Male Fertility Instagram Live with Ian Stones of Testhim

Jen X Testhim Instagram Live with Ian Stones

In light of it being Men’s Health week in June (10th-16th), I reached out to Ian Stones from Testhim to discuss male fertility. We had a great chat all things male fertility and testing over on Instagram. You can listen to the live here. It really was a very insightful chat so I wanted to share the chat on here for you to have a read/send onto your partners.

Jen Walpole [00:00:01]:

Hi, everyone. So this week on Monday was the start of men's health week, so I reached out to Ian Stones of Testhim to get together to have a chat about all for our chat. And I've just let Ian in, so when he's here, we'll get started with some introductions. So, yeah. Thank you for joining us this evening. Hi, Ian, how are you?

Ian Stones [00:00:42]:

I'm great, and you?

Jen Walpole [00:00:43]:

Yeah, good, thank you.

Ian Stones [00:00:46]:

Good, good.

Jen Walpole [00:00:48]:

Right. So thank you so much for your time. I know it sounds like it's been super, super busy recently. I think there's been a lot of events, things happening.

Ian Stones [00:00:57]:

Yeah, it's silly conference season for us, so we're all over the place. But it's all good fun. Yeah, all good fun. Spreading the word.

Jen Walpole [00:01:04]:

And I'm so grateful that you could fit us this talk in this week, because obviously it's men's health week, so, you know, there's no better time to talk about male fertility. I know that you are sort of talking about it all year round, so whether it's men's health week or not, so important. And I am the same in the sense of working with couples. You know, it's really important to consider both partners in the fertility remit, and we'll get into that in a little bit more detail as we get started. But first of all, let's start with introductions. So do you want to introduce who you are and a little bit about Testhim as well?

Ian Stones [00:01:46]:

Absolutely. Sure. So, yeah, I'm Ian Stones. I'm one of three founders and directors of Testim. So myself, Toby Trice and Michael Close, and we basically got our heads together a few years ago, all from our own individual experiences in or around the fertility world. Actually, Michael and Toby were both fertility patients at very different times with very different outcomes. And my background was acupuncture and supporting couples through treatment. And each of us knew that there was a major problem in terms of male fertility care, male fertility support.

Ian Stones [00:02:23]:

And when we put our heads together, like, okay, we need to do something about this, we need to change the narrative, we need to provide better information and more support to men. And that's how we got where we are and ended up doing what we're doing with Testhim. And so Testhim is about raising awareness, getting men educated, making sure they got access to the right tests. And importantly, they're getting those tests at the right time, and then after that, they're getting the right support, so they know where to go with that information, they know who to speak to, and that they're getting the right, you know, speaking to the right medical professionals. That's the other key thing.

Jen Walpole [00:02:58]:

Absolutely. And, you know, let's dive in and start with some of these questions then, because I think it's kind of relevant to what you've just been saying in terms of, you know, there was a real gap, wasn't there, in terms of the support that was potentially lacking. And why do you think male fertility is often unexplored?

Ian Stones [00:03:20]:

God, that's such a huge question, isn't it? And there's a lot of reasons behind that. And that issue, I think one of the biggest issues is that there's been the societal and almost a medical belief that fertility is a female issue. And maybe 50, 60, 70 years ago, we weren't in the state that we are in terms of sperm quality. So maybe it wasn't such a big thing, but even so, I'd imagine there would have still been a lot of male factors even back then. So we have this societal belief that female fertility is a female issue, when actually we now know it's a 50:50 split. So society makes us believe that a lot of focus is therefore put upon the woman. A lot of the medical investigations are aimed at the woman. The treatment, of course, is very heavily female focused, and so it should be to some degree, because the woman has to have the investigations and if it's IVF, she's got to have the hormone injections and what have you. So there's all of that that's gone on. Men aren't ever led to believe that they have an issue. You know, we're told that we can conceive until the day we die, you know, that we're forever producing sperm. And, you know, then you've got the system and the system being the NHS and the nice guidelines, again, they don't really recognise male fertility, so there's not a lot of information or kind of guidance on that side of things. So I think there's really a whole kind of sort of gamete of things, excuse the pun, that are causing this issue around men not really being investigated and explored. And I think one of the other big things is actually the data and the research. So actually there's a lot less research around some of these issues, around male fertility that has changed recently, over the last few years. But actually it's then making sure the right clinicians and the right decision makers are looking at and actually reading that research and accepting what it says. So, yeah, it's a really complicated picture really? When you think about it?

Jen Walpole [00:05:28]:

Yeah. Yeah. Obviously, there's so many different factors involved but I feel like the tide is starting to turn. You know, clinic to clinic, it can differ in terms of their approach, but, you know, things are definitely moving in the right direction. And I can see that when I work with couples now, I find, you know, the guys are just as on board as the women. You know, they're there for the introductory calls. They want to know what they can do and they believe that they can make some changes. I do find that the younger generations, I want to say, coming through, I do find that a little bit more. They're a little bit more open. I think, you know, everyone's focusing on health and wellness a little bit more now. There's been a real drive, hasn't there, in that kind of industry? I think people are just more aware of, you know, their overall health and, we know that fertility is a proxy for overall health, so, we know we can make a difference. So, yeah, I think the tide's starting to turn with that, but there still needs to be a lot of work done, certainly, and it's about raising awareness, isn't it, making people aware. You know, a lot of people haven't heard of some of these tests that I know we can touch on today. Things like the DNA fragmentation, for example. And even if they are aware of it, sometimes they're told they can't do anything to improve those results. So, you know, that's the kind of stuff that we're up against. But I do feel like it's starting to shift, which is great.

Ian Stones [00:07:13]:

I think, you know, we've just got it. You know, it's just great that we're doing this tonight, and I've done many of these lives now, and it ends up being, you know, it's the same message often, but this is what we have to do. We just have to keep repeating the message. And I see so much more on Instagram now from people like yourselves, other nutritionists and other professionals. And sometimes the clinics really kind of putting that message out there about male fertility now. And if you go back four or five years that I don't think that was happening. No, you know, male fertility was still the kind of the. Well, no, just nobody was really talking about it. So, yeah, the narratives changed, I think, you know, the phrase is, but, you know, it's out of the box now. You know, you wrote pandora's box is open now. You know, the messages are out there. People are learning, and I think kind of patients are probably feeling more empowered these days as well. They're, you know, they're more selective about what clinic they go to. They're open to ask more questions to the consultants. And I think the really important thing is that we do this, or the men are part of this conversation as well, because for too long, men have been the neglected partner or the neglected subject within IVF clinics or within consultations with GPs. You know, just do your semen analysis and that's it. You know, you don't need to do anything else. Whereas actually, I think now men are more empowered to actually ask some questions and hopefully get some, some good advice.

Jen Walpole [00:08:44]:

Yeah. It just kind of made me think about where you said about being disempowered or people are more empowered now. But, you know, for a guy to hear that has semen analysis is kind of okay, or, you know, there might be some parameters a little bit out, but, you know, they're not really worried about it. It is really, you know, it's very demotivating and disempowering to feel like, well, there's nothing you can do. You're just factored out now and the focus is on your partner. And then they're, you know, like a rabbit in headlights trying to do all of this stuff. And actually, you know, they could be still working alongside their partners today to improve that because we know that normal or good is not amazing and actually, we can strive for better.

Ian Stones [00:09:34]:

Absolutely. And I always say to any man that I speak to, you've got the opportunity to turn your sperm health around potentially. Women have got a lot more work, needs to put a lot more work and time into trying to improve their egg quality. But men, you can turn it around in three, four months. Simple diet and lifestyle changes. If you're not doing the absolute fundamentals of good diet, cutting out smoking, reducing alcohol, then actually do that and you will see an improvement in your sperm health probably pretty quickly. If you don't, then it's time to ask some questions and dig a bit deeper. But this is the thing, as you say, men lose that opportunity when somebody turns around and says, oh, semen analysis is all right, you know, don't worry.

You know, we'll refer you on to IVF, that they'll help you out if there's anything else to do. But really, the narrative should be okay. Seem analysis is okay. There's probably more you can do to improve it. And actually, let's not rest on our laurels, because a semen analysis that is okay can still have other problems that aren't showing up on semen analysis. About 25% of men with normal semen analysis will have high DNA fragmentation. So it's a very crude measure of overall fertility, really. A semen analysis?

Jen Walpole [00:10:54]:

Yeah, absolutely. Yeah. And that's it. I've had it before where clients have come to me. They've had, like, three rounds of IVF back to back. This is obviously pre working with me. And, you know, they've never tested more than a semen analysis with male partner, and then, lo and behold, they've got the DNA fragmentation there. So, yes, absolutely. And we'll talk about when you think the testing should happen in a second. But I also wanted to just touch on where you said about how, you know, they can turn it around really quickly, but equally, even if it's okay, things can go downhill very quickly as well. So it's not something to take for granted. And actually getting on top of their health, doing everything that he can to support a better sperm parameters. Better sperm quality is then going to, you know, make their chances or increase success and live pregnancy rates come, you know, IVF or whether it's natural fertility. So, you know, it's important to just kind of stay on track with that, isn't it?

Ian Stones [00:12:04]:

Yeah, absolutely. Absolutely. There are, in theory, sort of quick fixes, you know, a quick fix still being three, four months. And as you said right at the beginning, male fertility is a proxy for general health. So if you're sub-fertile or you're not optimum in terms of your sperm quality, that could be an indication that you're going to get problems further on. So it's not about just, okay, well, I do this for three months and job done. All the time that you're trying to conceive, you need to be working hard to optimise your sperm quality. Everything you do for that is going to improve your chances of conceiving naturally. It's going to improve your chances of success through IVF, but it's also going to be, you know, have a positive impact on your overall health. And I actually saw a new study today that was promoted in, I think it was a website called Nature, or it might be in a journal. I only actually read, only read the research, didn't read where it was from in terms of where it was hosted, but it was looking at the food that was fed to male mice and what the impact was on their offspring. But they also then looked at obese men, human men, not mice, and the impact that potentially has on their offspring. And they have now found that children whose father was obese when they were conceived are more likely to inherit or develop a metabolic disease, usually. Usually diabetes.

Jen Walpole [00:13:36]:

Yep.

Ian Stones [00:13:37]:

So it's not just about getting pregnant. It's not just about the quality of the embryo. This is about the long term health of your future child. And I think that's another really strong message that we can try and get across to men that they have such an important role to play here, that it isn't just about getting pregnant, that you're passing on your genetic health and quality and the quality of your sperm is getting passed on to your child in terms of their well being.

Jen Walpole [00:14:08]:

Yeah, absolutely. And, you know, metabolic conditions, it's a growing problem and it costs, you know, the health system an absolute fortune. And, you know, if we can. If we can eat better while we're trying to conceive, I mean, I see it all the time with couples where, you know, they really, really do, they're very compliant because they want to see results. They obviously want to get pregnant. They want to have that healthy pregnancy, but they take on board all of the changes they make, significant changes to diet and lifestyle, and they don't want to go back to kind of ordering takeaways a couple of times a week. And then we see it filtering through to their children.

I've got clients who they're giving their children, like milled flaxseed and all sorts of, you know, nut butters and eating the rainbow and it's really lovely to see. So, yeah, it's so important. And the repercussions, the ripple effect from supporting your fertility at that preconception, time is going to be life changing, hopefully not just for you, but for your. And the future generations as well. So, yeah, I'm completely on board with all of that. The other thing that I wanted to ask you, is what testing do you think is absolutely essential? And also at what point? Because I sometimes get a little bit, not confused, but stuck with this in the sense that sometimes people don't have all the budget in the world to do, obviously, semen analysis. We can get through the GP. And sometimes there is a waitlist, but generally speaking, that's not necessarily an issue. But if we are concerned there might be DNA fragmentation, do you believe that we should be doing that test, like, ASAP, as a baseline? But if they can't necessarily afford to retest it in three months, is it better to do the changes and then test, what's your thoughts on that?

Ian Stones [00:16:14]:

Yeah, it's a really good question. At this Femtech event yesterday on a discussion panel, we had exactly the same question. What should the kind of order of testing be and where should we be prioritising? And I think, you know, I would always say that when a couple of trying to conceive maybe between six months or so, I think that's now one of the cutoffs is go see your GP, go through that process, get into the system, and that's really where a guy should be having his semen analysis. And a semen analysis is a good starting point. You know, it's a good initial test and it will look at, you know, how many sperm have you got? Are they swimming in the right direction? What shape are they? And give you a pretty broad picture. So it's a good starting point. So that's really where all men should be starting, and that should be through their GP. Ideally.

Then, you know, depending what's going on, it might be several months or maybe another year until, you know, the GP might say, okay, go away, carry on trying. There's going to be so many factors here, the woman's age, egg reserve and goodness knows what else. But let's say they do get sent away for some time and they carry on trying and nothing happens. You know, then they're eventually going to get a fertility referral. Then eventually that may well lead to IVF. And I think really at that point, or before that point, is probably where you want to be doing some more advanced testing for the men. Because what we tend to see at the moment, and I think you kind of hinted at this, Jen, is you might see a couple go through two or three cycles, and that first cycle of IVF will be a bit of a kind of fact finding one. And we're going to give you a fairly standard protocol and see what happens.

But, you know, there may be no success. There may be success, but then a miscarriage and, you know, maybe the embryos don't develop very well, and then somebody says, oh, maybe we should look at the sperm. It's like, well, why go through two or three cycles and then go back and look at the sperm? So I, you know, my belief is, and really our belief for Testhim is, is that preconception, care, so the nutrition, lifestyle, diet, do everything you can to optimise the sperm that way. You may then want to retest the semen analysis to see if it's improved. But if you're going to be heading for fertility treatment, that's really personally or from Testhim, we would say that's probably where you want to start investing in some more detailed tests. And so this is where we get into maybe a testicular ultrasound scan, oxidative stress, sperm DNA fragmentation, and there's a lot of talk about sperm DNA fragmentation testing and partly, perhaps fuelled by our activity. And it's a fantastic test, but you've got to bear in mind that that is one test that can possibly be done in conjunction with other tests, you know, because you've got to think about the history, you've also got to think about the age of the woman. So this is another big deciding factor of when you're going to do these tests.

So, you know, in the scenario, I've kind of just set out that maybe a couple are going to wait a year or so for IVF. If they're in their early thirties, then that's fine, they can wait. If she's 38, 39, then actually you might want to do the advanced testing for the man a lot sooner, because the thing is, if anything shows up, what we have to do is try and get to the root cause, and that might be infection, it might be a varicocele, might just be lifestyle and diet, and then what we need to do is we need to take action and fix those things. And then you're looking at three, four months for the sperm to recover, minimum. So, again, so there's a timing factor with that. There's so many variables that you've got to factor in. Yeah, so the question.

Jen Walpole [00:19:59]:

Yeah, I think so. Basically, if you're going through IVF treatment, I think it's a little bit more clear cut, isn't it? I think whether it's NHS or self funded, there's a lot goes into it, mind, body, emotionally, as well as potentially a financial investment. So doing the test ahead of that is absolutely essential. I think I always come in a bit. I'm stuck when it's sort of when people are looking to support their natural fertility. But I would say with the DNA fragmentation, if there's a history of, say, recurrent miscarriage, then that's when I'm probably going to be pushing for it as soon as possible, because until I know, you know, we're sort of saying to them to stop trying to conceive while we're working on everything else and trying to get to the root cause of what's going on, so.

Ian Stones [00:20:53]:

And actually, I had. I had that exact conversation with somebody yesterday at this event I was at and him and his partner, pretty young, I think they're in their late twenties and they've already had two miscarriages, so they've conceived easily, but he hasn't even had semen analysis because they've conceived naturally. So you're right there. And something I kind of forgot to say, really, is that if there are signs, means that male factor could be at play. So recurrent miscarriage, you know, unexplained infertility, which is also a bit of a broad statement, IVF failure, embryos not developing, then that's going to, you know, if there's other red flags, one of the other things is, you know, you sort of hinted at the cost and that some people might not be able to afford things, you know, at the moment, DNA fragmentation testing is perceived as expensive. I don't actually think it is expensive, and I'll explain that in just a second. But one of the other things you could do as a man is, okay, get your semen analysis through your GP. We offer a testicular ultrasound service through testing. That's 140 quid. Go and get a testicular ultrasound done. Because varicocele is one of the biggest causes of DNA fragmentation. 40% of men have a varicocele. So if you've got a varicocele and that's confirmed by a simple scan that might, then that's going to cost you a little less than a DNA frag that might then inform you to actually say, you know what, now I've got confirmed varicocele, investing in a DNA frag is going to be worthwhile because then you can actually decide what you're going to do with that information.

Jen Walpole [00:22:29]:

Yeah.

Ian Stones [00:22:31]:

I want to touch on the cost of the DNA frag because this comes up so often that couples are, oh, God, you know, it might cost 4500 pounds at the moment with a consultation with a clinician. That information that you get from that test is incredibly valuable because if you've got high DNA fragmentation, that's telling you there's something going on somewhere, whether it's lifestyle, diet, infection, varicocele, you know, workplace environment. So that information allows you then to make an informed decision as to what you're going to do next. It allows you to try and get to the root cause. And actually a lot of the causes of DNA fragmentation are entirely treatable and what you then might be able to do is treat the cause. It may negate the need for IVF altogether. So if you've got to the root cause and you've treated it, and this isn't going to be true of everybody. I do understand that, but it could make all the difference.

So it's money well spent as far as I'm concerned. But of course, the problem we have is that where clinics are saying, okay, you had a DNA frag and it's high, they're then going to recommend ICSI. And actually, ICSI isn't the solution to DNA fragmentation. What we've got to do is get to the root cause and treat that.

Jen Walpole [00:23:50]:

Yeah, absolutely. I think cost is sometimes a factor if we're thinking about timing of testing and whether we're going to do a DNA fragmentation and then potentially retest to make sure. Okay. But, you know, I know some top urologists, they don't necessarily recommend retesting. So potentially getting that baseline test would be ideal. And then work, get to the root cause, like you said, and work on those things alongside the nutrition, the lifestyle, all the other things that we can do and see where we get to. But like you said, you know, I really like that kind of quick, easy, well, cheaper option that people can go and do the scan if potentially budgets don't allow for the DNA fragmentation.

Ian Stones [00:24:43]:

Yeah, and you've got to bear in mind, though, of course, if you come back with novaric acid, you could still have DNA fragmentation. And sometimes we don't know where DNA fragmentation has come from. Sometimes it's a kind of a. It's a packaging issue, you know, it's the way the sperm are being made that you can't do anything about. So, you know, retesting is. Is a great option if you can afford it, you know, find out what the root cause is, fix the root cause, retest a few months later. But, you know, everything we're talking about here, diet, lifestyle, nutrition, testing, it's all about optimizing the sperm. It's optimizing that sperm to give you the best possible chance of conceiving naturally or the best possible chance of success if you're going to go for an IVF cycle.

Jen Walpole [00:25:27]:

Yeah, absolutely. And I liked your point about it being invaluable. Like, the information is invaluable and you can't put a price on that. So, yeah, I completely agree with you. And then I'd love to know what sort of overall trend you see coming through with male infertility issues. So, actually, my journey was one where we had to have IVF and it was male factor. So, it's a topic that I'm very passionate about. And I really want to make sure that people, get the right support and men are included. I do see quite a mixed bag. But how do you find things your size with Testhim is, you know, I know count and concentration is talked about a lot in terms of that being sort of on the decline, particularly in the last 50 years and even more so in the last 20 years. But, what are you seeing your side with regards to some of the issues that are coming up?

Ian Stones [00:26:31]:

Yeah, it's a real mixed bag. And I think generally we're probably picking up the more complex cases anyway. You know, our mission with Testhim is really going to be to try and cover, you know, 15 year olds to 50 year olds and, you know, preconception, care and fertility education in the young. And at the moment, I think we're still picking up those that are kind of in the trenches of fertility treatment. So we're naturally seeing men that are, you know, got some complex issues going on, you know, anti sperm antibodies. But in terms of, like, the semen analysis. Analysis, is that I see, you know, again, some of them absolutely fine, some of them are absolutely dire. Morphology is always an interesting one, and very rarely would I see morphology above 3% or 4%.

It always tends to be that little bit lower. And there was a comment in here from GFET, who I know, about the fact that semen analysis is very subjective, and there's some really interesting studies around the reliability of a semen analysis, because there's a whole accreditation process that goes on with certain labs across the UK, and there's a huge disparity around the results that come in on identical samples. So, you know, you see mixed, very mixed results. So, yeah, sometimes, honestly, it's. I see a bit of everything. In all honesty, what is interesting, I think what I have really noticed since we launched the ultrasound service is how many men are coming through with a varicocele.

Jen Walpole [00:28:14]:

Yes, I've seen this a lot as well. Like you said, 40%. I'm not surprised when I didn't know the figure, but when you said it, I was like, gosh, I'm not surprised because everyone I've referred to, urologists, they've picked up varying degrees of varicocele.

Ian Stones [00:28:34]:

Yeah, I mean, we haven't sold hundreds of the tests, but I would say it's probably about 70, 80% of the ones we have sold have come back with a varicocele because the guys always have a chance to have a consultation with me afterwards or phone call. So I've been quite surprised that it's been as high as it has. But then, equally, I'm not that surprised, because the men that are going for these scans are men that are struggling. Yeah.

Jen Walpole [00:28:58]:

They might be getting. Yeah. Having the DNA fragmentation and. Yeah, yeah. Okay, that's really interesting. Okay, and then what do you think? So this kind of probably leads us on quite nicely to talk about a little bit of nutrition and lifestyle. I know you've touched on things like smoking and alcohol, but what are those biggest kind of challenges that we see to male fertility and men's health, I suppose, today.

Ian Stones [00:29:30]:

Oh, that's good. I think. I think most men are pretty clued up with the alcohol and smoking thing. Yeah. Rarely do we do end up chatting to men that are overdoing it on that side of things, because, again, because we're generally chatting to people that are already in a fertility journey, they've usually heard it, and the guy's heard it many times over, so he's usually doing pretty well. He might still be having a few beers. I have had guys where I've needed to encourage them to tweak it down a little bit. So I think, you know, that's fine. And generally okay, so most of them are doing all right, but it is always quite surprising when you dig into somebody's diet a little bit and their lifestyle, it's like, oh, okay, right. You know, you think you're eating healthy, but actually you need to change X, Y, and Z. So there's that going on. You know, vaping, I think, is a big concern at the moment. It's been completely miss sold to people that it's okay. And obviously, people are taking it up as a new kind of newfound hobby rather than using it to get off cigarettes.

Jen Walpole [00:30:38]:

So I just can't believe how popular it is. I've just come back from the south of France on holiday, and maybe it was because I was relaxed and, like, looking around and people watching, and I could not believe how many people I saw couples with babies and they're both vaping. And, yeah, I was very shocked. And, you know, the problem with it is, you know, there's not all the studies that we have, like, we do with alcohol, with smoking. But, you know, I actually remember, I think it was Zita West and Melanie Brown were talking about how 20 years ago they were saying, you know, reduce your alcohol to about this. And, you know, do you do all these lifestyle things? And they didn't necessarily have the evidence around it then, but they just knew it mustn't be good, you know, it can't be. How can putting those things in your body be good for you and good for your fertility? And lo and behold, you know, they were right. And it's the same with vaping.

You know, we're going to see studies coming out, it's not sort of any better than smoking potentially, and we just.

Ian Stones [00:31:47]:

Don't know that even worse, because actually there was Doctor Helen O'Neill from fertility. I saw a little reel with her. It's like the fact that, you know, with, with smoking, you can at least track it quite easily that, you know, I'm smoking ten cigarettes a day with vaping, people are just chuffing away on this thing constantly. So actually the volume that they're taking in. So, you know, I think one of the things I kind of say is like, if you look at what's going on with male fertility and sperm quality at the moment, you know, what we're seeing really, I think is reflective of the huge change in our lifestyles over the last four or five decades. The massive change in our diet and the foods and the processing of our foods that's going on, the technology that's surrounding us, the lifestyles that we're leading. So we're now seeing it. We are the guinea pigs, we are the test rats and we're seeing what's happening to ourselves.

And vaping will be another one of these things that ten years down the line, it's like, oh, actually, now let's see what's happened to sperm quality. So these are all factors. I think the other factor is our sedentary lifestyles as well. We all spend so much more time sitting because of remote working and just sitting at a desk. You know, I think a lot of people are work very hard to keep active and exercise, but it's all too easy to sit for a long period of time. And we know that that means the test scores are getting squashed between the thighs. The insulating effect of office chairs. You know, I'm sat on one right now. You haven't got be sat on it for very long for it to raise your scrotal temperature enough to. To decrease sperm production. So all of these factors are really quite significant.

Jen Walpole [00:33:32]:

Yeah, because obviously the testes are on the outside of the body for a reason and, you know, it's even just a couple of degrees can impact things. Is that right?

Ian Stones [00:33:43]:

Well, yes. So, yeah, the testes need to be two to three degrees cooler than core body temperature. That's kind of like the Goldilocks zone of sperm production. So as soon as you start nudging that temperature up, then your sperm production is going to go down. In fact, this panel that I was on yesterday, one of the chaps that was with us, was talking about a trial of a little device that you could somehow put on the scrotum that had water in it, and then that water became heated, so it heated the testicles up. What they found was it actually killed it. So it was designed as a contraceptive device, and they found it then killed the sperm that the man then produced after having this little kind of heat pack on the testicles. So, yeah, if you think what we're doing with heated car seats and goodness knows what else.

It's really bad. Then you've got, you know, if you've got polyester underwear, if you're wearing skin, skin tight jeans or really tight pants, and they're squashing your scrotum up. And then we got to cycling and lycra, that's a whole other, you know, instalive in itself. But all of these things contributing to scrotal temperature rise, which is going to decrease sperm quality, and it's going to increase sperm DNA fragmentation. We know heat's a major factor for that.

Jen Walpole [00:34:58]:

So do they just need to sit there with an ice pack on their balls, then?

Ian Stones [00:35:03]:

Well, you know what? It's funny you should say that. So we have recently launched some specialist underwear for men.

Jen Walpole [00:35:09]:

I saw that. Yeah. Yeah.

Ian Stones [00:35:11]:

Cool beans underwear. I haven't got a sample pair to show you right now, but our podcast is coming out on Thursday with about cool beans, so you can listen in about how it's been designed. And it's got this special mesh pouch to allow air to flow around the scrotum. And it's got a whole level of support tied into the waistband, so it kind of gently lifts and supports the scrotum. So, actually, then, if you're sitting for a long period of time, you're not losing your balls in between your thighs. They're actually then sitting up out, so on top of your lap rather than in it. So, yeah, they're quite novel and quite unique. So there's no need for an ice pack.

Ian Stones [00:35:47]:

There are other pants out there.

Jen Walpole [00:35:49]:

Yeah.

Ian Stones [00:35:49]:

Where you need to put your ice pack in the freezer, put it into the pants and then swap it over. You know, it comes with its own challenges of, you know, being near a freezer and packs leaking and goodness is what else? So, yeah, Corbin's underwear. It's quite a novel invention. Lovely.

Jen Walpole [00:36:05]:

I'll share it on my stories. And just another thing you just mentioned, I won't get into it too much, but with the cycling, my understanding is it's over a certain amount. So if it's excessive. But I think, you know, you can find a study for anything, can't you? You know, there'll be studies talking about one or 2 hours a day. I think the one that I read was like four or 5 hours of. So you know, someone that's training, for example, for a triathlon or, you know, really someone going out all day, let's say on a Saturday. Cycling. What are your thoughts on that? Is kind of a little bit of cycling to and from work. Okay. Is it more excessive?

Ian Stones [00:36:47]:

So I've written an article on this that's on our news page of our website. And so I trawled through various research papers myself, and it was a real mixed bag, but the kind of feeling I got was around 5 hours a week is kind of where the threshold is.

Jen Walpole [00:37:04]:

Maybe it was a week. Yeah, a week from what I was. A week.

Ian Stones [00:37:08]:

Yeah, yeah. Not 5 hours a day, but what I've, what I found, having written a lot of papers or a lot of articles for our website and read a lot of papers, is actually generally it comes down to moderation and with all of this stuff. So if you do anything to extreme, so no exercise and sit on your ass all day, you're gonna have sperm problems. If you're training for an ultra marathon and always training and doing excessive running or cycling, you're gonna have problems. Problems if you're in that, again, Goldilocks zone. If you're in that middle ground where most of us are, you know, we're eating healthy, we're moving regularly, we're doing some exercise. You're doing a little bit of cycling, but not more than 5 hours a week, then you're going to be okay. So yeah, you know, commute to work.

If it's, you know, not greater than, well, cumulative of 5 hours a week, then it's probably going to do you a little bit good. You know, a bit of exercise, get the blood flow, you know, try and wear supportive underwear that's not going to squash everything up. So actually cool beans, quite good for cycling as well, you know, and just try and moderate it and balance it out. I often say to men like, you know, do a bit of yoga and do some weights, you know, do a little bit of cycling, but not too much and a little bit of running, you know, try and mix it up rather than doing all of one exercise that may become detrimental.

Jen Walpole [00:38:28]:

And what do you think the problem is with that? Is it more the heat? That, or one of the things that I was considering recently, I've just got a client in mind here, but it was, you know, their energy expenditure. So if they're really intensely working out, you know, obviously reproduction isn't a vital function like, you know, our heart beating and breathing, etcetera. So, you know, is that energy getting diverted to the muscles and the cardiovascular system and, you know, the other systems of the body that need it to, you know, the energy metabolism, etcetera, and therefore that those nutrients and that energy is simply not going to make its way down to the sperm and to the.

Ian Stones [00:39:18]:

Yeah, possibly. I think one of the mechanisms is oxidative stress. So oxidative stress occurs. It occurs as a result of metabolism, so actually us burning and using oxygen, and that process produces free radicals. And these, these are cells that go around, you know, obviously, you know, this, they go around stealing electrons off of other cells or something like that. And so it creates a bit of a. It can create a bit of a snowballing kind of storm effect.

So if you're exercising to extreme, you're going to be, you know, your metabolism is going to be a lot higher, you're going to be burning a lot more oxygen. It does increase your oxidative stress. You know, if you're doing general kind of level exercise, it's not going to be a major problem, and there's going to be a lot of benefits to that. But if you're doing anything too extreme, it's going to add to it. The other thing might be elements of inflammation, perhaps. So if you're doing a lot of exercise that's creating, um, you know, a high demand on the muscles, then that may cause temporary inflammation, which, again, is going to add to oxidative stress. So, you know, it's just about being sensible and cautious and just try and keep it all relatively balanced.

Jen Walpole [00:40:32]:

And for someone like that, would oxidative stress be a test that you would recommend for them more so than the DNA fragmentation?

Ian Stones [00:40:43]:

Yeah. So oxidative stress again. So this actually talk about cost of testing. Oxidative stress is a little bit cheaper. It's going to, I think it's about 120 quid, maybe it can be done alongside a semen analysis, and that will give you almost instant result where it's pretty much instant result, and it will give you an idea of whether you're in oxidative stress. That will then give you an idea whether you need to change your lifestyle and diet and whether supplements might be beneficial for you. So antioxidant supplements. So it's a very, very good test.

Ian Stones [00:41:11]:

You might choose to do that instead of a DNA fragmentation test. If you've got high oxidative stress, it may mean you've also got high DNA fragmentation. So you might then want to follow up with a DNA fragmentation test. But the problem is they're not 100% correlated, so you can have one without the other. So you can have oxidative stress and not DNA frag and vice versa. So it's a very good test to have. But you may actually want to consider just doing the full suite of tests, including the DNA frag.

Jen Walpole [00:41:44]:

Yeah. Okay, then let's just wrap it up. I think I've come to the end of some of my questions, but I wanted to bust some myths with you. So this is something I do in my group program, which I have. I'm going to be launching it again in September, actually. And, yeah, it just kind of captures those really confusing questions that people have where there's a lot of conflicting messaging out there. So myth one is a semen analysis. Is it enough testing? And I think we've kind of answered it today.

Ian Stones [00:42:19]:

Yeah, I think we haven't we, as I said, it's a good starting point. It's a good basic initial test, but it's not enough to truly understand your fertility potential.

Jen Walpole [00:42:30]:

The other thing we haven't talked about is blood testing, I like a really comprehensive full blood workup. And, you know, I can't tell you the number of women who've been pricked and poked with. You know, they've had so many blood tests, and they come to me with a whole folder of tests that they've had, and I create a bit of a case history in terms of, like, you know, what things we are looking like. And the guys have had nothing tested. So, you know, at the beginning, absolutely. Semen analysis. And I'll always write to their GPs to get that full blood work up as well. And then, like we've spoken about today, obviously there's other tests depending on your case history. But obviously, you know, look, doing a little bit more digging, working with someone like myself, speaking to you guys, they can maybe understand a little bit more about what that might look like for them. And then the second myth is, is ICSI the answer to male factor infertility?

Ian Stones [00:43:29]:

No, no, no, no, it's not. It's and this is probably one of our biggest bugbears. So ICSI, it's a fantastic treatment and it's a well documented treatment and it's the right treatment at the right time for some cases, certainly, where you've got a very, very low sperm concentration, you haven't got enough sperm to do traditional or conventional IVF, then ics can be very, very well indicated for that. But you know, what clinicians, what embryologists are trying to do with ICSI is choose the best sperm. And they have got techniques to clean and wash the sperm and to try and choose the right sperm, you know, so maybe with some HPA binding or pixie. But at the end of the day, I kind of always, I come up with the analogy of a barrel of apples. You know, if you've got a barrel of apples and there's a hundred in there and a hundred of them are good, the chance of you putting your hand in and finding a good one is 100%. Now if you've got, if it's 50:50 and you can't see inside this barrel, really, you can't.

All of the apples look fine on the outside, but the core might be rotten or damaged. Until you pick that out and open it up, you're not going to know. So the higher the level of DNA fragmentation, no matter what the clinic does, they're picking from a bad bunch. You know, it's like trying to choose a football team when all the players have got two left feet, you know. So what we, this is why we want to do the test. Find the root cause, treat the root cause to try and improve that sperm quality overall and then you've got a much better chance. If you still need ICSI, you still need ICSI. But you, the embryologist, embryologist has got better ingredients and better sperm to choose.

So yeah, ICSI doesn't, it's, it's not the be all and end all in terms of sperm selection and again, overcoming DNA frag.

Jen Walpole [00:45:23]:

And you know, when we talk about costs earlier, I mean, obviously ICSI is far more costly than just simply running a DNA fragmentation. And I've seen it where theres been one failed round of IVF. So then the next time they're like, oh, I know, lets use ICSI and its going to cost you an extra. I don't actually know how much. I think its 1500, maybe two grand more potentially when they could have just done a DNA fragmentation if that was potentially the issue, which, you know, maybe we found that out at a later date.

Ian Stones [00:45:58]:

Some research that we shared earlier this year, there was a study that showed ICSI done on the day of ICSI that was carried out where DNA fragmentation by the SCSA style assay on that. On that sample, on that day, where there was high DNA fragmentation and ICSI was used, the level of aneuploidy in the embryos was much higher. So it just showed that actually, it doesn't. It's not. You're not creating better embryos by using ICSI if you've got high DNA fermentation, because exactly as I explained it, you're choosing from a bad bunch. So you're potentially actually more likely to get a bad embryo. Whereas if you've got enough sperm and you've got high DNA fragmentation and actually left the sperm and egg to their own device in an IVF dish, in a petri dish, then the natural selection may allow a good sperm to get through.

Jen Walpole [00:46:54]:

That was more, was my reservation with it, because, you know, with natural selection, the best, you know. Yes. You know, surely if there's some DNA fragmentation in the sperm head, it's not going to be quite as good a swimmer, you know, it's not. There might be other sperm that are going to be.

Ian Stones [00:47:13]:

It may still get there and it may still get in. What we want to try and achieve is still the same, which actually still to optimise the sperm. But it's just making that point that this study found that the embryos were not good quality where you had high DNA frag on the day. It just shows that ICSI may not help.

Jen Walpole [00:47:32]:

No. Okay, that's really, really interesting. And then myth three. And I see this a lot, you know, women that have got, say, endometriosis or pcos, and so the focus is very much on them and they feel like. And the male partner can sometimes think, oh, well, you know, the issue lies with her. I'm okay. And like we've spoken about, my semen analysis might be okay, but that's quite a big myth. Would you agree?

Ian Stones [00:48:04]:

What, in the sense that, okay, well, she's got confirmed PCOS or endo, therefore it's nothing to do with.

Jen Walpole [00:48:10]:

I guess he's just unexplored, isn't, you know, it's potentially just on explore.

Ian Stones [00:48:15]:

Oh, yeah, yeah. So he's not tested at all. Yeah, because. Yeah, because you found an issue, then obviously everyone hones in on that issue. And where you've got endo or PCOS, then, you know, obviously that becomes the huge focus. But if you've got PCOS, then the egg quality is going to be, you know, compromised. Um, you know, I don't know if that's the same with endometriosis, but you can have other problems as well.

Jen Walpole [00:48:40]:

Yeah.

Ian Stones [00:48:40]:

Again, it comes back to giving yourselves the best possible chance. So, you know, if you've got PCOS and possible, you know, impaired egg quality, then that sperm needs to be even stronger to overcome any problems there. Because, you know, one of the things with DNA fragmentation is the egg has the ability to repair that. You know, it gets the DNA. It says, hang on a minute, this isn't quite right. Let's. Let's tidy this up a little bit and then, you know, we make an embryo and off we go. But actually, that the ability of the egg to do that deteriorates with age.

And if it's a poor quality egg anyway from PCOS, then again, you know, it's going to struggle to fix the sperm. So, you know, you just always want to be giving yourself the best possible chance no matter what's going on. So, yeah, just because you've got confirmed factor on the female side doesn't mean there's not a factor on the. On the male side and that it should be ignored.

Jen Walpole [00:49:34]:

No, absolutely not. And the final myth is there's nothing you can do to improve DNA fragmentation. And I've actually heard this through clients, you know, some clinics have told them that and, you know, that's why they don't do DNA fragmentation testing and, you know, they'll just use ICSI, for example.

Ian Stones [00:49:55]:

Yeah, that's really sad if people are hearing that advice. And I think one of the worst I heard was a woman who'd been through nine miscarriages into a miscarriage clinic, had discussed, or wanted to discuss DNA fragmentation testing for her partner. And the clinician said, don't bother wasting your money, just go and buy your pregnancare supplements from boots. I thought, wow, we have data, we have research and plenty of studies to show the impacts DNA fragmentation has on live birth outcomes, you know, as well as embryo development. So it's a really, really crucial and important part of the equation and, you know, it's. Clinics need to be seeing this data, reading this data and taking it seriously and advising patients accordingly, you know, for them to completely poo poo it and say it doesn't do anything and it's not important. There's nothing that can be done for it is not really, you know, I'm to choose my words carefully here. It's not really particularly good advice and there is plenty that can be done to improve DNA fragmentation.

And again, there's research out there to prove it. You know, you know, you might argue it's anecdotal medicine that, you know, Toby had a varicocele, he had high DNA fragmentation. All confirmed. They had two rounds of failed IVF over six years. He had his varicocele treated and repaired and three months later, they conceived naturally. So, you know, we've seen plenty of men improve their DNA fragmentation through lifestyle interventions or other interventions that were needed.

Jen Walpole [00:51:32]:

Yep, absolutely. I completely agree with all of that. And just to finish up, so people can order the DNA fragmentation through clinics, is that right? Via testhim?

Ian Stones [00:51:47]:

Yeah. So our service is live. A lot of people still ask us, when's the DNA frag service coming? It's here. It's already live. We've done quite a few hundred tests already, but actually, the way we're working at the moment is just through clinics and clinicians. So it might be that you go to your IVF clinic or you go to an andrology clinic and they will run a DNA fragmentation test and it will actually come through us. It will come to our lab at. At the University of Kent, or it may go elsewhere.

There are obviously other providers, but, you know, a lot of them are coming our way now. There are some clinicians and nutritionists that can refer direct into TDL and they are the lab that are moving our samples around down to our lab. So there are options that way. But it's not a direct consumer test at the moment. So it does have to be done through a clinic or a clinician. You know, the important thing is get the test, get the information, get the data and then decide what you do from there. But, you know, give us a follow, stick with us.

You know, we will be evolving the service over the rest of this year and many years to come. So, you know, we want to make it more accessible. We want to make it more affordable for men.

Jen Walpole [00:52:59]:

Absolutely. And where can people have the scan?

Ian Stones [00:53:05]:

So the testicular scan, so they can buy that through our store. So our store or just go to Testhim.com and click on store, they buy the test and what happens is they get unique code and that then allows them to go through to book one of the about 40 sites across the UK. So we partnered with ultrasound direct. Not all of their sites offer testicular scans, but, you know, it's all listed on our website as to where you can get a scan. But do, if you're not, if you're not sure, do phone up and check with them before you buy the scan. But the important thing is that we then offer the follow up with myself, either a 15 minutes phone call or a 30 minutes zoom call, because what we found was men were getting their scan results but no further information on what to do next. So, you know, we want to make sure that that bit of the journey is joined up. So I will then help them, you know, I'll have a look at the summary, have a look at the results.

If they've got confirmed varicocele, I can then direct them to further testing or further clinicians and sort of guide them on that journey.

Jen Walpole [00:54:08]:

Brilliant. Okay, that's really, really great. Thank you so much for explaining all of that. And, yeah, I'll post a few of these links and things on my stories as well for people. But thanks again, Ian, it was great to chat to you, all things male fertility. I'm just. Yeah, I've learned some new things, you know, chatting to you tonight and, yeah, I'm really excited to see kind of what you do next with test him because it all looks really, really great and positive. So, yeah, well done for all of that amazing work.

Ian Stones [00:54:42]:

We've got an exciting, fun little campaign hopefully coming up in July, so keep your eyes peeled for that one.

Jen Walpole [00:54:48]:

Okay, brilliant. Thank you so much. Have a good rest of your evening and I'll speak to you soon. Take care, bye.