The Fertility Test Most Men Are Never Offered | Dr Michael Eisenberg and Dr Natalie Crawford

Simon Hill (0:04)

For the listeners, I wanted to start with the backstory for bringing you two together to have this conversation today.

Natalie, you and I had a conversation maybe half a year ago now, and that was an incredible conversation about fertility, but really specific or mostly specific, not exclusive to the female reproductive system. And in that episode, though, you mentioned a few things about sperm health and male fertility that certainly surprised me and surprised our community. And I went away and was doing some more reading, and the more I was reading about sperm health and learning that it's not just about conception and it influences the development of the fetus and pregnancy outcomes and perhaps even influences or is associated with other outcomes for males, I became more and more interested in this topic. And I also have a personal stake. So I'm at the stage of my life where the next couple of years, I'm looking to plan with my partner to have children. So I then went and looked for a podcast, a resource, just as anyone else might, that was really, really comprehensive, covering male fertility with a urologist and an OB-GYN, and I couldn't find it. So I invited both of you and kindly you said yes, and here we are.

So that's the background. Michael, perhaps we start with you.

Michael Eisenberg (1:33)

All right.

Simon Hill (1:34)

Because you're new to the show. Thank you for making your way down to LA to do this.

Can you just run people through your academic background qualifications in urology and the kind of world that you live in with regards to male fertility and the things that you're thinking about?

Michael Eisenberg (1:54)

So to become a sort of a male fertility specialist, the path is you go through medical school, then you do urology residency. So it's five or six years.

And then for those of us interested, you do a special additional year to focus on male fertility. So I did that. And then I'm currently at Stanford, so I initiated the Male Fertility Program there. I've been there for about 15 years. And essentially what I do is help men have babies. So I partner with our gynecology colleagues, our reproductive endocrinology colleagues for couples that do need assistance and work on the male to optimize sperm production for men where there's no sperm, help to find sperm or restart sperm production, trying to understand the etiology of any difficulties and work to fix it.

Simon Hill (2:40)

Then at Stanford, you're involved in research as well?

Michael Eisenberg (2:42)

I also do research as well. Yeah. So I try and understand the origins of stigmatogenesis. A lot of the things you talked about, this link between overall health and reproductive health, that's one of the main focuses of the lab. I think both things that we can do to optimize a man's health, they can improve reproductive health, improve sperm production.

But also we've increasingly learned that reproductive health or sperm production may be a window into future health. So men with impairments in sperm production have higher risks of later chronic diseases. I'm trying to understand why that is and what men can do, hopefully, to mitigate some of that risk.

Simon Hill (3:17)

And how do you think we're going as a society in terms of having this conversation?

Michael Eisenberg (3:23)

I think it's getting better and better. I mean, obviously, this podcast here, I think, is an example. I think more people are understanding it a little bit more. I think as there's been more dialogue and research about sperm counts, there are changes over time and declines over time. I think there's a lot more awareness of it. I think that from a political level, I think we're seeing a little more focus on it as well from a research standpoint, from surveillance standpoint. So hopefully, it's getting better. I think it still lags far behind what's needed just because it is such an existential issue.

But I think I'm optimistic about the direction.

Simon Hill (3:58)

And Natalie, you've been on. But in case listeners didn't catch our last episode, which I really recommend people go back and listen to what are your qualifications and what does your clinical work look like with regards to fertility and how does male fertility kind of work into that?

Natalie Crawford (4:17)

Thanks for having me back, Simon. I'm thrilled to be here. I'm a reproductive endocrinologist. So I did four years of OB-GYN residency and then three years of reproductive endocrinology fellowship for my training. And I was really fortunate that where I trained, there was a male fellowship-trained urologist who was in our department of reproductive endocrinology. So I had a lot of insight really early on to male-specific problems and understanding especially in the time frame when we weren't talking about it as much that male fertility is a huge piece of the puzzle. We've luckily seen a cultural shift where now we are talking about male fertility being half of the causes of infertility.