0:02

Hi, I'm Rachel Sherriff

0:02

and welcome to the fertility

0:04

suite podcast. Our aim is to

0:04

educate and empower couples who

0:08

are struggling with all aspects

0:08

of fertility. By giving you the

0:12

information to make informed

0:12

decisions along the way. We've

0:15

had a little rebrand since

0:15

series one, we were formerly the

0:18

fertility method podcast. But in

0:18

this second series less assured,

0:21

we still have the same high

0:21

standard of fertility experts

0:24

coming to share their knowledge

0:24

and support you. So if you are

0:27

struggling with fertility,

0:27

miscarriage or you just want to

0:31

arm yourself with the facts, and

0:31

this podcast is for you.

0:35

Hello, everybody. And welcome

0:35

back to another episode of the

0:38

fertility suite podcast and

0:38

today joining us we have the

0:42

amazing Claire Mooney now Claire

0:42

is an embryologist and an

0:45

anthropologist and also the

0:45

founder of fertility solutions,

0:49

which is a specialist male

0:49

fertility clinic. And it's based

0:53

in Bekins field in partnership.

0:53

So welcome, Claire, thanks for

0:56

joining us. Good morning, Rachel, thank you

0:57

so much for having me on. I'm

1:00

honoured and excited. I'm excited. I know this is

1:03

going to be a great episode,

1:05

you've just got so much

1:05

knowledge and experience. So I

1:08

think today we're going to talk

1:08

about sperm DNA fragmentation

1:11

and sort of issues that may

1:11

affect sperm quality. So if

1:14

you're listening, and you've

1:14

perhaps had unsuccessful IVF, or

1:18

you're struggling to get

1:18

pregnant naturally. Or you might

1:21

know that there are some issues

1:21

with the male side of things,

1:24

but you're not really sure what

1:24

then this is the episode that's

1:27

really going to help you and

1:27

Claire has this amazing amount

1:31

of information that is going to

1:31

make things so much easier for

1:34

you to understand. So let's jump

1:34

straight in Claire. So let's

1:37

start talking about sperm DNA

1:37

fragmentation. So what is it

1:40

like for people listening? What

1:40

is DNA fragmentation?

1:44

What a great question. And I

1:44

think 10 years ago, the answer

1:48

for me would have been full. Not

1:48

sure. But my background is

1:53

embryology and it is years of I

1:53

hesitate to say helping couples

1:59

because I think unfortunately,

1:59

in my in my previous life, we

2:02

probably didn't help as many

2:02

couples as I would have liked.

2:06

And DNA fragmentation sort of

2:06

came into my life about 10 years

2:10

ago when I when I set up

2:10

fertility solutions. And it is

2:16

what to give you sort of a

2:16

summary. It's a much more

2:18

advanced sperm test, that

2:18

actually probably is more

2:22

relevant I feel than a semen

2:22

analysis alone. And when you

2:27

have a normal sperm count,

2:27

obviously, a lot of your

2:30

listeners will have had their

2:30

partners will have had semen

2:32

analysis. And that's where we

2:32

look at the number of sperm, how

2:35

they're swimming, what kind of

2:35

shape they are any evidence of

2:38

maybe obstruction or infection,

2:38

but it's quite basic. If I told

2:42

you, Rachel that 20% 20% of men

2:42

that have a normal semen

2:46

analysis are profoundly

2:46

infertile. Would that shock you?

2:50

Because it because it certainly

2:50

shocks 90% of the people that I

2:53

speak to? Because and it's and

2:53

it's really obvious as to why

2:57

that that would be the cause

2:57

because sperm our DNA with a

3:01

tail. Their whole purpose is to

3:01

get from from the woman's vagina

3:05

up to the fallopian tubes and

3:05

fertilise the egg but that's so

3:09

the sperm themselves are just

3:09

vehicles. And when we're looking

3:13

at the vehicles, we can say yes,

3:13

there's lots of sperm there.

3:15

That's great. The testicles

3:15

making sperm and the sperm is

3:18

swimming, the head shape, but

3:18

we'll talk about that later. I'm

3:21

not overly sort of fussed about

3:21

head shape in certain

3:24

circumstances, but actually

3:24

looking at the inside of the

3:27

sperm the DNA, the actual bit of

3:27

the sperm, the fundamental

3:30

component that makes the baby

3:30

logical, right? I mean, it's

3:34

logical that you would look at

3:34

the actual business bit of the

3:38

sperm, which is the DNA. So what

3:38

we do or what we now do over the

3:42

last 10 years, is we have ways

3:42

of looking at how healthy that

3:47

DNA actually inside the sperm

3:47

head is. And if you imagine I

3:52

like to think of it as a row

3:52

patchily DNA is quite coiled

3:55

like that. So if you imagine a

3:55

very frayed rope, imagine a

3:59

frayed rope, you know that that

3:59

ropes not looking that great.

4:01

And what's time to replace the

4:01

rope? Maybe it's about to break.

4:05

That is what frayed sort of what

4:05

that is what Hi, fragmentation

4:08

in sperm looks like. It looks

4:08

like a lot of breakages within

4:12

the DNA. And when you've got

4:12

that when a man's got that, and

4:16

we've measured that, and we can

4:16

see that's the case. We know

4:19

that he's much more likely to be

4:19

suffering from infertility. And

4:24

I suppose at that point, what we

4:24

know is that in I mean, I always

4:29

I wouldn't say get excited when

4:29

I see high fragmentation that

4:31

might not be the right word.

4:31

Because obviously by the time

4:34

people find me, we're talking

4:34

miscarriage failed. IVF very,

4:40

quite understandably upset,

4:40

upset patients, but I'm worried.

4:44

But when I see that I know that

4:44

it's, this is and this is the

4:47

important thing. It's

4:47

improvable. You see, you know

4:51

eggs is eggs. I mean, I'm 50

4:51

years old, I certainly can't

4:55

have a baby anymore. And women

4:55

are born with all of their eggs.

4:59

But sperm isn't Like that sperm

4:59

is constantly made in a

5:03

testicle. And if the DNA

5:03

fragmentation is abnormal, so if

5:07

the frag, if the DNA inside the

5:07

sperm is normal or abnormal, you

5:11

can do so much more about that,

5:11

because men's fertility is

5:14

highly improvable. So it totally

5:14

makes sense to understand not

5:19

just how your sperm are looking,

5:19

how they actually are inside

5:25

what's going on inside the

5:25

sperm. Because a lot of our

5:29

mistake, actually conversely,

5:29

that a lot of people come and

5:32

see me with all kinds of strange

5:32

shaped sperm, it's actually

5:35

really normal for sperm be

5:35

abnormally shaped and a human.

5:38

If I could show you mouse versus

5:38

human sperm two might do at some

5:41

point, it's very different. It's

5:41

very, very different. And it's

5:44

very normal for us to have very

5:44

abnormally shaped sperm. But

5:48

what we do know is that some

5:48

people with very abnormally

5:51

shaped sperm with normal

5:51

fragmentation levels are much

5:54

more likely to be fertile. So it

5:54

isn't also about finding the

5:58

infertile man that we can

5:58

improve and help. It's also

6:01

about finding the fertile one.

6:01

And so you can say, well,

6:05

actually, we don't think it's a

6:05

male factor. In fact, Rachel,

6:09

I'd say, of the people that come

6:09

and see me half of them maybe

6:12

more, I usually say I don't

6:12

think this is a male factor. I

6:16

think this is egg and sperm

6:16

meeting, or another issue, or an

6:20

issue with the endometrium, or

6:20

the fallopian tube or your cycle

6:23

or something else. So it's

6:23

really important to use this

6:27

test, in my opinion, as a way of

6:27

triaging what's actually going

6:32

on with the carpal. And we've

6:32

got an obligation to do that.

6:35

Because even when you're young,

6:35

even when you're in your 20s,

6:39

and your annual partners in his

6:39

20s, you can still have

6:42

fertility issues. Even when the

6:42

man has had a baby, maybe the

6:47

previous partner maybe three or

6:47

four years ago, or, or sooner,

6:51

you can still have male

6:51

fertility issues. And male

6:55

fertility issues are treatable.

6:55

They are treatable. And so if we

7:01

don't look at the man, we're

7:01

missing half of the puzzle, and

7:05

we're missing the treatable half

7:05

of that puzzle.

7:09

Yeah, I think I love what you

7:09

said about the sperm being a

7:13

vehicle for DNA. It's basically

7:13

like a DNA bus. Right? And you

7:16

can't, you can't see in a bus, I love

7:17

it, you know,

7:21

the DNA bus analogy of things. That's

7:23

exactly right. But

7:26

then you can't see that DNA on a

7:26

basic sample, which is why it's

7:29

really important to have the

7:29

sperm DNA flag test. And I

7:32

really liked what you said

7:32

again, about triaging. So, this

7:35

is what we do in our clinic all

7:35

the time, we're triaging people.

7:37

And actually, if you can

7:37

eliminate male factor, hopefully

7:41

as a potential calls is a

7:41

massive tick in that box, and

7:45

you can move away from spending

7:45

your time and efforts there and

7:48

you can focus on other things.

7:48

And I think that isn't, you

7:51

know, diagnostics is really

7:51

important in helping you to get

7:53

to the bottom of why you've got

7:53

unexplained infertility or why

7:56

you're having unsuccessful IVF.

7:56

You know, if you can run that

7:59

test, and you're basically

7:59

helping yourself to understand

8:05

what might be causing the issue.

8:05

So, again, you know, that I

8:08

thought that was interesting what you said that actually, there's a large proportion of

8:10

your clients where everything

8:13

comes back. Okay. Exactly. And that that's so

8:15

important for us because it's

8:19

about Well, for me, it's about

8:19

assessing this on all different

8:22

levels. So it's about saying,

8:22

hang on a minute, what's going

8:25

on with the couple because you

8:25

can't exclude the woman

8:27

obviously, we don't want to make

8:27

the same mistakes that are

8:31

sometimes gynaecological

8:31

colleagues might be making

8:33

sometimes by not sort of looking

8:33

at the mind. So you have to say,

8:37

well, you know, what's happening

8:37

with with with with the female

8:40

partner? Are, is there a cause

8:40

of infertility that's actually

8:43

been diagnosed and identified?

8:43

Does she have blocked fallopian

8:47

tubes? Because if she does, then

8:47

IVF is the next logical step. I

8:51

would agree with that. Because

8:51

you egg and sperm can't meet but

8:55

making sure that sperm is good

8:55

quality is so important, because

8:59

even if you end up having IVF

8:59

it's not the universal answer to

9:04

fertility problems. Because if

9:04

it was, I wouldn't be sat here,

9:07

I'd still be in a lab somewhere

9:07

as an embryologist, you know,

9:10

making 80 to 90% of my patients

9:10

smile and happy. But the reality

9:15

is, is that in the UK, the

9:15

National live birth rate for IVF

9:19

treatment is around 30% at best.

9:19

So there are obviously 70% of

9:27

patients end up with out a child

9:27

having spent eight to 10,000

9:32

pounds on average. Now, if you

9:32

if you actually reverse that,

9:37

and you look at the man and you

9:37

eliminate the man or you improve

9:41

the man's sperm such that it's

9:41

he's got low levels of

9:44

fragmentation, and good quality

9:44

sperm. That statistic goes up to

9:48

70%. It does for us with with

9:48

our fertility consultant, so I

9:55

see no reason why that couldn't

9:55

be a universally applied

9:59

statistic. because we're not

9:59

wizards, you know, we're we're

10:04

scientists, but we're applying

10:04

really good science to what's

10:07

wrong with patients. So there's

10:07

no reason to suggest that by

10:11

examining the man really

10:11

carefully from the beginning,

10:13

the beginning, the beginning,

10:13

please the beginning, not not

10:16

not five years after, then from

10:16

the beginning, you can actually

10:19

increase those statistics, I

10:19

know that you can. I mean, there

10:23

are there are obviously groups

10:23

that are doing that now. And in

10:26

the States, they're doing that a

10:26

lot more. And, and in Europe,

10:29

they're doing that a lot more as

10:29

well. Because what we have here

10:33

is we have this system whereby

10:33

we have the National Health and

10:36

and don't get me wrong, I'm very

10:36

proud of our national health,

10:40

because it's it applies to

10:40

health care for people that

10:42

couldn't afford it. It's a very

10:42

good philosophy. But its problem

10:47

with fertility is that it is so

10:47

limited in its budget, and what

10:51

it can do, and the answer to

10:51

every problem, all IVF problems

10:56

is, so it all, excuse me every

10:56

fertility problem with IVF. Now,

11:00

I like to analogize this

11:00

sometimes to heart surgery. So

11:04

imagine that the answer to every

11:04

person that had a cardiac issue

11:09

was a heart transplant. It's

11:09

okay, your heart's beating too

11:13

fast matter, we're going to

11:13

change your heart, we're just

11:16

going to give you a new one lie

11:16

down, you might die, you'll be

11:19

on immunosuppressive therapy for

11:19

the rest of your life. But we're

11:22

going to do this. So it's just

11:22

about what we need to do is just

11:26

apply really good diagnostics

11:26

and science to what's actually

11:30

wrong with the couple. And that

11:30

applies to men and women. And

11:34

once we do that, there's no

11:34

reason why why a more sort of 50

11:38

to 70% pregnancy rate with IVF

11:38

couldn't be achieved, saving the

11:41

National Health millions of

11:41

pounds, maybe billions. So it's

11:47

so logical. Sometimes my

11:47

patients say to me, well, it's

11:50

why haven't somebody else done

11:50

it? Why are you the only person

11:53

doing it? And it's historic,

11:53

essentially. So fertility is

11:58

seen as a female issue. It has

11:58

been throughout the ages, you

12:01

can go back to Biblical times,

12:01

and it was seen as a female as

12:05

an as a female issue, not a male

12:05

issue. Even when it was clearly

12:10

a male issue. I had many, many

12:10

wives and none of them got

12:14

pregnant, and then they got

12:14

pregnant with other men, that

12:16

that is documented. So it's a

12:16

historic thing, but we can but

12:21

this is 2024. This is what I

12:21

find. So I don't know, surprise.

12:26

I'm with you. And it's 2020

12:26

bore. And yet, we're still not

12:32

saying from the very beginning

12:32

when a man and woman walks into

12:35

the GP practice. Well hang on a

12:35

minute, a year's trying, you're

12:40

only 25 You've had children,

12:40

maybe from a previous

12:43

relationship. Mm hmm. More

12:43

likely to be a man to be a male

12:50

and male fertility issue. Let's

12:50

send you for all the assessments

12:54

to see a urologist Of course,

12:54

which is super important. There

12:57

are lots of wonderful

12:57

gynaecologist and I work with

12:59

them. But your ologists I

12:59

honestly think there are under

13:03

20 urologists in this country

13:03

that really specialise in

13:07

fertility at the highest

13:07

possible level. The top of that

13:11

tree is a gentleman called

13:11

Jonathan Ramsey. And Mr. Ramsey

13:15

is, well a world authority now

13:15

on men's fertility. But that's

13:21

the other issue we have is that

13:21

it's like brain surgery, almost

13:24

that there are very few

13:24

individuals that are highly

13:27

highly specialised in men. And

13:27

we definitely need to work to

13:31

change that. And really the

13:31

changes Rachael needs to come

13:34

from the National Health in my

13:34

opinion. That's where this needs

13:37

to start with because it would

13:37

be logical to say, look, you

13:42

know, we need to change what we're doing from the very beginning. And this is our

13:43

national health system, which we

13:47

need to change. It's actually a

13:47

very interesting clinic at the

13:50

moment in Wexham, Park hospital,

13:50

run by two of my esteemed

13:53

colleagues, that actually for

13:53

the first time in history, or

13:57

not history, but that sounds a

13:57

little dramatic. So for the

14:00

first time that I know of,

14:00

there's a male and female NHS

14:04

clinic where the man sees the

14:04

neurologist. The woman sees the

14:09

gynaecologist and then they talk

14:09

at the end of it and and lo and

14:13

behold, oh shock they've got an

14:13

amazing natural pregnancy rate

14:18

has improved so this is this is

14:18

what you need to do you need to

14:21

have a two doors a male and

14:21

female one and then those doors

14:25

need to merge at the end of that

14:25

talk.

14:27

That's key right? You want said

14:27

to me and I never forget this.

14:30

He once said to me, there should

14:30

be a urologist in every

14:34

fertility clinic in the UK and

14:34

it's like it makes sense right?

14:37

It's for exactly the reason

14:37

you've just said you can

14:39

massively improve the natural

14:39

fertility success rate. It's

14:44

it's illogical for people to be

14:44

going through unsuccessful IVF

14:49

unsuccessful, you know, um, you

14:49

know, having miscarriages then

14:53

have to look at the male factor

14:53

and I think going back again, to

14:57

what you said about it needs to

14:57

come from the NHS. I agree

15:00

because I feel like when you

15:00

speak to patients, a question

15:03

that comes up repeatedly is,

15:03

well, the NHS don't do that. Why

15:06

should I have to pay for it

15:06

privately? It's like the NHS is

15:09

seen as the gold standard. And

15:09

actually, yes, they are in many

15:13

ways, but actually for

15:13

fertility, they're not the

15:15

private care is far more, you

15:15

know, which

15:20

I agree with you, Rachel, which

15:20

is, which is not what we have

15:22

the National Health for, is it,

15:22

because then you have these

15:26

unfair divides of those that can

15:26

afford and those that can't, I

15:31

mean, lots of my patients go

15:31

abroad, I'm actually not against

15:34

that, you have to say, I think

15:34

there are some very good clinics

15:36

that are, there's a very good

15:36

clinic in Athens called AR PE,

15:40

actually, that that is doing a

15:40

really good job and a really

15:43

good has a really good pregnancy

15:43

rate. So I mean, there are

15:48

clinics out there that certainly

15:48

are are cheaper than than the

15:51

than the UK. But ultimately, I

15:51

always say to patients, you're

15:55

going to spend no matter where

15:55

you go somewhere between five

15:59

and 10,000 pounds for an IVF

15:59

cycle. And wouldn't it be a

16:03

wonderful thing, if that could

16:03

just be handled by our national

16:07

health? For all? I mean, we

16:07

obviously have a postcode

16:10

lottery as well, with national

16:10

health, and that depends where

16:13

you live and how old you are.

16:13

And whether you have children. I

16:17

actually heard actually one PCT

16:17

that if you've had a

16:19

miscarriage, you don't know you

16:19

don't qualify for fertility

16:21

treatment. I thought crikey that

16:21

is unbelievably unfair, is a

16:26

stupid word. So yes, to start

16:26

from the NHS would be the

16:30

perfect way to go. The NHS would

16:30

do three tests. Actually, we

16:35

haven't talked about that. The

16:35

next test that I think we should

16:37

talk about, which is micro

16:37

biomes, and pathogens. My

16:43

patients are shocked sometimes

16:43

to hear how full of bacteria we

16:47

all really are. I mean, it is

16:47

quite a scary thought that we

16:52

have as many bacteria in our

16:52

body as we do cells. So sorry,

16:57

Rachel, I was just gonna say so

16:57

does, like, let's just go back a

17:00

tiny bit. So like, how might you

17:00

know, if you have DNA

17:04

fragmentation, you do the test?

17:04

Find out you've got DNA

17:08

fragmentation? What could cause

17:08

it? So infection and pathogens

17:12

is one of the causes. So yeah,

17:12

we've definitely let them in. We

17:15

can definitely talk about that. I really want to talk about that. And then maybe other

17:17

things that can cause DNA for

17:20

how do you know if you've got

17:20

fragmentation? Well, the the

17:23

answer is that, you know, you

17:23

don't until you start looking

17:27

into it. But usually the

17:27

patients that I see have years

17:31

of unexplained infertility, I'm

17:31

not a great believer in

17:34

unexplained infertility. I think

17:34

it's undiagnosed, but they have

17:39

years of unexplained

17:39

infertility, they've usually

17:42

been through maybe an early

17:42

miscarriage, that's a

17:45

miscarriage that happens before

17:45

the before the female partner is

17:48

12 weeks pregnant. And they've

17:48

had failed IVF that has not

17:53

worked and all of the clinics

17:53

and everybody else expected it

17:57

to so the sperm looked great.

17:57

The female partner got a good

18:02

number of eggs above eight eggs,

18:02

those eggs were all mature, they

18:06

were all in you know, injected

18:06

with sperm or or placed with

18:09

sperm. The fertilisation

18:09

afterward was was was

18:12

reasonable, although sometimes

18:12

it can be reduced with sperm

18:15

factors as well. And then

18:15

something strange happened in

18:18

the laboratory and that the

18:18

embryos, usually after you've

18:22

had your embryos fertilised,

18:22

either naturally, more naturally

18:25

with IVF or with the XE where

18:25

they inject sperm into eggs,

18:29

then what happens is the embryo

18:29

starts to grow. And it's in the

18:33

laboratory for five days.

18:33

Usually after that, the first

18:36

day we look at it and see

18:36

fertilisation, the second day,

18:40

the egg, the embryo should have

18:40

divided to a two to four cell

18:43

embryo. The third day, it should

18:43

be around about six to eight

18:47

cells. The fourth day is usually

18:47

what's called a moral more

18:50

relation, so it looks a little

18:50

bit messy. And then the fifth

18:54

day should be a blastocyst. Now

18:54

what we see with a lot of

18:57

patients with high fragmentation

18:57

levels, is we do see embryos

19:01

that got to about four to the

19:01

eight cell stage. But what

19:04

happens at the eight cell stage

19:04

is that the embryonic genome

19:07

turns on. So up until the eight

19:07

cell stage, the maternal genes,

19:11

the egg genes have been

19:11

controlling development

19:14

completely. So along comes the

19:14

sperm DNA starts working around

19:19

the four to eight cell stage,

19:19

and then you see the embryos

19:23

slow down. Some of them stop

19:23

right there, and then, and some

19:26

of them just don't develop very

19:26

well. So by day five, they're

19:30

slow or they're fragmented. And

19:30

the embryologist is saying to

19:33

the patients, they're not doing

19:33

very well, they haven't got what

19:37

we would expect them to have at

19:37

this stage. Usually, at the

19:40

blastocyst stage, you have an

19:40

inner cell mass, which is the

19:42

bit that goes on to create the

19:42

baby and the trophectoderm,

19:45

which goes on to create the

19:45

placenta. So at that point, the

19:49

lab rings you and says, Well,

19:49

I'm sorry, it's not looking

19:51

good. We'll probably transfer

19:51

one embryo maybe tomorrow and

19:55

it's not looking good. So I find

19:55

that a lot of patients and

19:59

that's situation had an

19:59

undiagnosed male fertility issue

20:03

because the embryonic genome

20:03

turned on and the sperm genes

20:07

turned on at that stage. So we

20:07

do helpful

20:10

for people listening. You've

20:10

been through that scenario where

20:13

you've had good egg selected,

20:13

you've had a good fertilisation

20:16

rate, and then you've had that

20:16

drop off. You've then ended up

20:19

with not many blastocyst that is

20:19

so helpful for

20:23

many blastocyst. That's right.

20:23

And then sometimes, you see the

20:27

sperm is a very intricate I

20:27

suppose it's a very intricate

20:32

organelle. And that the DNA

20:32

inside it obviously is tightly

20:36

wound inside the sperm head. You

20:36

obviously it unwinds when the

20:41

embryo when the when the egg

20:41

fertilises. But the biggest

20:45

problem I suppose, for most

20:45

fertility clinics is that they,

20:49

you can't really see what's

20:49

going on inside the embryo

20:52

inside the genetics, you can

20:52

only see this from a visual

20:55

perspective. And when you're

20:55

looking at this as an

20:57

embryologist, which I was for a

20:57

long time, you're only looking

21:00

at the visuals of what's going

21:00

on. So I do think that the

21:05

important factor here is that if

21:05

this happens to you, you work

21:09

out whether this was a sperm

21:09

issue by having a fragmentation

21:12

test. But then of course, if it

21:12

is a fragmentation issue, what

21:17

do you do at that point? And at

21:17

that point, you can it's very

21:20

simple. It's actually really

21:20

simple what you do, of course,

21:24

and I'll just go back to the

21:24

heart analogy, your heart's

21:26

beating really fast. Where are

21:26

you going? You're gonna you're

21:29

gonna go in to see an osteopath

21:29

or a gynaecologist. You're gonna

21:33

go and see a dermatologist. No,

21:33

you're gonna go and see a

21:36

cardiologist. And it's the same

21:36

thing got high DNA frag. You go

21:42

and see a urologist, a male

21:42

fertility consultant that

21:46

specialises in men, and that's

21:46

not gynaecologist. And they

21:50

would tell you that, you know,

21:50

they probably did about five

21:52

minutes of Urology back in med

21:52

school. So to send someone to

21:56

see a gynaecologist with male

21:56

fertility issues, and then to

22:00

go, Oh, I wonder why that didn't

22:00

work. It is crazy, isn't it?

22:03

It's like me starting to see

22:03

patients for cardiac. You know,

22:07

I'm a cardiologist today. Come

22:07

on in. So So that's it. So you

22:12

go and see a urologist who then

22:12

starts to work it out. You say,

22:16

Well, hang on a minute, what's

22:16

going on here? And yes,

22:18

lifestyle is a factor we can

22:18

absolutely we should talk about

22:21

that. I do feel that men get a

22:21

little bit of a hard time though

22:24

sometimes because they usually

22:24

people say, Well, you know, what

22:28

pants are you wearing? What are

22:28

you doing? And lifestyle is

22:32

really important. But if you

22:32

have a structural abnormality in

22:35

your testicle as 40% of men do

22:35

with male fertility issues for

22:40

the Verica sale, then there's no

22:40

amount of of healthy eating or

22:46

cooling that will help that, you

22:46

know, you have to then treat it

22:49

like when the you know, in the

22:49

cardiac analogy, you've got to

22:52

unblock the artery, or you've

22:52

got to do something to improve

22:55

the testicle. But the ROI just

22:55

does that the biggest issue we

22:58

have is what you touched on a

22:58

minute ago, and what we touched

23:01

on. urologists that really

23:01

specialise in men's fertility

23:06

are not the majority. The

23:06

majority of neurologists

23:09

specialise in all kinds of

23:09

things. Erectile dysfunction,

23:12

kidney problems, urinary

23:12

problems. So it's finding the

23:18

consultants that really

23:18

specialise in this. And I would

23:21

say, I'd say it's under 20. But

23:21

it is a growing field. Yeah, I'd

23:25

say there's probably under 20

23:25

That really, really get it. Mr.

23:28

Ramsey calls says that to me

23:28

sometimes. And he's right. It's

23:32

about really understanding it

23:32

and getting it. But there is so

23:35

much that can be done so much so

23:35

that when you see Mr. Ramsey,

23:39

I'm going to use him as an

23:39

example, I'm afraid because I

23:42

work very closely with him. And

23:42

I have I have more statistics on

23:45

him, you see, because I'm a data

23:45

nerd. So basically, we know that

23:50

90 Over 90% of men that see Mr.

23:50

Ramsey see an improvement in

23:54

their sperm parameters, whether

23:54

that be the number, the swimming

23:58

the shape, or the DNA

23:58

fragmentation levels. That's a

24:01

fact. So that's a very high

24:01

statistic. For any and I think

24:06

it is because of Mr. Ramsey's

24:06

considerable knowledge and

24:10

experience, but, you know, there

24:10

are others in the wings, who

24:16

probably, you know, you could

24:16

name them all, but probably the

24:19

best we need them. We need them. We need

24:19

more. We need them. We need

24:22

more. Yeah. Yeah, it's great. I

24:22

think, again, for people

24:25

listening, you know, that's that

24:25

you've just quoted just gives

24:29

people so much hope that if

24:29

you've had unsuccessful IVF, and

24:32

that is your scenario that

24:32

you've had, that you've had good

24:34

egg numbers, that could

24:34

fertilisation, you've had that

24:36

drop off, and you've listened to

24:36

this podcast and you're

24:39

thinking, Oh, is there an issue

24:39

with DNA fragmentation on male

24:42

factor? Just knowing that, you

24:42

know, just one neurologist has

24:46

got that statistic, you know, is

24:46

amazing because you think okay,

24:49

actually, like you said at the

24:49

beginning, you you can change

24:52

that we can really have a good

24:52

impact on sperm and therefore,

24:55

you're gonna hugely increase

24:55

your chance of hopefully getting

24:58

pregnant naturally. You're not

24:58

Eating IVF. Again,

25:01

also, you can work it out as

25:01

well, because I would have to

25:04

kill you to try and get a DNA

25:04

fragmentation test result from

25:07

you, you'd literally have to put

25:07

a woman through maybe 100 IVF

25:13

cycles, you'd almost have to

25:13

kill her to get this one value

25:16

but a man, most men have over

25:16

100 over 500 sperm in their

25:22

jacket most men do. Even when

25:22

your sperm numbers are really

25:26

low, they are still in the

25:26

hundreds of 1000s. So a normal I

25:31

actually don't like that word

25:31

sorry, maybe edit that one out.

25:34

Because normal, I don't think

25:34

there's no such thing as that.

25:37

Really, it's quite, it's quite

25:37

a, it's actually quite a

25:39

misleading word within our

25:39

industry as well, because you

25:42

know, you see a semen analysis,

25:42

you see, it's normal. If I was

25:46

not doing this for 30 years, I'd

25:46

be like, Well, I'm obviously

25:49

fertile, normal equals fertile,

25:49

but it doesn't you see, as I

25:53

said earlier, 20% of men with a

25:53

normal semen analysis are in

25:57

fertile. And I mean, just having

25:57

one test that can actually work

26:02

out whether there are issues

26:02

with the man's fertility is

26:05

amazing. I mean, most men have

26:05

500 sperm in their ejaculates.

26:09

So you can actually do this test

26:09

and run this test on even low

26:13

numbers, because a lot of

26:13

patients that come to see me,

26:16

you know, have have partners

26:16

that have a very low sperm

26:19

number. But even so, low sperm

26:19

numbers are still usually in the

26:23

hundreds of 1000s. With female

26:23

fertility, you would literally

26:27

have to kill the woman to get

26:27

enough eggs to do a DNA

26:31

fragmentation test, you'd have

26:31

to have 100, IVF cycles, and it

26:35

would not be possible. So to

26:35

just be able to say, look, you

26:40

know, it's not likely to be to

26:40

be the sperm quality is so

26:45

powerful in this situation for

26:45

couples. And the sooner we know

26:50

this, the sooner we establish if

26:50

this is the case, the better for

26:54

everybody. And when everyone

26:54

says to me, some someone says to

26:57

me the other day, oh, you know,

26:57

you're so about the man, not

27:00

that I'm like, no, no, no, no,

27:00

I'm not. I'm actually not about

27:03

just the man, I'm about the

27:03

woman as well. Because until we

27:07

actually improve this, the sperm

27:07

quality and we improve

27:11

everything that's going on with

27:11

fertility, we can't actually

27:14

help the female partner as well,

27:14

because it's a couple issue. And

27:19

when I talk to couples, I never

27:19

speak to the men on their own.

27:23

Well, unless they want me to,

27:23

but I usually would speak to the

27:25

couple, establish what's going

27:25

on, try and understand whether

27:30

this is a male factor or not.

27:30

And I mean, I mean, my mission

27:34

at fertility solutions is men's

27:34

fertility, but it's also to make

27:37

this all a bit more accessible.

27:37

Because at the moment, it isn't,

27:41

at the moment, if you want a

27:41

really good fertility

27:43

consultation with a male and

27:43

female fertility consultant, you

27:47

will have to go and see a male

27:47

consultant than a female

27:49

consultant, you'll spend around

27:49

six 700 pounds, the two probably

27:53

won't meet in the middle or

27:53

talk. And then you're sitting

27:56

there trying to work it out

27:56

yourself. I have so many

27:59

patients, Rachel that come and

27:59

see me that are trying to work

28:02

it out themselves, Google and

28:02

Googling everything because they

28:06

don't understand or quite

28:06

rightly, are struggling to

28:09

understand what's wrong with

28:09

them. So you're Googling trying

28:11

to work it out. Because Google

28:11

is, you know, free, but I think

28:15

quite dangerous in this situation. This is the reason we set up our

28:17

one to one facility and

28:21

miscarriages. So we work online

28:21

with couples to do that, because

28:25

there's no right there's no

28:25

continuity of care, like, you

28:27

know, people will use all over

28:27

the place and it's left to the

28:30

patients, like you said, Google,

28:30

work it all out. And that

28:33

overwhelm around that and the

28:33

scope for perhaps barking up the

28:38

wrong chain tree or spending

28:38

money on things you don't need

28:40

to be spending money on is

28:40

massive. So that's what we do.

28:43

And like being able to refer to

28:43

people like you has been

28:46

amazing. Because we can say,

28:46

Look, we really think you've got

28:50

a male issue here, after we've

28:50

screened them. You need to go

28:53

and speak to someone you need to

28:53

see what to do is you need to

28:55

have this testing done, enables

28:55

us to bring to be that sort of

28:59

continuity of care and be that

28:59

person, the client can always

29:02

come back to and say, Well, I've

29:02

read about this, what about

29:04

that? You know, and you can

29:04

either sort of say no, you don't

29:07

need to worry about that, or

29:07

yes, maybe we do need to talk

29:09

about that. So you're completely

29:09

right. It's this lack of

29:12

continuity of care. And the

29:12

patient is left to pick up the

29:15

bits in the middle and it's I

29:17

actually worked with many, many

29:17

now acupuncturist reflexologist

29:22

dieticians that are doing an

29:22

amazing job in the background.

29:26

Now, not even the background of

29:26

Christ, it needs to be at the

29:29

front of triaging what's going

29:29

on. Because you're right. It is

29:33

like putting together a puzzle

29:33

that you can't quite put the

29:36

middle of the puzzle together.

29:36

You know, one person is doing

29:39

the right hand side, one person

29:39

is doing the left but never the

29:41

to meet. And so I'm now

29:41

obviously, you know, working

29:45

with amazing clinicians like

29:45

yourself, Rachel, but our

29:48

saying, Look, nothing else is

29:48

working. What is the problem?

29:52

Wouldn't it be nice for us all?

29:52

If if we could reverse that and

29:56

have the couples come and see us

29:56

from the very beginning of their

29:59

journey? Need to say, look, you

29:59

know, I'm thinking about having

30:02

a baby in a few years time, what

30:02

should I do to prepare? You

30:06

know, what should I test to make

30:06

sure everything's going to work

30:09

together. So wouldn't it be a

30:09

dream, that's the dream. That's

30:13

the dream. The dream actually,

30:13

for me is a clinic that has all

30:18

of these things under the same

30:18

roof that you walk into. And I'm

30:22

seeing more and more couples

30:22

now. I mean, I'm 50. So when I

30:26

speak to lovely couples who are

30:26

in their 20s, they're half my

30:28

age. And the one thing that is

30:28

happening that I am seeing is I

30:32

am seeing a lot more patients

30:32

now in their 20s, and 30s, they

30:36

will hang on a minute, we're

30:36

thinking about delaying for to

30:38

having children, let's go and

30:38

check it out. First, let's go

30:41

and prepare for fertility,

30:41

let's, you know, talk to

30:44

somebody about our diet, about

30:44

our lifestyle, about how we can

30:47

improve ourselves, because our

30:47

bodies are the same as they were

30:52

in prehistoric times. But our

30:52

desires for them are very, very

30:56

different. So obviously, the

30:56

average age of death, you know,

30:59

in prehistoric times was around

30:59

40. So I'm not saying from that

31:03

point of view, but we right now

31:03

are living in a way that is very

31:07

unnatural, very the food we eat,

31:07

what we do with our bodies, how

31:12

we how we live our day to day

31:12

lives, I mean, we're hunter

31:15

gatherers, we should be out

31:15

there hunting for berries and

31:18

nuts, and every now and again,

31:18

coming across a big food store

31:22

and eating it. So I think that

31:22

also, you know, being able to

31:26

say from the very beginning, how

31:26

can we try and sort of almost

31:31

treat our bodies in a way that

31:31

is as natural as possible, when

31:33

we're trying to conceive would

31:33

definitely be advantageous. And

31:36

that does involve diet,

31:36

nutrition. I mean, acupuncture

31:39

is an ancient ancient therapy,

31:39

it you know, you can trace it

31:42

back to, to the to the 2200,

31:42

note 2000 BC. So we do know that

31:48

all of these things are very

31:48

effective. And obviously, you

31:52

know, if you were 2000 BC, you'd

31:52

only have you'd have acupuncture

31:54

to control pain, to control

31:54

cycles to control your health.

31:59

And so to have that element of

31:59

science and holistic therapy,

32:05

incorporated into gynaecology in

32:05

urology, that's the answer. The

32:09

answer is to understand that the

32:09

body is one hole. Yes, it's

32:14

testicles. Yes, it's ovaries.

32:14

Yes, it's fallopian tubes. But

32:17

it's not mechanical. People

32:17

think of their bodies as well.

32:21

I've got an ovary. I've got a

32:21

uterus, I've got a good EMH.

32:23

I've got sperm. Why isn't it

32:23

happening? But it's not

32:26

happening? Because there's a lot more that's involved in fertility than just egg sperm,

32:28

fallopian tubes and ovaries and

32:32

uterus is, that's a fact that we will change. We will change

32:34

it there. We'll get there. Let's

32:37

talk about let's talk about

32:37

infection. Because that is one

32:42

thing that, you know, comes up a

32:42

lot. And actually, when I say to

32:47

clients, I think you might have

32:47

a Seminole infection, or there

32:50

might be some bacteria there

32:50

that we don't want there. It's

32:53

almost like kind of like a bit

32:53

of a shock sometimes. And people

32:56

say, Well, no, we've not got any

32:56

sexually transmitted infections.

32:59

We've got anything. Yeah, let's

32:59

that sort of bust a few myths

33:02

around this area. That'd be

33:02

great. Course.

33:05

So when I see a couple where a

33:05

semen analysis has been done on

33:10

the NHS, or somewhere else, to

33:10

be honest with you, and I see

33:14

low ejaculate volume, more than

33:14

they call it round cells, and

33:18

they don't know what it is,

33:18

usually it's white blood cells,

33:21

that it's maybe got a high or

33:21

low pH, or the motility of the

33:26

sperm is a bit slower than it

33:26

should be. I immediately think

33:30

pathogen in that semen bug in

33:30

the semen. And we don't call it

33:34

an infection generally, because

33:34

it does elicit images of

33:40

Gonorrhoea and chlamydia and all

33:40

the things that we wish, you

33:43

know, obviously, when we've been

33:43

young and everything, try and

33:45

avoid, but very, very, very

33:45

rarely, in fact, not not last

33:50

year, and I see I've seen over

33:50

2000 Men last year, very, very

33:54

rarely would we ever find

33:54

chlamydia or Gonorrhoea and

33:57

semen. Very rarely, we're not

33:57

talking about that bug. It's

34:00

usually a nice little bug called

34:00

Enterococcus faecalis. Usually

34:04

that bug, and bugs in semen

34:04

caused all kinds of havoc for

34:08

known reasons, and importantly,

34:08

for unknown reasons as well,

34:13

because of course, the

34:13

mechanisms of these things are

34:16

not always known because it's

34:16

very difficult to do the

34:19

research that would find it out.

34:19

You it would be very unethical

34:22

to do that. So we know that it

34:22

slow sperm down bugs in sperm,

34:27

we know that it probably lowers

34:27

their ability to fertilise the

34:30

egg as well because I don't

34:30

think the DNA inside the sperm

34:33

is affected. I have to say that

34:33

I think there's a separate

34:36

mechanism going on there. So it

34:36

slows the sperm down, reduces

34:41

the chances of that sperm

34:41

fertilising the egg reduces the

34:45

reduces the ability of the sperm

34:45

to sort of find the egg as it

34:48

works. I think that's what we're

34:48

talking about. And a lot of men

34:52

that come in to see me have this

34:52

bug in the semen again. I mean,

34:58

I don't really do reviews and

34:58

stuff because I'm too old, but

35:01

you know, more and more of our

35:01

patients that do review us are

35:04

talking about this particular

35:04

journey, the journey of failed

35:08

fertility failed IVF treatment

35:08

of bugs in semen by a urologist

35:14

and then being pregnant.

35:14

Miracle. See, I'm not really a

35:18

fan of that word, particularly

35:18

though, of course, it's a

35:21

miracle to the couple. But for

35:21

me, it's science is just

35:25

applying good scientific

35:25

elements. So when you find these

35:30

bugs, they're a problem

35:30

naturally, but my God, they're

35:34

afraid to say that they are a

35:34

problem in the IVF lab, because

35:37

you have to remember that in the

35:37

IVF lab, we're using teeny tiny

35:41

volumes of media tiny, I mean,

35:41

imagine that in your, in your

35:46

uterus, you've got a mug full of

35:46

fluid, it's not quite that much.

35:49

But let's say a mug, or say, a

35:49

mug. If you if you take that if

35:51

you take, put your finger in

35:51

your tea and just pop it on the

35:54

on the worksurface. That that.is

35:54

What the IVF clinic will be

35:58

using to fertilise your eggs and

35:58

to culture them for five days,

36:02

okay, it's called a micro drop.

36:02

Most clinics use a micro drop is

36:06

the most efficient way of doing

36:06

things. And if they're using an

36:08

embryo scope, which watches the

36:08

development, they have to do

36:10

that. Now, imagine bugs in your

36:10

cup in your mug. They're

36:16

affecting things, but my God,

36:16

they're affecting things in a

36:18

micro drop, because suddenly

36:18

you've got a massive

36:20

proliferation of bugs. And

36:20

that's when we see embryos slow

36:25

down, again, the DNA can be can

36:25

be completely responsible for

36:29

the embryo slowing down but

36:29

soaking the bugs as well. And

36:34

we're actually doing research at

36:34

the moment on how DNA

36:36

fragmentation and bugs relate

36:36

because no one's done that. No

36:40

one said these two things

36:40

related. Personally, I don't

36:43

think that they are because I

36:43

see normal fragmentation and

36:46

loads of bugs and no bugs and

36:46

terrible fragmentation. I don't

36:50

think they are because and I'll tell you why. I don't think they're associated because the

36:52

DNA is so tightly wound in the

36:56

sperm head. I don't think any

36:56

bacteria basically is affecting

37:00

the actual sperm inside, but

37:00

it's affecting them outside and

37:04

it's affecting the embryos that

37:04

are developing in an IVF dish as

37:07

well. Absolutely guaranteed.

37:10

Is that because it purely

37:10

because it becomes harder for

37:13

the embryologist to select

37:13

healthy sperm in because you've

37:17

got such a small sample? Is that

37:17

what you're saying? That maybe

37:19

they can't get the best sperm to

37:19

fertilise the egg because the

37:23

sample is so infected with

37:23

pathogen. Well, that makes it

37:28

perhaps, no because imagine if imagine if

37:29

you're doing IVF treatment and

37:32

you put into the dish, this

37:32

teeny tiny dish, a little tiny

37:37

little seed of sperm. Now,

37:37

obviously bacteria are

37:41

microscopic, you could fit a

37:41

million a billion of them on a

37:44

pinhead a billion on a pinhead.

37:44

So imagine you've put that

37:48

pinhead into a tiny little drop

37:48

in the dish. You're then gonna

37:52

get a massive proliferation of

37:52

bugs. So you can't see Rachel

37:55

you can't see them. The

37:55

embryologist doesn't come and go

37:57

Wolf. Look at all those bugs,

37:57

they look great, but you can't

38:00

see them. You can sometimes see

38:00

the media moving a little bit

38:03

but you cannot see them until

38:03

it's too late until you've

38:07

transferred the embryos and it

38:07

hasn't worked. So

38:10

the bacteria basically then

38:10

infect the embryo that's what

38:12

you're saying that's right the bacteria have

38:13

in fact the embryo slow

38:15

everything down in that drop

38:15

effect the embryos ability to

38:18

continue dividing it's

38:18

completely ludicrous not to make

38:22

sure again from the very

38:22

beginning that there are no bugs

38:26

in semen now in our clinic where

38:26

we send the the patients to

38:31

comment to her she's already

38:31

already been way too busy that

38:34

is but we know we check that

38:34

first. No bugs, zero bugs, great

38:40

DNA Frank, low level or good

38:40

quality sperm. So we start the

38:44

process from the very beginning. And the semen culture if I'm

38:46

correct, it's not like a

38:49

complex, expensive thing to do.

38:49

Right. So that would be really

38:51

easy to introduce within NHS IVF

38:51

clinics I would say from a

38:55

fortune like you said it's cheapest chips. The NHS

38:56

clinics had literally just take

39:00

the semen put it on a back on it

39:00

on a they do UTI they do. They

39:04

do culture all the time in a

39:04

pathology department, which is

39:07

mostly where the semen analysis

39:07

takes place if you're on the

39:10

NHS, so you just put the little

39:10

sperm, the semen on a petri

39:14

dish, you grow it, and it would

39:14

be the easiest thing in the

39:18

whole wide world. For them to do

39:18

that. I've said this over and

39:21

over just to say, look, we'll

39:21

look at the sperm and then we'll

39:23

stick on a petri dish. And two

39:23

days later, we'll make sure

39:26

there's nothing growing. Great.

39:26

Perfect. I wonder what would

39:29

happen actually, I would I don't

39:29

know let's let's hypothesise

39:32

what would happen if that did

39:32

happen? Well, the bacteria would

39:35

come back the GPS would give it

39:35

give it a good go treating it

39:39

and sometimes that would be all

39:39

that was necessary. A course of

39:42

antibiotics help the patient to

39:42

conceive naturally. I mean, what

39:47

I would say though, is that I

39:47

have think you have to be very

39:49

careful in the results of semen

39:49

culture because a lot of people

39:54

will get their semen culture

39:54

results and say right GP give me

39:58

loads of antibiotics. And a lot

39:58

of the time it can work. But

40:03

when it doesn't work, it doesn't

40:03

work spectacularly, because of

40:06

course, you have to then ask

40:06

yourself, why are those bugs

40:08

there in the first place? What

40:08

did what what happened to make

40:12

those bugs there? Now some

40:12

people I see with retrograde

40:16

ejaculation whereby they're

40:16

ejaculating and a lot of their

40:19

sperm is going into their

40:19

bladder or otherwise, I see

40:23

patients with obstructions in

40:23

their reproductive systems,

40:27

prostate issue, seminal vesicle

40:27

gland issues, and very rarely,

40:32

but it does happen testicular

40:32

cancer. So I think you have to

40:35

be very careful when you've got

40:35

the semen culture results, what

40:39

you do with them, because the GP

40:39

is one way that the GPS or

40:43

general practitioners, I'd be a

40:43

terrible GP, and they are not an

40:47

amazing and geologist. So it's

40:47

much better to then if you have

40:50

got bugs in the sperm, no matter

40:50

where you've diagnosed them, or

40:53

how you diagnose them to go and

40:53

see a urologist knows, Timothy,

40:58

just tell us exactly, thank you.

40:58

Yeah, so a fertility urologist

41:02

that knows what they're doing

41:02

that knows what they're going to

41:05

do with those results. Because

41:05

we need to ask ourselves, has it

41:09

gone? Because so many people

41:09

actually take antibiotics and

41:13

then never check if it's gone?

41:13

No, make sure the bloomin things

41:16

gone. That's the other thing that's

41:17

worth pointing out. Because this

41:19

comes up in clinic a lot.

41:19

Patients will say, Oh, well, my

41:22

husband had some antibiotics

41:22

last week for throat infection.

41:25

So that would have cleared it

41:25

up. It's really important that

41:27

people understand that bacteria

41:27

or pathogenic bacteria is often

41:32

resistant to certain

41:32

antibiotics, and it needs a

41:34

specific antibiotic to treat it

41:34

like so that bacteria you talked

41:38

about was it into the caucus, we

41:38

call it like that will need a

41:41

specific antibiotic that targets

41:41

it. That's

41:44

right, and not every antibiotic

41:44

that that you take will will

41:48

give the same response in a

41:48

different patient. So you do

41:51

sensitivities usually to see in

41:51

the petri dish, what the bug is

41:54

actually resistant to. But the

41:54

most important thing to

41:58

understand is that we're missing

41:58

a massive trick. By not looking

42:02

at the man we are male fertility

42:02

is linked with diabetes is

42:07

linked with lifestyle issues.

42:07

It's linked with cancer, you

42:12

know, it's associated with with

42:12

testing, it's associated with

42:16

lots of different pathologies or

42:16

health conditions, that when

42:20

they're when they're not

42:20

addressed, can be very life

42:23

threatening. So by not by taking

42:23

a man with a low sperm count,

42:28

let's go back to a man with a

42:28

low sperm count where it's

42:30

obvious there's a problem, and

42:30

then not sending him to a

42:33

urologist for a proper thorough

42:33

assessment and treatment is

42:38

irresponsible, in my opinion,

42:38

because men are not just wiggly

42:43

tadpoles in their semen, the

42:43

answer to male fertility issues

42:46

is not Ixy. It's not IVF

42:46

treatment, it shouldn't be

42:49

applied as a universal

42:49

technology for all. At that

42:53

point, the man should be given

42:53

the same amount of care that the

42:56

woman does usually actually have

42:56

on the NHS, some scans and blood

42:59

work urine cultures, all kinds

42:59

of things to say, Look, why is

43:03

this young healthy man got a low

43:03

sperm count? Has he got low

43:08

testosterone? Has he got issues

43:08

with with with male hormones,

43:12

has he got a prolactinoma a

43:12

tumour on his on his brain that

43:16

is slowing all of these sperm

43:16

down. So by not by finding

43:20

something and then not

43:20

investigating it properly and

43:22

appropriately, you're actually

43:22

in my opinion, not behaving in a

43:27

very ethical way either, which

43:27

is ultimately, you know, well,

43:32

not ethical, maybe not the right

43:32

quite the right word. But you're

43:36

not, you're not sort of applying

43:36

the appropriate sort of

43:40

treatment to patients where you,

43:40

you know, buying something it's

43:44

seen as a whole diagnosis in

43:44

itself, but the testicles are

43:47

very responsive to what's going

43:47

on with the man's health in

43:50

general. The patient should always be at

43:51

the centre, right? The patient,

43:54

I always say can is to be

43:54

patient, centred and lead. Yes,

43:58

you put the patient first you

43:58

can't go wrong, right. Like

44:02

if you just have more

44:02

conversation between different

44:04

people that specialise in

44:04

different things, because the

44:08

ultimate way to treat anybody is

44:08

to have discussions between

44:12

specialities they do that

44:12

actually very well in the brain

44:15

surgery world. They all sort of

44:15

talk, you know, endocrinology

44:19

talks to surgery, and they have

44:19

very good what's called MDT

44:22

meetings for go back to the

44:22

Wexham Park hospital model.

44:26

They're having really good MDT

44:26

meetings where they discuss

44:29

gynaecology urology lab. And

44:29

then they have these meetings

44:33

where they decide what they're going to do with the patient based on everybody's brain and

44:34

everybody's speciality, that's

44:38

the way forward the way forward

44:38

is to put lots of different

44:41

specialities in the same place.

44:41

And then the patient goes to see

44:45

them all. And then there's a

44:45

massive meeting at the end of

44:48

it. So let's say for example,

44:48

what's the dream? So the dream

44:51

for me is gynaecology urology

44:51

lab, holistic, sitting in one

44:55

room, maybe four of us saying

44:55

right Mr. And Mrs. Smith, what's

44:58

everybody thinking? What's

44:58

everybody doing? What do you

45:02

think? What do you think? What

45:02

do you think? And then coming up

45:04

with an amazing treatment plan

45:04

for this part for this partner,

45:07

these these patients to a get

45:07

them pregnant naturally, not

45:12

with IVF treatment. I mean,

45:12

we've been making humans for

45:15

centuries, we didn't need IVF

45:15

IVF has been around for 40

45:18

years, and we've been around for

45:18

hundreds of millions of years.

45:22

So let's actually talk about

45:22

what's wrong with this couple

45:24

and work it out. And then once

45:24

we work it out. So blocked

45:28

fallopian tubes, okay, but of

45:28

IVF. But before that, shall we

45:30

all improve the gametes as much

45:30

as possible? Rachel, how much

45:34

acupuncture, nutritional

45:34

therapy, how long do they need,

45:38

you know, usually around sort of

45:38

three months to really prepare

45:41

your body properly for these

45:41

processes, lose a bit lose

45:44

weight, you know, get better

45:44

nutrition, get healthier, and

45:48

your body and your mind as well,

45:48

because my goodness, everybody

45:51

forgets the mind and all of

45:51

this. And yet, it's super

45:54

stressful, and the mind is

45:54

incredibly important as well.

45:58

And then I think you'd see the

45:58

pregnancy rates that that this

46:01

particular consultant who is

46:01

pretty much doing this is seeing

46:06

and and I think the American

46:06

clinics also are much better at

46:08

this as well, overall, and they

46:08

do have better IVF pregnancy

46:12

rates, then we have as well,

46:12

because of course they have this

46:15

advantage and that insurance is

46:15

paying for everything. So the

46:19

insurance says right well, one

46:19

IVF cycle only everybody. So can

46:22

you please make sure there's

46:22

this egg and this you know, and

46:25

the sperm quality is perfect

46:25

from the very beginning. So if

46:28

you're an American IVF clinic,

46:28

you're far more likely to have

46:31

nutritional therapy,

46:31

acupuncture, see a gynaecologist

46:33

see a urologist and work out

46:33

what's wrong first, and then

46:37

have one IVF cycle that creates

46:37

lots of embryos, and have have a

46:41

pregnancy from that cycle.

46:41

Because also, if you do need IVF

46:45

treatment, what we need to get

46:45

away from is success being one

46:50

baby, because in my opinion, a

46:50

successful IVF cycle is not one

46:56

baby, most people want in this

46:56

country and abroad an average of

47:00

one to three children. So you

47:00

should actually be catering for

47:04

when you're looking after

47:04

somebody that has to go through

47:06

all of this, their family needs

47:06

rather than just their pregnancy

47:10

needs. So one cycle is proposed lots of

47:11

programmes cycle that

47:15

set one cycle, lots of eggs,

47:15

lots of good quality sperm, lots

47:19

of embryos frozen, so you could

47:19

have a baby and then another

47:22

baby and then another baby.

47:22

That's what I firmly believe. I

47:26

think instead of you know,

47:26

congratulating ourselves, when

47:28

someone gets pregnant has a

47:28

child, we should actually be

47:31

thinking well, did we do the

47:31

maximum to make sure that their

47:35

family complete. And if you're

47:35

having to pay for IVF treatment,

47:38

I think you have an obligation,

47:38

again, to understand that, you

47:42

know, 8000 pounds is a massive

47:42

amount of money for 99% of the

47:46

population, everybody. So if you

47:46

have to spend that it's trying

47:52

to family complete. And if the

47:52

NHS also approach this, like

47:55

this, male, male, female,

47:55

holistic, if they actually put

48:00

all those things together, then

48:00

they would, they would also end

48:03

up with IVF treatment that then

48:03

helps their patients to become

48:07

family complete, rather than

48:07

just pregnancy, one child

48:11

complete. I mean, it would save money for

48:12

everyone right? And effort and

48:16

emotional strain and all the

48:16

other things that go with it, I

48:18

think, yes, we will, we will get

48:18

there. So I am fully aware that

48:24

lots of people listening after

48:24

this will be like, I need to

48:27

speak to that woman. She's

48:27

amazing. Like how do people get

48:30

in touch with you? And what sort

48:30

of process like obviously, I've

48:35

said that you found the

48:35

fertility solutions clinic,

48:39

which is an investment field,

48:39

how can people work with you?

48:42

How can they contact you? What

48:42

services are you offering?

48:45

So we work with people all over

48:45

the world now, we sit and wait

48:49

for planes, or we sit and do

48:49

what we're doing today, you

48:52

know, remotely discussing and

48:52

the one thing about this was

48:55

good about COVID If there was

48:55

anything was there was with the

48:57

communication elements improved

48:57

in life. So I'm sorry to mention

49:02

the COVID word everybody. I do

49:02

apologise about that. It almost

49:05

killed me inside as well. So

49:05

going back to what I was saying

49:09

about accessibility. Now, what

49:09

we find is that obviously

49:13

there's the NHS is private to

49:13

see private consultants, in my

49:17

opinion is way too expensive at

49:17

this stage. So we do we are sort

49:22

of making this more accessible

49:22

to people. We are literally

49:25

doing at the moment, Rachel full

49:25

consultations with a review of

49:30

someone sent me 100 files this

49:30

morning, and I'm going to read

49:34

them all before this evening,

49:34

but I speak to her. So what we

49:38

know is that we are making this

49:38

more accessible so you can book

49:41

an appointment with me. It's

49:41

hidden on our website. Actually,

49:44

we're on purpose because when it

49:44

wasn't hidden, it was a real

49:47

problem but about three quarters

49:47

of the way down the website

49:49

fertility solutions.co.uk Yeah,

49:49

that's right. Is a picture of me

49:54

eight years ago, sitting behind

49:54

a microscope for about 10 years

49:57

ago when I first started the

49:57

clinic and you It says in formal

50:00

20 minute chat with a with a

50:00

with a, you know, consultant

50:04

sort of thing. And so if you hit

50:04

that it takes it straight to my

50:06

diary, I do Saturdays evenings.

50:06

And I would absolutely recommend

50:12

if you book an appointment with

50:12

me that you please please please

50:14

make sure that you're on there

50:14

together with your partner, and

50:19

that you send me at least all of

50:19

the semen analysis stuff that's

50:23

been done, because it's really

50:23

helpful to actually be able to

50:26

re review everything. I mean,

50:26

ideally, I like to see the semen

50:30

analysis stuff, the lab sheets

50:30

from the embryology team, the

50:34

summary letters from the IVF.

50:34

And any EP you documents that

50:37

exist after someone's had a

50:37

miscarriage. So we do need as

50:41

much information as possible. I

50:41

mean, if it has to be 100 files,

50:45

no problem. I've got, I've now

50:45

got two admin people that helped

50:48

me read the whole thing and

50:48

summarise it all. And the great

50:51

thing also is that because I

50:51

worked so closely with I think

50:54

some of the best consultants

50:54

that I've I've found over 30

50:57

years, I actually if I don't

50:57

know something, I'm quite good

51:00

at saying I don't know, and I'm

51:00

happy to ring learn or have

51:05

jazz, I'm happy to ring them and

51:05

say like, I don't know, you

51:08

know, what do you think so? So I

51:08

think that's the biggest, most

51:11

powerful thing we do is connect

51:11

the situation together to be

51:15

able to say, look, I don't I

51:15

don't really know. I mean, it's,

51:19

I'll be honest with you. Usually

51:19

I can see something within about

51:22

a minute of reading people's

51:22

notes. But if I can't, then I'll

51:26

take it to somebody who might be

51:26

able to see something that when

51:29

they read the notes, so we're

51:29

doing it for 55 pounds,

51:35

hopefully for a long time, you

51:35

know, hopefully because, you

51:39

know, it's always tricky to try

51:39

and offer these things. And

51:41

also, I think sometimes I find

51:41

people are suspicious of it as

51:45

well. And I Oh, why is it so

51:45

cheap? Because otherwise you

51:49

won't talk to me, you will talk

51:49

to somebody else. And then, you

51:52

know, you'll go down a journey

51:52

that I will have a problem with

51:55

ethically as well. So I don't

51:55

think that you get into this

51:58

Rachel to make loads of money. I

51:58

mean, there are ways to make

52:01

lots of money. And and I'm

52:01

sorry, but healthcare is

52:04

definitely not one of them.

52:04

Because obviously, you've got to

52:06

be thinking the whole time with

52:06

your, you know, without any kind

52:09

of purse strings attached to any

52:09

of it. And we are an independent

52:14

fertility clinic completely. So

52:14

if you have IVF, I get nothing.

52:19

If you go and see urologist I

52:19

get nothing going see

52:22

gynaecologist zero, we don't

52:22

make loads of money on doing

52:26

things, we make money on doing

52:26

what we do really well, which is

52:29

male fertility diagnostics, that

52:29

we don't then sort of, you know,

52:33

referral fees, we don't take

52:33

those here. So if we send

52:37

somebody to somebody else, we

52:37

don't, we don't charge for that,

52:40

because it will provide a

52:40

different sort of reason for

52:44

doing something. So I think

52:44

that, you know, that's what

52:47

we're doing. And I, you know, I

52:47

know that it's making a

52:51

difference. And, you know, I'm

52:51

trying to keep a record now of

52:55

what's happening, of course, because that's also very difficult as well, trying to

52:57

keep a record of what actually

53:00

happens. Yeah, that's why we're

53:00

gonna get very admin heavy here.

53:03

Because you need to watch what's

53:03

going on, you need to make sure

53:07

that what you said worked, help.

53:07

Tighten

53:10

on. Okay, yeah, well, from our

53:10

side of things, we definitely

53:13

know you're helping our

53:13

patients, which is amazing. So

53:16

and I'm sure there's hundreds of

53:16

1000s or more that you're going

53:18

to help after this. So for

53:18

anyone listening, I'm going to

53:22

place like details in the

53:22

podcast information. And you can

53:26

that will link directly through

53:26

to Claire's website for facility

53:30

solutions. And like I said,

53:30

there's ways that you can get in

53:32

touch with her and book for

53:32

consultations and all the tests

53:35

that we've talked about as well

53:35

today. More importantly, so I

53:38

just want to say one last thing as you Rachel,

53:38

I'm so sorry, I know that your

53:40

time is precious. Also say that.

53:40

But the moment we do find with

53:47

DNA fragmentation testing is

53:47

that it's obviously very, very

53:50

expensive. And we are actually

53:50

working very hard at fertility

53:54

solutions. Now, to reduce that

53:54

expense, there is a clinic

53:58

unfortunately, that has

53:58

monopolised how expensive it is,

54:01

it to be fair, it is a very

54:01

difficult test to do. And it

54:04

does take days sometimes to do.

54:04

But we are now with with you

54:09

know a great expense to

54:09

ourselves, which we will not

54:12

recoup, we are now setting up

54:12

DNA fragmentation testing at

54:16

Bekins field so that we can

54:16

start offering this test at a

54:19

reasonable price. I mean, we're

54:19

obviously we have to charge what

54:23

it actually costs us to do. But

54:23

I'm going to try and try and

54:26

reduce because at the moment it

54:26

costs around four to 540 600

54:30

pounds to do it. We're going to

54:30

try and take at least 150 pounds

54:33

off of that. So I just want to

54:33

say that you know and and so we

54:39

are doing our very best to try

54:39

and make this more accessible.

54:42

Give people the answers quicker

54:42

for prices that are not we don't

54:47

get me wrong. I still think 300

54:47

pounds is a lot of money, but

54:50

it's more accessible than 600

54:50

pounds. Yeah, and a lot cheaper

54:54

than IVF. Yes, everything's

54:54

cheaper with IVF

55:00

Thanks so much, Claire. That was

55:00

amazing. Yeah, if anyone has got

55:04

any questions for Claire, you

55:04

can hop on her website and

55:07

equally you can drop us a DM on

55:07

my Instagram site. But yeah,

55:10

thanks, Claire. We'll speak to you soon. Thank you so much, Rachel. Take

55:12

care