Sperm Analysis: How to Interpret Your Results (Episode 321)

Full Transcript: Episode 321

Lisa Hendrickson-Jack: this is the fertility Friday podcast episode number 321 welcome to the fertility Friday podcast your source for information about the fertility awareness method and all things fertility I’m your host Lisa Hendrickson-Jack I’m the author of the fifth vital sign and the fertility awareness mastery charting Journal I’m a certified fertility awareness educator and holistic reproductive health practitioner with nearly 20 years of experience teaching women to connect to their fifth vital sign through menstrual cycle charting balancing hormonal health and optimizing the menstrual cycle without hormones I’m outspoken about hormonal birth control and its impact on fertility and overall health because you have the right to know how your body works and how artificial hormones disrupt that natural process I host live coaching programs to help you achieve optimal fertility and health because it’s important to have healthy menstrual cycles regardless of whether or not you want to have babies I’m also a wife and mother of two beautiful boys I know I know I’m a busy girl but I managed to fit it all in this podcast is designed to empower you to take full control of your cycles your fertility and your overall health and I’m so excited that you’re here with us today in today’s episode I’m welcoming back my guest Dr. Sklar this is his third appearance on the podcast I previously had him back in episode 32 and 134 and so I’ll be sure to link our previous episodes in the show notes page but in today’s episode we are really getting into it we’re talking about how to optimize sperm health primarily and also how to optimize conception in general today’s episode is a great follow up from last week’s episode so in last week’s episode I interviewed Dr. Thinus Kruger and we talked all about sperm morphology and how Dr. Kruger’s classification system of the strict morphology really changed the way we look at sperm and the impact of sperm on the ability to conceive whether it’s naturally or through artificial reproductive technology means if you have experienced an issue with sperm quality with your partner or if you have concerns about that that’s a possible reason why conception hasn’t been happening this episode is really important in this episode we break down the different sperm parameters and in addition to that you know really help you to understand what that sperm analysis is all about and also providing you with very specific actionable information for what to do where to go next and how you can improve those factors to ultimately improve your chances of conception let me just take a moment to share a little bit about Mark for more than 18 years dr. Dr. Sklar aka the fertility expert has been helping couples struggling to conceive empower their fertility naturally with his online fertility programs and virtual consultations he’s the creator of Fertility TV a YouTube channel dedicated to natural fertility with over 100,000 subscribers the founder of the reproductive wellness clinic in San Diego California and the clinical director of MarcSklar.com helping couples via online programs and virtual coaching he has extensive experience and expertise in treating and resolving the causes of infertility and recurrent pregnancy loss with classical acupuncture and Chinese medicines a doctor of acupuncture and Chinese medicine board-certified herbalist and oriental medicine practice and the president of the American Board of Oriental Reproductive Medicine Sklar approaches his patients with an open mind compassion and a medically integrative perspective so without further ado let’s jump into my interview with mark

Lisa Hendrickson-Jack: so I’m really excited to welcome Mark back to the podcast thank you for joining me mark

Dr. Marc Sklar: thanks for having me I’m excited to be here again I love your work and and the information you put out so it’s always an honor to be with you

Lisa Hendrickson-Jack: well thank you and likewise and so this is your third appearance on the show which is fun and we were talking about what to focus on today and of course I want to focus on male factor I’ve been harping on male factor infertility for a lot of years inspired by you of course but you know I work with a lot of women who are trying to conceive and of course with the work that I do it’s incredibly helpful to get timing and to get rid of some of those myths around how to you know try you know day 14 let’s just put that to rest that myth but at the same time what I continue to see is this hyper focus on it’s almost like a blame game when there’s a fertility challenge still you know with the knowledge that we have even with the science it’s really focused on like I was literally just talking about this was a quiet before our call that our medical system typically just puts this the the sole blame squarely on women not that it’s a blame game but also really minimizes the impact of the male so yeah we’re gonna talk about a few other topics but I would really love to start there so can you share with us from what you’ve seen in your practice in the last few years has there been a shift what’s happening in terms of the way that mainstream medicine is looking at the male factor

Dr. Marc Sklar: I think there has been a shift from the public side of things I don’t think that there’s been a huge shift from the medical professional side of things there are a few male fertility urologist that I know that certainly you know that’s what they do so they definitely put an emphasis there but that aside I don’t think unfortunately there’s been a huge shift in the mainstream medical world when it comes to male fertility and you know you you you started off by saying this kind of this this blame game gets kind of thrown around and I think I would use the word responsibility or responsible party and they tend to put that on the female for a lot of reasons but I think the main one reason that they do it is that because of the technology that they have available to them on the conventional medical side of things that it’s really easy to put that responsibility on the female because that’s an easier gateway into their services and I don’t know if that’s exactly why but it makes a lot of sense to me right like if a male comes in and his sperm counts a little bit low and his swimmers don’t swim as well and maybe morphologies not perfect but it’s okay you know they don’t really have a lot of motivation to go on to really motivate patients to move forward with IUI or IVF because rightly so if they put in if that person puts in a little bit of effort on their part hopefully we’ll see some changes and they should be able to get pregnant and there is this understanding from either party but let’s talk about it from this side of things let’s say there is a male factor if the eggs are optimal they’re healthy the quality’s great hormones are balanced cycles are normal everything’s working properly in the female side there’s so much that can be overcome on the male side if there’s a deficiency there so you know there’s this balance and the end I should say as I alluded to earlier it also happens in Reverse right if the if there’s an issue on the female side and the male side is perfect it can overcome some of those deficiencies to a certain extent as well so there is this this back and forth with that and I just think from an IVF medical professional intervention perspective that it’s a much easier way to get patients in also if we start to take into account the psyche of the male and the female you’re gonna start to have women are more apt to kind of push forward with treatment men are not men tend to wait a little oh everything will work its way out or I’m okay or you know like my arms not bleeding I’m fine I don’t have to go to the hospital right it’s that sort of perspective where women are just really proactive something’s a little bit off because I want to get this taken care of so there’s also that aspect of things in terms of pushing that agenda if you will right you know that responsibility to have the burden put on the female in the relationship which is really just not the case it’s it’s really a 50/50 ballgame when we’re talking about responsible parties in this situation and I just had a patient who reached out to me actually they’re not even a patient yet it’s a follower and she reached out to me and she was asking a question we’ve had two miscarriages we’ve been trying for two years we haven’t had any testing yet and to my questions like well I’m going to my OB in two weeks what should I ask for and so my response back was so in two years you have not had any testing whatsoever with two miscarriages she said well outside of a CVC and maybe my cholesterol and so that to me already one shows negligence on the OB side of things and two just shows that there’s so much information lacking and education lacking when we’re when on the consumer side on the patient side of things to be able to make informed and proper decisions when they want to move forward on their fertility journey so and one of those as you mentioned is his malefactor and mail responsibility mm-hmm

Lisa Hendrickson-Jack: well I mean he said several things that stood out to me I think one thing that was interesting was that you said that it has you feel like perception has changed on the side of the essentially consumer but on the side of the patient and I’m assuming that you mean that people are educating them because if if something’s not working and you keep trying it eventually people are gonna say okay well this isn’t working let me see what I can learn what I can find out and then he also said that in many ways that kind of it made me think of that old adage or whatever like if if if all you have is a hammer everything is a nail or something like that right because you mentioned that based on the their services it’s easier to look into the female side because ultimately what do they have for the male side so right the woman who tuned into this specifically because it’s talking about because we’re talking about male factor infertility try to talk a little bit about egg quality and things like that but why does she need to know because I still this is one of the things that I just educate on all the time so I in the work that I do when I’m talking with clients I hate on you know the WHO very low minimum standards versus what the actual sciences would be optimal for natural conception and try to start a conversation there because client after client after client after client I’ve worked with has been told that everything is totally fine my favorite word fine normal they’re the same thing in terms of everything I’ve been told is normal yeah I hear he’s totally fine and and then when we look at the actual numbers I’m like well let’s break down what fine actually means so can we start there share with us so for the listeners you can realistic or pen-and-paper but I feel like everyone needs to understand the difference between what the lab results say and what’s optimal for kind of natural conception birds and bees in your house

Dr. Marc Sklar: yeah and this is from the male perspective like the male parameters so when when we’re looking at parameters there are three main parameters that we’re looking for now when you do a semen analysis there are more than just the three parameters it’s broken down much more than that we’ve got the way the semen looks and the volume and so those are definitely still variables that are important but they are not often the ones that jump out as being the most important okay not to say that if I see those we don’t want to address those also like you might see leukocytes so if there’s an infection that’s also absolutely something that needs to be addressed and it can show some underlying issues or or problems that weren’t you know you weren’t aware of so and I should just comment real quick the semen analysis is a wonderful tool for men to get a baseline understanding for where their overall health is at right and I just want to say that again to everybody the semen analysis is a great tool and test to evaluate a man’s overall health men don’t have a lot of markers to check in terms of their overall health women have their menstrual cycle and so many other things associated with that that are that can be seen very easily or relatively easily and regularly that give them an indication if they’re healthy and what’s potentially going on men don’t have that much and the semen analysis is one tool to do that and so when we’re talking about those parameters we want to understand the three main ones the first one is count sometimes seen as concentration we want the count to be as much as possible because all the other numbers are percentages of that count of that number and so we also have to recognize that the numbers I’m about to tell you today are not the same normal values that used to be okay in the past so count right now what’s considered normal is anything greater than 15 million now that’s 15 million sperm on an ejaculate are considered normal okay every man regenerates more sperm about every 24 hours so every 24 hours we want at least greater than 15 percent just me saying that sorry 15 million not percent so me just saying that I mean granted I know that I look at these numbers all the time but to me that seems really low in terms of the amount of sperm that meant that a man should be producing what used to be considered normal used to be eighty and a hundred million we’re now at 15 million so lots of questions arise when we start talking about that one is well why did it go down and why is 15 million enough right we’ll come back to that I’m just posing those questions we’ll come back to the list a little bit then the next number is motility the way the sperm swim in a forward progression so it’s not just so this is a percentage so it’s not just the total number here percentage here it’s also it’s broken down into the best swimmers as well and and just you’ll see that in terms of like a through D or one through four depending on the lab and what you’re looking for there is that you want most of those to be the top-performing right in the a or B groups of that so what’s considered normal here in terms of a total number is four forty percent that swim well in a forward progression and then we want the majority of those I would often say over fifty percent to be in those a and B groups and so that’s a that that to me is you’re saying that of the 15 million we want forty percent of that to be swimming strong healthy swimmers fast healthy swimmers okay so already we’ve taken that number for from 15 right to about mmm five or six okay that’s a low number then when we go we would break it down even more we’re looking at morphology the way the sperm look how many are healthy in terms of having one head one body one tail that are all normal shape that’s what morphology is so what’s considered normal now is anything over four percent now for anyone listening you’ve we’ve just gone from fifteen million to about five and a half and now we’re at four percent of five and a half I mean I’m not the best at math but that number is pretty low right so just just normal just listening to this we already everything is a percentage of that and the majority of sperm that men produce are already abnormal and that’s considered normal then we want as many healthy sperm as possible in that count because everything is based off of that and that’s also the easiest number to change and influence so 15 million to me is really really low I’ve heard some colleagues say two hundred million you know I just want that number to be as high as possible because everything else is based off of that so that’s the main breakdown that we’re looking at when we’re talking about a semen analysis

Lisa Hendrickson-Jack: well so that is essentially that the World Health Organization 2010 their standards and so when you’re working with a couple coming from a functional perspective what is optimal for natural conception because and and talk to us about that one

Dr. Marc Sklar: yeah I like that number because I think that when people hear that we don’t necessarily think to ask the pertinent questions which is has it been studied is there a certain level of sperm that is how do I I’m trying to think of how to say it is there a certain level of sperm below which it becomes more difficult to conceive or below which it takes a longer time to conceive or a lower percentage chance per cycle and of course the answer is yes it has been studied yeah look we we need four so those numbers and I’m glad you brought that up because I want to come back to that right now as we go into that other point or question which is these parameters I believe and no one has outwardly said this at least not that I’ve read but these numbers for me were determined based on IUI and IVF technology that these are the numbers that they feel are the minim amount needed to have a successful IUI I would actually say there specifically for IUI because for IVF you just need single one single sperm towards one single egg so depending on how many eggs are produced that’s the amount of sperm you need so you need ten or twenty or whatever that number is you don’t need millions right but for IUI you definitely need millions so these parameters were really created for a couple who are deciding if they want to go through an IUI and if the doctor feels like they have enough to actually have a successful insemination cycle but for natural conception I just think they’re way too low one is most couples are not just having intercourse once to achieve this or hopefully not just once to achieve this you’re you’re having intercourse every other day or every day in a window of time and so you need enough sperm that’s being produced over that course of time to give you an optimal opportunity and so for me I think I really shoot my magic number is 80 million when we’re talking about a count like that’s where I ideally want male sperm count to be at because I think that really optimizes everything else when we’re talking about percentages off of that can you also add your ideal concentration oh yeah but I think the more important number is not necessarily concentration its total motile sperm this is a number that is a calculation on the motility percentage and the I think it’s counter concentration and they’re doing the calculation the calculations actually not very straightforward so I couldn’t tell you exactly how they do it one of my colleagues went through it with me as a male urologist and we sat down and he worked it out I was like that’s way too complicated he’s like that’s why we have a computer that does it so but that number we really shoot for that number to be about 40 if we can get that total modal and often we’ll see it much higher than that if we have some decent numbers like 80 or 90 that total modal is really the key there when looking at an IUI and certainly for more so for IUI IVF again you can pick the one or two sperm or whatever number you’re looking for so that I think that’s really important but I think the reason why for me the reason why that count number we want to be around eighty is because when you’re looking at the health of somebody that the higher that number is the healthier they are in my opinion and so that’s a huge indicator for me in terms of the overall health and strength of that individual does it mean that those other parameters aren’t important but I think there’s a lot of potential other variables that come into play when we’re talking about those other parameters like morphology for instance that person could be totally healthy but have a structural issue that could be causing low morphology and that doesn’t mean that they’re not healthy they could have had trauma to the testes of their Casteel you know some sort of blockage but they could be totally healthy and every other in every other way so that’s why that count for me is there really is a big indicator for for that for their overall health and strength natural conception we want to really see those numbers be as high as possible I don’t often see unfortunately right now I often don’t see morphology go above 10% and patient very rarely I will and then I question it I’m always confused because I just don’t see it that often I do think we can see the motility definitely get boosted up quite a bit especially in those those first two areas those a and B you know how fast and how well those those firms swim in a forward progression and that’s really what you want you want them to be swimming strong healthy forward for natural conception we want more sperm because we need to allow that one or two to get to where they need to go and I often joke that sperm aren’t the brightest you know they they they have a single focus and that focus is based on a beacon between the sperm and the egg it’s not like they can find their way and you know they don’t have a map and they can’t once they get stuck in little crevices and holes they it’s very hard for them to get out of where they need to go so we need to have we need to maximize that with as many good healthy sperm as possible mm-hmm

Lisa Hendrickson-Jack: well so often if I have a some type of conversation around this and even just explaining what it means in terms of math I think it’s really helpful to to look at certain things in life based on math but if you have a certain count a sperm count and then you kind of break it down as you did based on motility and then based on morphology and you see kind of like that true number of potentially viable sperm or at least closer to the ones that would actually be capable of fertilizing an egg I feel like that conversation is often what is missing from whatever interaction that you have with your doctor because I’ve had this happen over and over again where it’s literally like the doctor said it was fine we’re normal or whatever they didn’t actually sit down and say anything about what it actually means what those numbers mean and what the implications could be and so then really you have a couple who just totally either just completely the woman completely thinks it’s her responsibility and completely thinks that her partner is completely fine because that’s what that’s what comes out of this conversation you know if no one goes through the analysis and just talks about it if no one talks in general about how in order to make babies that takes two people honestly I don’t what you said was none of the couples that you’ve seen the morphology was higher than 10% because obviously the healthy people that are I shouldn’t say healthy people but the couples who are conceiving easily are not coming to you for aspirin obviously not going for a sperm analysis but what I can say based on my experience so again this is take it or leave it but I just don’t believe that there’s any men out there that are just so healthy that they don’t even need to take a multi like I just I think that the concept that that these men are just so healthy that they don’t even need to even think about doing anything is completely insane but I’m curious to hear your comment on that

Dr. Marc Sklar: look the the I agree with you I don’t think you know I’m super conscious of my health and what I put into my body and what I do but does that mean that um the healthiest I can be no is there room for improvement absolutely do I have stress and I’m juggling all sorts of other aspects of my life does that impact my health yes are there moments where I don’t eat as healthy as I should or could absolutely so can we all improve hundred-percent and any man that says I don’t need to do anything better or different is just being delusional to themself right like we can all do better none of us are perfect including myself and I am telling you if you ask my wife she will tell you I am hyper sensitive and hyper aware of the food we buy and the things we eat and our environment and all those things but we’re not perfect we can’t be it just doesn’t exist right so can we do things to improve our overall health and our and our sperm a hundred percent we can all of us can all men can do this we need to figure out what it is that we need to improve maybe for some it’s not diet because you’re really good on that but you’re not great in another area you know maybe you don’t take some vitamins are the vitamins gonna be harmful not if you take the right ones so you know there are things that we can all do the main reason I said that I think that the public is more aware right now then they have been let’s say three or four years ago is because I do see one I see more husbands being part of the conversation I do see more more men wanting to take initiative and be and and be part of the solution versus part of the problem they want to be there to support their wife whatever they can do what’s my part I often hear them say so you’ve spent a lot of time on my wife is there anything I can do right so this is a huge change for me than what I’ve seen before and it’s really encouraging now I still see those who have never had a semen analysis done and you know when I asked they’re there when I asked my patient to say can you have your partner or your husband go and have a semen analysis done up put in the order they said no he’s not he’s not ready right now I mean this just happened last week he he’s not okay with it and I’m just baffled by the whole thing and I just said to her look if he needs a conversation with me just let me know I’ll put him in his place and let him know that he needs to go right now to go have it done I mean it’s not the end of the world let’s for all the men listening and for all the partners listening so you can chuckle a little bit and then push your husband to do it it’s like what’s the worst thing about them giving a simple they are having an orgasm like I mean of all tests that anyone can do in the world I mean they they have to give a sample and as a side effect they get to orgasm I mean there’s no test that a woman could say that they get that pleasure and enjoyment now yes is it awkward is it’s strange is aiming difficult a hundred percent but that doesn’t mean that they shouldn’t do it I mean I tell everyone when my wife and I were trying to have our first son again I didn’t know it’s gonna be a boy but it’s try to have our first kids the first thing I did when we said we wanted to try is I’m not waiting I’m gonna go give a simple and I did it for two reasons one is I won’t obviously wanted to make sure I was okay and the world that I live in you know it’s just something I wanted to check off but – I can’t have an HSG I I can have my hormones tested but it’s not gonna tell me the same thing as my patients I’m not gonna have an ultrasound a vaginal ultrasound I’m not gonna do any of those things I can’t right so I can’t connect with my patients in those ways other than what they tell me I can have a semen analysis at least to understand from that perspective what it’s like and so that’s the other reason why I did it so I’m telling you yes it’s awkward it’s not the end of the world

Lisa Hendrickson-Jack: well so for those nerves as we I mean I’m sure we could talk about sperm for a couple of hours but as we kind of I feel like one of the things that the listeners at this point are probably thinking is okay so I’m on board what are some of the things I can do kind of whether or not my partner has had an analysis done so just in the sense that you know there are general things so maybe we could talk about a few things that are known to impair sperm production and then just a few general things that can improve it of course if there’s the recommendation is of course to like get the sperm analyzed and then if there is a problem of course there’s more specific things you can do if you determine that but I think there’s still general overall things that can be put in place

Dr. Marc Sklar: oh yeah so I always come back to the foundational things for for all of us I’m sure you’ve talked about it many times on a myriad of podcasts that you’ve shared and I’m sure patients have heard me say this or listeners have heard me say this over and over but for men we want to I always say the foundational things have to be looked at first and foremost so we want to make sure the diet is locked in and healthy so how about being perfect it’s about being good you know you can have your flexibility but it should you know you should be minimizing junk food sugar sodas all the crap that we know is crap right like just because we like it doesn’t mean that we don’t know it’s crap and it’s bad for us but we still eat it so we want to we want to eliminate those things exercise is huge one aspect of exercise is we want to be careful of what we’re doing so I’m not the biggest fan of like long bike rides just because of the seat and most men who are going for long bike rides are wearing the tight spandex and all of that so you know that’s not my favorite thing doesn’t mean you can’t go on a bike ride no it just means you’ve got to be careful of how you do it but weights are great other cardio are great in terms of exercise and there was some research that showed that for men specifically the more exercise they did the better their parameters were when it came to their semen analysis period it wasn’t about tapping it at a number or anything else it was just more exercise equal better results so that’s a big one is that to do with I’m just carry so I do think that they didn’t break it down that way but I do think that has to do with testosterone levels the more weight you push and the more you exert yourself the more your body is creating and generating higher levels of testosterone so that is also for those of you who have low tea then that is a way to boost that up as well but I would kind of push more towards the weight side the weight lifting side of things and you really want to strain yourself a little bit that’s that’s the key when it comes to testosterone levels but I do think that’s why that’s why that that came out but they didn’t they didn’t analyze it sleep is a huge one you know we all are trying to cram in extra work or get more things done and so sleep is the one area that we’re either waking up earlier or going to sleep later and so that gets compromised sleep is essential here a minimum of seven hours of good quality sleep no excuses everybody will say to me oh but I function best at five that’s BS it’s not true like I’m telling your body might be used to five but that doesn’t mean your body functions best at five there’s no research that shows that five is better than seven or eight period so you know we got to work towards that managing stress is a big one as well and stress is not going to go away it’s how we manage it what we do to allow our bodies to recover better from the stressors that we deal with in life so those are some some key things know tight underwear no hot tubs no saunas or at least not it’s honest for an extended period of time and not regularly those are some key basics that I always tell patients also when it comes to diet we really do need to be careful about alcohol and in a day and age where cannabis has become much more readily available and more accepted throughout the country and the world I would say that we also have to be careful of cannabis and take that absolutely can have an impact on male sperm

Lisa Hendrickson-Jack: I was gonna specifically ask what that the cannabis the cigarette smoking and the alcohol and so yeah I didn’t mention cigarette smoking but that’s like in my mind that’s already a given of no yeah but I say it out loud obviously right for that for that purpose but one of the things because I worked obviously predominantly with women and what I find I mean we’re all human being so no one is perfect and you know sometimes when there’s a clear kind of sperm issue there’s also like a clear kind of it’s like that like a clear kind of factor that could be negatively impacting it mm-hmm so I’ve worked with a variety of clients for whom for their partner there’s like a thing that their partner is particularly whether it’s exercise or you know habit or whatever but there’s like a particular thing that they’re concerned about that like I’ve heard that this thing could be affecting it so when it comes to things like related to habits like alcohol smoking and cannabis what have you found in your practice if anything like talk to the women who are listening who are like yeah but my partner you know drinks a pack of beer like every other day and we talk about it yeah and if I bring it up it’s just gonna be another fight like what do you how do you address that those types of issues with your clients

Dr. Marc Sklar: it’s it’s so hard it’s it’s such a hard thing because we’re all attached emotionally mentally psychologically we’re all attached to these habits for different reasons whether it’s I will say for most people it’s a coping mechanism for stress so one is you’re never gonna get them to let go of that if they don’t find another way to cope with their stress so the first thing that I would say is that they have to find another outlet that allows them to manage their stress maybe that’s playing basketball maybe that’s you know weightlifting I’m first bad as I don’t like someone to go on a 10-mile bike ride I’d rather they do that then you know smoke cannabis right or drink alcohol so we’ve got to have a give-and-take here that being said it’s much that conversation is much easier coming from me than it is coming from you my wife if I tell her something it’s like yeah you just said this before you know it’s easy to ignore right the people that love you the most and that you love the most and that you’re closest to are the people that are the easiest to ignore for whatever reason I mean I just see this routinely if my brother tells me something like yeah whatever leave me alone you’re annoying right but if they hear the exact same thing from a medical professional or expert now you know Soto said that I should stop smoking what do you think about that well I’ve been telling you this for whatever amount of time and I just stopped so it’s just it’s an easier conversation for them to hear if it comes from somebody other than you as their partner and I think that’s that’s an important thing so I think they need to be part of the conversations part of the consultations with your medical professionals and maybe you give the medical professional a heads-up before so they can bring that up and address it with them I have more weight and have more ability to make a change because I can cite research and push your partner or husband to make those changes because the one point I’m gonna say to them is this do you want a child how important is it to you is the cannabis is the smoking is the alcohol whatever it is more important to you than having a child with your wife you can answer that question however you want it’s your decision not mine I’m not attached to it however I’d like to think that we can all agree that it’s more important so what are we going to do to give you that opportunity to be successful it’s not an easy thing anyone who’s been drinking smoking or smoking for a period of time or now I guess edibles for a period of time it’s not an easy thing to get to get away of but we’ve got get away from but we’ve got to come up with one they’ve got to be willing to do it and then – we’ve got to come up with a plan now does it mean it has to be all or nothing in all of these cases I’m ok with baby steps like I’m good if with a 50% reduction to start and then we go work from there right any reduction in those habits is going to yield a positive result in the area that we want

Lisa Hendrickson-Jack: oh that was good oh my goodness I just I think that’s one of the challenges because at the beginning of the call when I was talking about you know how the medical system addresses it I’ve also worked with clients whose partners clearly have an issue in one area or another and whose medical professionals have basically just not even mentioned it or told them that they were good and that also has a lot of weight when you’re sitting in a medical doctor’s office and they basically say he’s totally fine only for you to do some research into the sperm stuff find out that he’s not actually fine but what your partner heard from the doctor was like I’m fine yeah the guy in the white coat told me I’m okay so I’m good I’m good yeah not to change anything for all the listeners just like suggest this episode to your partners if they’re open to it use your phone and record what Mark just said like reverse back a couple minutes because yeah that was powerful and and ultimately you’re right and I completely agree with you that you know anyone who’s been in a relationship with another human being for a long period of time knows that you can say the exact same words over and over and it just doesn’t have the same weight as somebody else and it just is what it is and so yeah I couldn’t agree with you more on that so one thing I did want to ask to kind of squeeze it in so when I asked about the the parameters for sperm you asked me to clarify the male parameters or the you know the the parameters for women so would you be able to talk to us just a little bit about some of so kind of flipping over to the the female side what are some of those parameters that we’re looking at I know just to lead us into it one of the questions I get a lot is about AMH levels and could you talk to us about some of those parameters including AMH from what I’ve read in the research AMH is you know highly effective to predict IVF success but not necessarily the be-all and end-all for natural conception success so maybe take us through some of that so that we have a better idea of how that works

Dr. Marc Sklar: yeah absolutely so for any couple who’s been trying for look I don’t unless you’re really young I don’t really go off of that year Mark you know the real thresholds for testing and evaluation that your OBGYN are gonna base it off of are are you 35 or younger or 35 and older that’s their marker and from there if you’re younger they want you to have been trying for a year before they start testing unless you have some underlying issues that they’ve already been aware of and if you’re over 35 at 6 months my thing is if you’ve been trying for six months you know something’s off I just want you to start to get tested and and so and especially if they’ve been timing yeah right you know you’ve been exactly you’ve been Tommy you know when you’re ovulating you guys have been putting the time in during your fertile window and nothing’s been happening no I think it makes sense to at least start being proactive and start testing and that’s really what I try to in still in my patient base and my followers for every female you we start off with an HSG which is also known as the dye test I think in many communities in circles and that’s to check to see if your fallopian tubes are open right if that’s an essential piece for me if we don’t know if your fallopian tubes are open we still have a lot of questions unfortunately I’ve seen doctors never check it and start doing IUIs and not good situations I just don’t know how we could move forward with that so without that excuse me so we want to do it is it the most comfortable procedure no not necessarily if there’s no obstruction it’s less uncomfortable but it is an important diagnostic tool to use and then when we’re talking about lab tests which is really the next indicator but you know what now that I think about it before I do that if you haven’t been tracking your cycles if you haven’t been monitoring your cycles and so many women are not doing that and not educated on this piece and you can go back and listen to a ton of other podcast sessions on Lisa’s podcasts on this exact topic of tracking and monitoring your cycles and what’s normal and so on but we want to at least know that you’re having a good length of menstrual cycle or at least know what it is when are you ovulating what’s your fertile mucus look like like these are all diagnostic tools that are not super valuable to your OBGYN because they don’t really spend a lot of time with it it doesn’t mean that they’re not important and valuable but hopefully you’ve all already been doing that by the time you get to this piece and so now you’re looking for lab tests so when we get to lab testing in hormone testing I always start off with the key fertility hormones which are as you mentioned AMH anti-mullerian hormone which is an indicator for ovarian reserve how many eggs we have left theoretically that can be done on any day of your cycle I prefer to do it because I do see a difference when it’s done at other times of the cycle so I do prefer to do this at the beginning of a cycle when I do my other tests and then FSH follicle stimulating hormone la luteinizing hormone and estradiol which is one of your three primary estrogens those four hormones are essential to be done on day two three or four of a female menstrual cycle meaning that day one is the first day of bleed and you’re counting forward from there so that’s when those labs need to be done that’s not the end-all be-all of lab testing I’ll repeat a bunch of other I’ll say another a bunch of others right now those don’t necessarily need to be done on day two three or four but I typically like to do them all together to minimize the amount of trips you have to make to a lab so prolactin which is the hormone that increases when you produce breast milk DHEA which is a primary precursor hormone testosterone both free and total I do like to test progesterone here just to make sure it’s low because it should be low but the main time to test progesterone is actually seven days post ovulation to get a good proper reading of when that of what your levels really are and then I think what’s also really important is vitamin D and a full complete thyroid panel which is not just TSH which is thyroid stimulating hormone but all the other main thyroid hormones T3 and T4 and the antibodies as well mm-hmm

Lisa Hendrickson-Jack: well thank you for taking us through that I mean so we don’t I don’t think we have time in today’s called it like go through all of those hormones obviously but could you talk to us about image because that’s a big one you know I mean women have all these questions about it because you know the way the doctors present AMH is they say they basically say that it’s a representative of your age essentially essentially your ovarian age right and like I said based on the research on AMH it seems like the doctors kind of overstep because the research is is not saying that this is the be-all and end-all if you can or cannot get pregnant naturally the research does talk about the connection between IVF success so I just want to hear your thoughts on that

Dr. Marc Sklar: yeah I I agree 100% it’s not my favorite hormone to test I test it because I think I need to have that information for patients I don’t think it’s the fertility version of the best thing since sliced bread right it’s it’s okay it’s an important marker to understand but I don’t think it tells us everything AMH. The other issue I have with AMH is often a lot of the fertility clinics and OBGYN offices are really just testing AMH now and foregoing all the other labs so you just heard me say that whole list of tests that you should have done how many of you listening have actually had all those done by your doctor so they said yes we tested everything right because I know they told you they tested everything but they probably haven’t and then they told you yeah everything looks normal but does it really so you know most fertility clinics are just testing AMH now and maybe testing FSH and estradiol when you start a cycle but they’re really not testing it diagnostically so I would encourage you to have all of those things to get a clearer picture now AMH I find one of the reasons that I don’t put all my eggs in that basket sort of speak is because it fluctuates you know if AMH is a true indicator of ovarian reserve from everything we’ve all learned about a female body and reproductive system you only you’re born with all the eggs and you don’t produce more so if that’s the case and this marker is an indicator for ovarian reserve that number should never go up right I mean we’re just using logic here plain logic that number should never go up it should only go down over time yet we see it go up so then I have to ask myself why does it go up then I have to ask myself do I trust the number well I might trust the number if I’ve done it three or four times and it keeps coming back to the same but if it keeps moving and I know lab tests are just a snapshot on a given day at a given time so take that explanation what you will with it but if it keeps moving then I have to ask myself why is it me as a person is it the lab test I think it’s a little bit of both so one yes to your point Lisa AMH is primarily a good indicator for how you’re going to respond to an IVF cycle in terms of success it’s not a great indicator for if you will be successful trying naturally I’ve had plenty of patients with point zero five point four you know you name the number under one I’ve had it and they’ve gotten pregnant with those numbers so it can’t be in and of itself an indicator if you can or can’t get pregnant but then I start to have lots of questions about what it’s really telling us and I have my theories about it none of this is substantiated by research but I just don’t believe that it’s testing exactly what we believe that it’s testing so the MH is a marker that is being released by the follicle itself so if it’s testing ovarian reserve like they say that it should be testing the amount of follicles that are in the little treasure box and our ovaries right that’s hidden deep deep deep I don’t think it’s actually doing that I think that treasure box is locked and it can’t see inside I don’t think you can test that what I do think is and again this is just my theory what I do think is that we have a conveyor belt from that box to the end of our ovaries where the egg comes out to mature every cycle and gets released right to that follicle coming out and ovulating I think there’s a conveyor belt and each month your little treasure box is pushing out some ovaries some some follicles excuse me onto that conveyor belt and that’s the marker that it’s testing is how many are actually on that belt let’s just say for instance your body was under a lot of stress or things weren’t optimal maybe your ovaries say hey I want to hold on to some of these because I don’t know what’s happening and this is not an optimal time to get pregnant so I’m gonna lock up my box and save as many as I can so if it’s only putting out one on the conveyor belt at a time versus 10 or 20 which it could do to pick out the best one that it’s all–it’s has the test if it’s that’s what it’s testing is that one or that ten or that 20 or that five whatever is on the conveyor belt and that’s what it’s picking up so if you optimize fertility and reproductive function then there’s more being put on the conveyor belt that number rises if things go awry and the body’s holding on to more there’s less on the conveyor belt that number goes down so this is just my theory that I’ve had for about 10 years after watching levels go up and down and fluctuate over time it makes sense to me because this is what I see with patients as we optimize things that number goes up and things improve and if things aren’t great then they go down and so we see that number changes mm-hmm

Lisa Hendrickson-Jack: yeah I know it’s interesting and as you were saying the numbers go up and down I mean it’s well researched that women come off birth control the AMH number is lower and then both the hormones rebound and the cycle starts to normalize and I don’t know your body recovers from having this artificial splurge of home runs in your in yourself after a period of six to seven months that number does begin to normalize as well as ovarian reserve and all of those types of things I think this is this is the challenge for any practitioner who actually works with humans like the piece of paper and we started to it’s almost like we worship it or something we think that it’s infallible and we kind of bow down to this piece of paper when you as a human are standing in front of the the practitioner and what I found from all these years of interviewing practitioners is that when you’re speaking to practitioners who work with humans you know over decades the lab tests are an important piece of the puzzle but the human in front of you and their experience with how these lab tests you know accurately or not so accurately predict outcomes like this is this is why you need a person with experience to help you

Dr. Marc Sklar: it’s you know I had to hold back my laughter because it made so much sense but it brought so much joy to hear you say that look the just to your point the testing is important we’re not saying that you shouldn’t be doing the testing I start with all my patients you haven’t had the testing we have to get the snapshot we need to see where you’re at today knowledge is power knowledge and testing shouldn’t be fear and so we want to use that information to empower you as a fertility couple who wants to have a child to make better decisions about the path you should go on and how you want to do we want to empower you to move forward with a path that makes sense to you may that path make sense to some of you to be going down IVF our IUI sure it’s not my place to tell you my my belief is though that 80% of the patients and couples who go through IVF don’t need to be going through IVF my belief is that that knowledge has become fear fear to make choices that you wouldn’t have otherwise made at this time in your life and we want that knowledge to turn into power for you to make better choices correct those imbalances that are seen have a plan to do that give it the time to do it see the results and get pregnant naturally and I think that’s where the mix-up happens is we get so scared and feel pressured into making some of these decisions that we otherwise would not have made you know without the person on the other side of a desk in the white coat saying oh your fertility numbers don’t look good right okay so they don’t look good but what can you do as a person who is educated smart powerful you have the ability to conceive because that’s what your body is able to do and was created to do or one of the things that was created to do so what can we do to optimize that what can you do to empower yourself and your body to get pregnant on your own and often we don’t ask ourselves that questions we ask well what treatment can you do to me to get pregnant what pill can you give me to get pregnant I’m not saying those things aren’t valuable but I think we often forgo our power and our abilities and give it over to somebody else to make those choices and to get us pregnant versus you taking some of that responsibility onto yourself mm-hmm

Lisa Hendrickson-Jack: well as we draw to clothes and trust me I have like a hundred other questions I can ask but I’m and I rainin in so I do want to kind of get your sense like as a kind of last thought for the audience so and this is something I’ve been saying since basically the beginning of the podcast since I started broadcasting my voice across the airwaves but there’s always this idea that and it’s based on our allopathic medical model that if I have high AMH a high FSH high prolactin that there should be a specific supplement that I take that is going to lower that number on the lab and then that’s going to fix me and then I’m going to get pregnant and I’m not saying that there aren’t specific supplements that can’t help with those things but you said something towards the beginning of the call when we were talking about male fertility and you said that what a man does a semen analysis it’s a measure of his overall health and hello broken record your menstrual cycle is a side of your health and so you know when you’re getting these labs and you’re getting these results and the numbers aren’t showing up properly for the woman who’s looking at her lab right now and your prolactin is high and our FSH is high and I feel like yes it is but I feel like that’s a very narrow view because when you actually sit in front of a person and you talk through the complexity there is that that is their life and their health all of a sudden those numbers tend to make sense like there tends to be reasons why you’re seeing that so anyways I’m just if you could leave the listener with something just related to those numbers and how it relates to health what would you want them to know

Dr. Marc Sklar: look I think this information should really wake us all up when we do our labs they should wake us up to say well what can I do better what can I improve in my health to have an impact on these results when anytime I do work I want to look at okay well is anything off all right something’s off what am I going to do about it how am I going to improve my life to improve those numbers some of it might be a pill some of it but might be lifestyle changes I think the first question we have to ask ourselves is and I think we can all be relatively objective about this when we look at ourselves and give ourselves that opportunity to be objective is to say okay so something’s off what do I think I can do better with myself in my health to improve my body and make it stronger I think we can all look at that and say well oh my diet hasn’t been great I’m not exercising I can use more sleep maybe I do need some vitamins like I think we can all be relatively objective with this and if you can’t or you don’t have the understanding and I’ll tell you I don’t like to treat myself so I want somebody else to kind of be objective and look at me um then reach out to someone who can look at your case objectively and say okay this is what I see these are the things that I think you should be doing or places to start and I think that’s what we should all be doing we need to be open to change and improvement and that’s where it starts when we see these numbers and be able to say to ourselves what can we do I have a I have a fertility wheel that I call it it’s 12 different areas of a person’s life that we can objectively grade or score that gives you the ability to see if something is off or which area needs more attention just by grading it right and so you can always start there it’s a free tool but we all need to be first and foremost open to improving ourselves not only for the sake of improving your health so that you can live a healthier life too for improving yourself for your partner so that you guys can get pregnant and have a healthy child but also three don’t you want to be around and be healthy for your family and your children later in life so I think there’s so much around this you know it impacts today and tomorrow

Lisa Hendrickson-Jack: okay and just one more sorry but felt like it was important can you speak to fear so the fear when you see those numbers oh my goodness is this gonna work eating healthy you mentioned fear and how that is forcing us into decisions that we may otherwise not have made and so maybe speak to fear

Dr. Marc Sklar: look fear is really powerful III think much of our medical system today is based off of fear this is your lab test something’s wrong you need surgery you know where you need something I’m not saying that those things aren’t true I’m saying that I think those things can be communicated differently that we all don’t have to make choices out of fear if you look at a lot of the ads and so forth on TV it’s all the same thing right so for those of you this information doesn’t have to scare you into making choices that you wouldn’t have made what I hope is that that that that information wakes you up to making better smarter choices fear is a powerful decision maker if you will but it also only goes so far because that starts to tax our adrenals starts to tax other systems and then starts to send us into anxiety or panic and so and none of that is healthy for us either so as powerful as fear is I think hope and optimism and possibility are much more powerful tools and emotions that we should all be living in and hopefully those tests that you’re doing really start to wake you up to realize that you can do more look something’s wrong and that’s what those tests show you but it doesn’t mean that you have to lose hope and be scared about it it should really be empowering to you to say what can I do and I’ll tell you most of my patients who put in the effort the time to make the changes with the plans that we read up see the results that they want sometimes it takes it happens faster sometimes it takes a little bit longer but more often than not we see patients improve their health and their fertility by making the necessary changes now if you’re scared that maybe these things might not work out what I would tell you is always know that I think there’s always a path and a treatment option for you one way or another so I don’t think you need to be scared I think you know there’s always possibility right so I’m gonna start one way but if that doesn’t work out or doesn’t work out to the degree that I was hoping there are always other choices and other options for treatment and that’s where I think IUI and IVF come in and if you make those necessary changes now to improve your health and improve your labs even if you don’t get pregnant you’re going to have better outcomes in your IUI and IVF later on so the work you put in now is not for nothing if it does if you don’t get pregnant naturally it will make you a better candidate and patient should you move forward with those other treatments later on

Lisa Hendrickson-Jack: amazing words to end on I think it’s really powerful to surround yourself with practitioners at least some of whom truly have a belief that your body is capable of doing it I mean the let’s use the placebo effect to our benefit if you’re working with a practitioner who believes that your body can do this that actually has weight science has spent 200 years trying to stamp that out by doing double-blind placebo-controlled trials anyways thank you sir take care Mark it’s always a pleasure to talk to you obviously I could’ve talked to Europe we went two minutes over and I really appreciate you taking that time please let the listeners know how they can get a hold of you how they can find you social media but also work with you I’m sure that there are listeners who heard you talk and I like obtain my partner needs to talk to mark

Dr. Marc Sklar: the the most straightforward way to find me is on my website MarcSklar.com (marcsklar.com) I’m on facebook and instagram just type in the fertility expert my youtube channel which is a huge resource for all of my followers is Fertility TV you can always find me there but if any of you just want to talk to me or my team to see if and how we can support you on your fertility journey the most straightforward way to do that is to sign up for discovery call which is MarcSklar.com forward slash discovery call and we can see if we’re the right fit to work with you and support you on your fertility journey

Lisa Hendrickson-Jack: wonderful well we will put all those links in the show notes page thank you again for being here mark

Dr. Marc Sklar: thank you Lisa it was fun

Lisa Hendrickson-Jack: thank you for listening if you enjoyed today’s show please share it with a friend you’ll find the show notes page for today’s episode over at FertilityFriday.com / 321 I hope that you enjoyed my interview with Mark it’s always a treat having him on the show and I appreciate all of the information I mean this is an episode to go back and listen to especially if you’re dealing with specific issues related to fertility or related to male factor this is definitely an episode to listen to twice or to pull out a pen and paper and to take some notes I mean there’s just so much important information in here and it can’t be understated how important it is we live in a world where for whatever reason you know when a couple faces fertility challenges we look squarely at the female and ignore everything else even when there’s kind of like a glaring issue like an issue with sperm parameters if anything this episode should highlight the importance of having a good understanding of what is the difference between the bare minimum standards what they mean what they were intended for versus the optimal standards especially when you’re trying to conceive on your own naturally this information and knowledge shouldn’t be particularly difficult to find and it should be something that you’re you know educated about when you go to your traditional doctors and fertility doctors but sometimes it’s just not really discussed and described in such detail and I do believe a big part of the reason why is because of what the tools are what are the tools that your fertility doctor your medical doctor what are the tools that they have to support you when you face fertility challenges well it’s typically a combination of IUI or IVF or ICSI and in those cases since it primarily involves putting the sperm with the egg or injecting the sperm and the egg in the case of ICSI or or doing a sperm wash and placing it in the uterus when you’re bypassing the natural aspects of conception then the conversation does become differently and the quality of the sperm can fall to the wayside however when you’re trying to conceive naturally and you’re really wanting an answer of why is this not happening this information is vital because for many couples 50% is the number malefactor is at least a contributing factor if not one of the main factors and you know even if for no other reason just to know that you’re both in this together and there’s things that both of you can do to improve your overall chances of conception instead of having this myth that fertility and fertility or fertility challenges or women’s issue and and you know that’s just the end of that so I do hope that you enjoyed this episode with Mark if you know somebody who could really use this information today if there was a friend or colleague or someone who came to mind when you were listening to today’s episode please do share it the link again to share today’s episode is FertilityFriday.com / 321 and make sure to take Mark if you’re on Instagram take him at the fertility expert let him know that you loved this episode and I’m at fertility Friday of course so let us know if you appreciated that the episode and even let us know if you have additional questions about the topics that we covered and so with that said I hope you have a wonderful week weekend day evening afternoon whenever you’re listening to this episode and of course as always until next time be well and happy charting