try and conceive naturally or you want to try and conceive with IUI where the sperms still need to swim using something like carnitine,

Using something like CoQ10 can improve motility. But if you’re going to do IVF or IVF with ICSI, the problem with the carnitine is that it’s really, really expensive. So we created two products because the reproductive health product, only antioxidants and methyl donors, not intended to improve motility. And if you’ve got a couple that’s doing IVF or ICSI, that’s all they need. It’s much less expensive. On the other hand, if you have a couple that’s trying to do natural conception or timed intercourse or IUI and the guy’s got slightly low motility, you use motility support formula. It’s significantly more expensive because the L-carnitine is so expensive as a raw material. Now you asked the question of how much L-carnitine. And that’s a really interesting question because if you go back and you look at the history of carnitine supplementation, it started with a company that invented a product for children that had been born with an inborn error of metabolism.

It’s called L-carnitine transporter deficiency. What do carnitines do? Carnitines, they’re sort of related to amino acids, but in our cells, they deliver fatty acids to the mitochondria for energy production. Think of it as like they’ve got the shovel and they’re shoveling coal into the furnace. That’s what carnitine does. It delivers long-chain fatty acids into the mitochondria so that they can be burned for energy production. So babies that are born with this enzymatic deficiency where the carnitines don’t work properly, carnitine metabolism is messed up. They die of heart failure at several years of age. They don’t live long. But it was discovered that if you supplement those babies with carnitine, those young children with carnitine, you can overcome some aspects of this inborn error of metabolism. How much do you need to give? 3,000 milligrams. That’s where –

Lorne Brown 

I had the right number.

Mark Ratner 

That’s where that dose came from.

And so they started using 3,000 milligrams to basically treat kids who had no carnitine, no ability to metabolize carnitine in their body. And the dose sort of got repurposed for male fertility. The first company that came out with a carnitine product, it was called Proxeed. And we’re talking almost 30 years ago now. And Proxeed was from a company called, it was the name of the product. The company that made it was called Sigma Tau. They were from Europe. They were the sort of primary movers behind Carnitine supplementation. And so Proxeed had 2,500 milligrams of carnitines per dose per day, which was the amount of carnitine that you needed if you were born with this genetic abnormality, but not if you were just a guy who wanted better sperm production.

Lorne Brown 

So what’s the data that you found for sperm quality for L-carnitine that you’ve seen? What’s the science say that moves a needle?

Mark Ratner 

Well, there’s two different forms of carnitine. There’s acetyl-L-carnitine, and then there’s just L-carnitine. There’s some discussion that’s been going on for years as to which ones metabolize better. But certainly a thousand milligrams per day has been shown to significantly improve sperm motility in studies that have been published 15 years ago we’re talking. All

Lorne Brown 

Right. So in your product, just things that you want, you want antioxidants. So you want, like you said, CE, zinc, lycopene, selenium are important. DNA, the methylation, B12 folic acids, motility, you like L-carnitine, CoQ10, vitamin D. So if somebody was doing the complete package, now this is where my view of this is take money out of it. I’d want everybody to take the one with motility as well. You talked about saving money, so I understand that part. I’m taking the money out first and just saying, because to me, if the sperm, I understand they’re not worried about the tail, the motility because they’re going to put their head in, but I’m always thinking that the sperm as a whole, if it has motility issues, I just think it’s not a great quality sperm. You said they’ll pick up the other one. So I’m like, let’s just make the sperm as good as it can.

That’s just my strategy. So for the whole, you want to work on the whole health of the sperm, including motility. The L-carnitine in your product, what is the dosage? The vitamin D, what is the dosage? And do you include CoQ10 in that or do you have to do that separately? Because you do have a CoQ10 as well.

Mark Ratner 

Yeah. No, we have a standalone CoQ10 because to deliver CoQ10 effectively, it needs to be mixed with a solubilization agent. Absorption of CoQ10 is really difficult. It’s a very large fat soluble molecule. If you don’t use typically an emulsification agent, we use something that’s called a self-emulsifying drug delivery system in our CoQ10 product, which is called NeoQ10. And so it has anywhere from three to six times better absorption than a standard CoQ10 that you might buy at Costco or Sam’s Club. So the point is that’s a standalone product. In our motility support product, Conception XR Motility Support, that has a thousand milligrams of L-carnitine and it has 2,000 units of vitamin D. That’s taking two pills a day of that.

Lorne Brown 

Perfect. All right, good. That’s good dosage. And again, I think for people trying natural IUI, that would probably be go all in holistically. Again, taking money off the table. And then IVF, you’re saying a lot of the clinics would just do the conception XR without the L – 

Mark Ratner 

Yeah, it’s just called reproductive health. We sort of position that. You can think of that as a male prenatal. Okay.

Lorne Brown 

Got it. Nice. You guys put together some nice products. So as we wrap up here, guys eat well, excessive alcohol, smoking, avoid hot tubs and infrared saunas, careful cannabis. The debate’s still out there, but right now caution says no. If you’re taking things for a hair product, if you’re taking things to bulk you up, talk to your healthcare provider because it may be interfering with your fertility. And then we talked about diet, but there’s some antioxidant supplements that can also support the count and the motility, the quality. So that’s really good. Anything we missed that we should be talking about on that? 

Mark Ratner

I don’t think so

Lorne Brown 

Alright. I got to have you back again eventually to be that fifth episode. I really enjoy our conversation. 

Mark Ratner 

Same here, absolutely.

Lorne Brown 

And reminding everybody that there’s an episode on resveratrol, there’s an episode on NAD, so episode 142, 143. And then there was a part one to this episode on PCOS now known as PMOS. And so I thank you for your time and I thank you for people tuning into the Coherence Code Podcast, reminding you that on the acubalance.ca website, lots of blogs on men’s health and female fertility. And we have a fertility diet that is free to download. It’s an anti-inflammatory low glycemic index diet. And we have links that take you to Theralogix as well to buy their products on our site or just ask us how to access that. Mark, thank you very much. I appreciate our time today.

Mark Ratner 

My pleasure, Lorne. Nice talking with you.

Lorne Brown 

Thank you for spending this time with us on the Coherence Code Podcast. I’m Dr. Lorne Brown and I will see you next week for another conversation on coherence and healing. If this conversation resonated with you, please like, subscribe or follow the show and also share it with someone who might benefit from it as well. Remember to take a moment to breathe, reflect and stay connected. Welcome to the Coherence Code Podcast.