Conception

Let's start at the start: conception. My guest on today's episode is Dr. Joseph Alukal. He's a urologist on faculty at Columbia University where he is Associate Professor and Director of Men's Health. We cover a lot of ground, including all things conception. Somehow we hit birth control, timing, ovulation, fertility, infertility, endocrine disruptors, sex, sperm, eggs, and hot French underpants. Seriously. 

Transcript

Episode One, Conception

Bart’s Narration:

You’ve entered the story at an interesting time, for me.

My name’s Bart. I’m back in school, getting my master’s in Journalism. I’m thirty-three, I’m married to Taylor, and we’re expecting a baby this fall.

 Taylor has me listening to these podcasts...at first we were listening to these TTC podcasts -- that’s Trying To Conceive. It was a new term for me, but if you’re thinking about having a baby and you’re over the age of thirty, you’ve probably heard it, and maybe you’ve heard them. 

 Let’s rewind a little. 

 My parents pulled me out of the health class in high school because they didn’t teach abstinence as a valid form of birth control. They were just afraid that my high teachers would tell me to use a condom and everything would be fine. So I was to be homeschooled in health. Spoiler alert: that never happened. And we didn’t talk about it again for FOURTEEN YEARS. And I blame them for everythinnnnnngggg. Just kidding.

 So maybe other people already know all this stuff, but I’ve been fascinated. And even if you did pay attention in high school, you were probably too hopped up on zit cream and teenage hormones and no-reason-boners to pay full attention. Raise your hand if you spent half of highschool with a texas tuck. If you don’t know what a texas tuck is...you can google it. Just make sure safe search is on.

Conceiving is this thing that teenagers can do by passing each other in a crowded hallway. They’re just so freakin’ fertile. When you hit thirty, you start planning it out. You wait for the right time to have kids. You get your stuff together. You get your finances in order. You Die. Just kidding you don’t dieeee but when all the planning is planned, sex is another thing that gets planned. 

 So let me tell you our story.

 My wife had this app called Natural Cycles. It’s a form of birth control called the timing method. Or the cycle tracking method. Or the Basal Body Temperature method. It consistently ranks among the least effective on the internet, but to be fair I think part of that is diligence. Maybe some propaganda from the birth control companies? Big Pharma anyone? Conspiracy theories? Chem Trails? 

 Whatever, it’s a higher maintenance form of birth control but it’s also totally natural. No drugs, and no foreign objects in your body, you keep getting your period. Why am I talking about this and periods. Does everybody already know this? I had no idea. Whatever. Here we are.

 Web MD gives this “family planning” method a 93% effective score vs The Pill, which is 99.7% effective. So take that into consideration. I’m not going to go over all the different methods of birth control because I don’t want to, and you probably don’t care.

 Here’s how it worked in practice for us, or rather, for my wife. Every morning at 5:30am she would wake up just long enough to take her temperature, that temperature gets saved in her app.

 And You can’t use just a regular thermometer because the Basal Body thermometer measures your body temp in tenths of degrees -- so it’s super accurate. And that’s the data you need -- or your app needs -- in order to accurately predict your cycle. Because your temperature changes when you’re ovulating...I had no idea, that is freakin’ cool. WHAT”S THE POINT VENTURA? ONLY THIS!

 When I heard that my wife wanted to use the family planning/ timing method, I thought, okay this means we’re going to immediately have a baby. My grandmother used the timing method. We called it Catholic birth control. She had eight kids. My sister uses catholic birth control. She has nine kids.

 So I thought, okay we’re gonna have like fifteen kids because this method of birth control is actually not -- it’s not even real.  But it is real, and it did worked. The app shows you a calendar and it blocks off red days -- the days when the lady is ovulating and when she is fertile you should not do anything.

 After a while and some conversations and some are you sures, my wife used the Natural Cycles app to switch from don’t-wanna-get-pregnant mode to wanna-get-pregnant mode. The days of the calendar that are marked red, turn to green. Green means go. Go means baby, maybe. Maybe baby. For us it wasn’t instant pregnancy. It was about four months or so. 

 Some folks it happens immediately, some folks take over a year -- According to the Mayo Clinic, if you’ve been having unprotected sex for a year, and you’ve been careful about timing it, and you’re not pregnant, you should get your gear checked out. And by gear, I mean balls. And by balls, I mean testicles. And by testicles, I mean your nuts. And for some reason dudes always want to make the woman get her stuff checked, but men are 50% of the equation which makes total sense. So do your part with your part. 

Let’s dive into episode one where we learn about conception. I spoke with Dr. Joseph Alukal: Urologist  on faculty at Columbia University where he is Associate Professor and Director of Men’s Health.  And he’s a guy. He’s down to earth, he told me to call him Joe. …here we go!

Bart
So Dr. Joe, thanks for agreeing to talk with me today. I want to jump right into the middle of this thing. How many guys do you think actually know how conception works? 

Joe
I mean, I roughly estimate a single digit percentage. Okay, I'm not kidding. Like, I think the majority of people there's physicians I know who don't have an understanding of this. The majority of people I think, don't have a real concrete understanding of like, what's going on? Or what has to happen for my partner and I to have a kid, to get pregnant have a kid. So why is it that we're all sort of running around out there armed with almost no knowledge on this topic? I don't know. And I mean, and to your credit, you know, what you're doing today? Hopefully, we'll help more people to understand some basic parts of this that they need to have some knowledge about.

Bart
Yeah, well, I'm just playing the 99% that doesn't know what's going on. And I think I'd play that part pretty well. What I'm hearing you say is that I didn't miss anything and sophomore year health class, which is a great, great thing to hear. Anyhow, can you take us through exactly what happens during conception or for conception, or in order to conceive?

Joe
So obviously, you know, some part of it actually has to do with sex, you know, couple needs to be having intercourse at the appropriate time where the female partner is ovulating. And when people sort of asked me ‘well doc, is it that important?’ I'm like, yes, it's that important to the extent that there are people using that as their contraceptive method. The rhythm method depends upon the notion that there's certain times of the month where it's, it's really effectively impossible to get a woman pregnant. And you really can't get her pregnant any of the times that there isn't an egg somewhere in her reproductive tract, you know, so it's, it's been ovulated from an ovary, it's traveling through a fallopian tube and that's the ideal moment words, it's gonna get fertilized.  

Joe (cont.)

So conception during that time of the cycle, again, starts with intercourse, and the male patient ejaculate semen into the vagina, and some number of those sperm are moving better than the other sperm. They're the Michael Phelps and they're, they're gone like that. They are very quickly through the cervical loss into the uterus and then they're on their way trying to try to find this egg. And they're signaling there that goes on on a on a cellular level that we still don't fully understand. People have been trying to figure out with research, how can we actually sort of make the sperm more attracted to the egg in an effort to try and boost fertility and that's you know, that's been unsuccessful to this point. 

Joe (cont.)

But, you know, there's an observation about sperm that I think is simple and, and super important. You know, these are the only cells designed to survive inside of another organism. You know, when they're made with a highly specialized sort of functionality. It's half your DNA, some enzymes at the top of the thing that can actually bind and fertilize an egg, get the DNA into that egg and a tail and then some energy. And so you know, the the notion that evolution has resulted in these things working the way they do I actually always find fascinating sperm can survive for several days inside the female reproductive tract. And you know, the human body, the male body takes 74 days to make new sperm and so you know, they have a short lifespan, relatively speaking, you know, and in the course of your wife, you're just gonna make an innumerable number of them, you know, so the notion that there's all kinds of pieces of this from an evolution standpoint, that's really just, you know, it's it's difficult to fathom.

Bart
Hey, it's me. It's Bart. I'm breaking the fourth wall to tell you some stats about testicles and balls. So a testicle is packed with tiny tubes coiled into bundles, stretched out they could cover half a mile. There are 1000 New sperm produced every second. There are 100 million new sperm produced every day; two trillion over a lifetime. I guess this is in a healthy, typical set of balls. Each and every sperm is one of a kind carrying a unique genetic package. I want to tell you about the woman's ovaries. For a minute because we're going to kind of transition over there. A woman produces all the eggs she'll ever have at birth, and that translates into several million while still in the womb, then eggs begin to die. At age 31. For example, a woman may only have a few 1000 eggs left, which means that you could only have a couple thousand A few thousand, couple few thousand kids if you were to have each egg result in a kid, which is pretty unlikely just because the way that you know it takes nine months for…I don't need to explain this. You know this? Nobody no woman is having a thousand kids. 

Okay, I refer to -- a I'm apologizing in advance for the next few seconds -- I refer to ovulation as an “egg drop”, which is essentially what it is. But I guess I just completely forgot the word for ovulation. So here we go. 

Bart (cont.) 

If you have, I'm sorry, ah… If you have if you have 12…If the woman has 12 Egg drops… Do… do different women have different lengths of time that they are ovulating?

 Joe
Yes. So you'll certainly meet women and then you know obviously, you know, patients as part of the couple, who will tell you, you know, my cycle is typically longer or shorter than than other women. I know. And I think that number can be as short as you know, 2425 days and can be as long as 34, 35 days. So I mean it's not it's not routinely the sort of 28 day cycle that people think of, but far more women than not are on that cycle. The idea that a woman with a shorter cycle still probably has the same length of time a few days that that egg is is fertilized double in her reproductive tract. That's, I think pretty typically the same. I don't think there's anybody where you're really only dealing with like, you know, 12 for less than 24 hours as opposed to you know, a few days. And so what I tell people they should be doing is if they want to properly time their intercourse, they need to get some sort of ovulation indicator for the female partner…

Bart 
The ovulation indicator I was talking about before is an app. It's called Natural Cycles. And women can also get an ovulation test to figure out their fertility window.

Joe
They need to know that she has regular menses Okay, so even if it's 25 days versus 35 days or anywhere in between, her menstrual cycle should occur an even interval of days apart. If it doesn't, then you do need to have her see the OBGYN specialist, you know, immediately or even her regular OBGYN just to try to figure out why might her cycles be irregular.

Bart
You may be wondering, do I as a man need to be tracking her cycle? Not necessarily, but kinda because you are a team on this group project. And it’s good to recognize that you have to do very little in this entire situation. So the least you can do is know about this stuff. The middle you can do is care about it. Men are 50% of the equation so what can you do to make sure you're in optimal baby making shape? Meaning what can you do to make sure your swimmers are in the freakin lap pool bud?  

Bart (cont.)

Some of the things I was reading were like you know if you're trying to have kids don't go in hot tub, failure of saunas, no steam room. Like don't be a long-haul truck driver.

Joe
You know, it's tough. I mean, like, can’t tell that guy to quit his job and then the underwear stuff. Yeah, or the cell phone in the front pocket. I mean, right now I've got my laptop sitting on my lap. So I mean, you know, I remind people that if any of those things worked as well as the internet believes them to work, we'd be using them as a contraceptive device. Right. But that but that being said, you know, again, I'm talking out of both sides of my mouth. One, there were some researchers in France who came up with a wearable underwear item that was designed to reversibly cause infertility. That did actually work, but it was so uncomfortable that they were never going to be able to have any commercial success with it, but it depended upon changing the temperature in the testicles. Making things warmer and shutting off sperm making and it worked--

Bart 
--Okay, stop traffic. Well hitch heating underwear. I had to look into this. So we're going to take a tangent taking a trip to tangent town. (music:  Tangent town! Let's go!) The heating briefs are one of the available devices this method was invented and is prescribed by Dr. Mieusset at the University Hospital in Toulouse. I'm reading this from Wikipedia by the way, search “Heat-Based Contraception.” In 2019, a French news channel reported that only about 20 men were wearing this contraceptive garment in France. It's not sold on the market and a poorly handcrafted design can cost is comfort over irritation. No other Do It Yourself models called jockstrap or bra also exist… a ball-bra no doubt. I don't even, Wow. Okay, wearing the device that presses the man's testicles against his body on a daily basis can raise their temperature by two degrees Celsius, which translates to raising their temperature by 35 degrees Fahrenheit. I can't believe this never took off. But right now any woman who's listening is saying oh you want to talk about uncomfortable or inconvenience? Try having your periods not by chemicals or an IUD or one of the other things that I don't even know about. 

Joe
I think most people who tell me you know Doc, I'm in a sauna for like an hour a week. I'm like, keep doing it. It's good for stress reduction. And that's not enough heat for me to have to worry. Different from the guy who tells me Doctor, I'm a welder, and I have an acetylene torch between my legs for eight hours. A day and it's 12,000 degrees Celsius unlike that dude has a problem. I mean, that's that is a regular heat exposure that is way out of the ordinary. The bad news is I can't tell that guy to quit his job either. Right? Like I just tell him okay, you know, we got to figure out some sort of strategy over the next few months. You know to insulate yourself from that better than you have been, you know, how bad is a semen analysis, that sort of thing. But I think most people with the sort of routine exposures that they're experiencing, I don't think they can do meaningful amounts of damage to their sperm.

Bart
Can I ask you about alcohol, recreational drug use things that are all the rage these days?

Joe 
Certainly. I mean, the marijuana studies are pretty confusing. You know, some of them make it look like that it's deleterious. Some of them don't appear to show that and some of them may be alleging that there's actually a benefit. You know, and I think the bad news is that we don't have any clear-cut sort of standardization of either dosing or the method of administration. So you know, what's the difference between edibles as opposed to somebody who's vaping marijuana as opposed to somebody who's actually smoking marijuana? And I, you know, we don't have a concrete answer that one or the other of those is better or worse. Certainly, alcohol, cigarette smoking, you know, I can I can consistently tell people hey, you should stop you know, when it comes to drinking, you know, dial it back to something that we consider less than moderate drinking so less than two drinks a day and try and figure out a way to somedays not drink anything at all. And cigarette smoking is just a no no, you know, and other tobacco is a no no the nicotine is really, it's really unfortunate for sperm making it turns out. So those are simple lifestyle modifications that people can make that actually can have a pretty big positive impact. But, you know, again, for a million different reasons, it’s hard to get people to quit smoking.

Bart 
So last question, I read this book by Shana Swan, about endocrine disruptors being the next global warming, you know, I talked to a guy that you know, Dr. Robert Oats at Boston Medical Center who said, chill out, dude, it's not the end of the world. Relax a little bit. So in this book, for listeners, basically it's you know, men today are half as fertile as our grandfathers and it felt a little bit like the sky is falling. GQ, the Atlantic, the New York Times, all of the publications started pumping out these articles about like, hey, it's time to freak out human race. But can you tell us can you give us some, some peace of mind?

Joe
Sure. Certainly. And I you know, I love Dr. Oats. He's also one of my mentors and, and a real leader in our field and I think a great voice of like common sense and reason many, many times. And there aren't too many things that I disagree with him. About. And I do agree that in most cases, in most settings, I'm talking to people about this and I'm suggesting, hey, you know, I don't want you to panic about this yet. Maybe not the way we've understandably panicked about Coronavirus or gold global warming. But we do need to be researching these questions. You know, I think I think one way to look at the studies that Shana pays attention to is to try and pick them apart and to pay attention to things like both the bias inherent to Who are you doing this testing in many of those studies are coming from Fertility Center databases, so we don't know what's going on in the person who does not require a fertility center to have his kids. And then as well, there's a big change in the methodology of doing those tests over the past 50-60 years. And so as a result of that, you know, maybe what we're looking at is just that change occurring in these studies. 

Joe (cont.) 

But I think there's also the possibility that it's real, certainly the most recent study that came out and I got asked to comment on this on cnn.com years ago, and I wrote a piece talking about the idea Hey, we really do need to be researching these questions. It divided up you know, the the Western world, the non-Western world, and people pursuing fertility evaluation from people participating in studies just providing a sperm count as part of another research study that was being done. And it did look like there was a change in everybody in the Western world. So Fertility Center, not Fertility Center, and the patients in the non-Western world going for fertility evaluation, but not the people just sort of living you know, participating in studies and not having problems presumably having their kids and that's the first data that maybe think okay, so you could imagine that there's something we're being exposed to in the West alongside this drift or change in the laboratory methodology, you know, that again, I think is a big part of these studies and has to be accounted for somehow and there's no great way to account for it. Okay. 

 Joe (cont.)

So, you know, maybe we don't know what percentage of it is one effect versus the other. But if there's anything we're being exposed to, that's impacting our reproductive health, why would we not be studying it? You know, sperm are fascinating things your human body makes something like 1500 of them every time your heartbeats. So I'm actually not surprised that you can derange a manufacturing process that's moving that rapidly pretty easily. You know, things like estrogens in our plastics or our water, you know that they can be playing a much bigger role in this then than anybody realizes. And of course, it behooves us to learn more about it not stick our heads in the sand. I agree with Dr. Oats suggestion that you know, don't panic is always good advice, right? But I think this is not a case where ignorance is bliss and we should just remain blissfully ignorant. I think we should try and figure out as much of this as we can understand. 

Joe (cont.)

Certainly, you know, channels point years ago, I interviewed her on a radio show on Doctor radio Sirius XM that I used to do when I was again at a different institution and NYU and I believe it was her it may have been somebody else but I thought it was her who brought up kind of the story of BPA when you're talking about like a BPA free bottle. What is BPA? It's something called Bisphenol A, and it was actually first synthesized as a synthetic estrogen by a German chemical company in the 40’s. And it was so unsafe when they tried to test it in terms of its estrogenic effects that they tabled it and they had to move on to making a different compound and unfortunately, the compound they came up with was DES. Diethylstilbestrol, which ended up creating all kinds of problems on its own later down the road. But the bizarre part was that they didn't just leave BPA on the side of the road and try and forget about it. 

Joe (cont.)
 
Somebody pointed out that it worked very well as an epoxy. So even though they knew that it had this kind of, you know, potential for really bad estrogenic effects. They started using it to glue the bottoms to the sides of plastic bottles. And so when we talk about trillions of tons of plastic waste that you know has some of this stuff in it. I, I do think it's something that again, we should be paying attention to not ignoring, you know, what is our long-term strategy for handling that? How do we make sure that a mistake like that doesn't happen again? You know, I think these are all super important questions. They need to be paid attention to

Bart
Yeah. I just watched the movie Dark Waters about DuPont chemicals from Teflon. 

Joe
Oh, yeah. Well, 

Bart
It's stuff that makes your skin crawl 

Joe
Yeah, right. Yeah. 

Bart
So humans keep doing this stuff to ourselves, where we, we keep pushing the envelope in the name of ingenuity and coming up with things that destroy ourselves, you know,

 Joe 
Yeah, there's a lot of hubris in there. You know, the notion that that we ought to have at this point, figured out that, hey, you know, we're not perfectly capable of perceiving all of the consequences of our actions. Maybe we shouldn't rush into, you know, making more of these compounds, just, you know, making trillions of tons of these compounds, these kinds of things, and that we've got to be careful about our health and the health of the communities we live in. But I suspect that you know, you, me, and your listening audience are all preaching to the choir.

Bart 
Well, Joe, thank you so much for talking today. Really appreciate your time. 

Dr. Joseph local is a urologist on faculty at Columbia University where he is Associate Professor and Director of men's health. Thank you for listening. See you later.  

Bart (cont.)

Oh, you're still here. You haven't left yet cool. If you like this, you know what to do. And if you don't know what to do, here's something that you can do. You can give me five stars on whatever app you're listening to this on. You can write a nice comment or you can share this with your friends. You could do all of those things if you want or none of them. Next week, we're going to be talking about infertility and IVF and it's going to be a hard but really good conversation with one of my best friends, Bryan. I hope you join us. And I hope you have a great week. Okay, bye-bye.

Music Credits: 

Agnus Dei X - Bitter Suite by Kevin MacLeod is licensed under a Creative Commons Attribution 4.0 license. https://creativecommons.org/licenses/by/4.0/

Source: http://www.amazon.com/Agnus-Dei-X/dp/B00QGC7W3Y

Artist: http://incompetech.com/

 
Good Times – Patrick Patrikios

Homer Said – Dyalla