#PTonICE Daily Show – Monday, April 15th, 2024 – Male fertility

In today’s episode of the PT on ICE Daily Show, #ICEPelvic division leader Christina Prevett discusses the role of physical therapy in the male fertility space.

Take a listen to learn how to better serve this population of patients & athletes or check out the full show notes on our blog at www.ptonice.com/blog.

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Hello everybody and welcome to the PT on Ice daily show. My name is Christina Prevett. I am one of our lead faculty in both our pelvic health and our older adult division. I’m going to apologize in advance if I sound a little hoarse. I am not feeling well, but that doesn’t mean that we aren’t going to be able to have an incredible episode here on the podcast. So today I wanted to dive in a little bit on male fertility. So last podcast episode that I did several weeks ago, I was talking about our role as physical therapists or individuals in the rehab space in fertility. That conversation circled very much around female fertility and around ethical considerations for fertility. We’re gonna continue that conversation. We are gonna launch off of that conversation into our male fertility and male fertility related factors. So I feel like when we are talking about individuals who are struggling with fertility related concerns, a lot of our conversation centers around the female pelvis. And that makes a lot of sense because individuals who are struggling with fertility, it’s oftentimes, we are hearing about assisted reproductive technologies like IVF and IUI that are largely interventions that are done for females. And so if couples are dealing with infertility, the female is oftentimes doing different interventions to allow for more successful rates of conception or implantation in the uterus based on a variety of factors. What I think is important for us to recognize, though, is that 30 to 50% of couples who are going through infertility have male-related infertility factors. Let me repeat, between 30 and 50% of couples seeking help for fertility-related concerns have a male-related factor in their journey. And I think this is really relevant for us to be starting to have conversations about because so much of our education has focused on the female pelvis and our males really don’t know a lot of things that relate to their fertility. So there was a cross-sectional survey that was published asking males of reproductive age about their fertility. 55% of them, 54% could not identify factors that positively influenced male fertility. So we have a role to play sometimes when we are working with individuals. This is probably not an area of practice where individuals are going to be all of the time marketing their services in male fertility, but I think it’s important that we talk about the male aspect of infertility as well. When we are talking about male related concerns, we have sexual response concerns and then we have sperm related concerns. When it comes to the sexual response related concern is that in order for conception to happen, an erection has to be able to be developed and maintained in order for that erection to lead to ejaculation in order for sperm to meet the egg. That sexual response needs to happen. If you are struggling with erectile dysfunction, if you are struggling with pain with ejaculation or testicular pain with sexual activity, those are going to be big barriers to a person being able to successfully have penetrative intercourse. We have a huge role to play in helping with erectile dysfunction and with individuals who are experiencing pain. And in our level two course, we go into a lot of these pain syndromes that focus around the male pelvis. And so the first thing is clearing some of those conditions. Secondly is we talk a lot about the sexual response being not just a mechanical property where you want to have sex, you get that sex response, and ejaculation occurs. There are a lot of bio-psychosocial factors that go into a person’s sexual desire, their libido, and issues related to their want for that type of intimacy. We have a book called Come As You Are that is focused on the female pelvis and the female sexual response, but we don’t have as many of the same type of resources for males who are struggling with the same thing, right? Like if you are really stressed out, if you are not sleeping well, new parents who are like in the thick of postpartum, that doesn’t just affect are females, that can affect our males as well. If they are struggling with mood disorders like depression or anxiety, that can have huge side effects on their libido and their desire for sexual activity. If they are on certain medications, it can have influences on their sexual desire. And so having conversations about the biopsychosocial factors of the sexual response are also important. So when we are thinking about the bucket of sexual response for males, our role comes into helping individuals with erectile dysfunction, if that’s something that we have cleared that may be in our wheelhouse around hypertonicities or different type of pelvic pain issues that are leading to that response. A lot of erectile dysfunction is a vascular response and individuals with erectile dysfunction are at higher risk for cardiovascular disease. So there’s a health promotion component there. And then we’re also going to have a lot of education around libido. If it is the physical act of penetrative intercourse that is a stumbling block for a couple who is dealing with infertility. We see this all the time in our female pelvis with those with vestibulodynia or other dyspareunias or pelvic pain syndromes. This can also be true for our male pelvis, which can create a barrier for individuals being able to have sex at the right time. Okay, so that’s kind of our male response piece. The second is on the sperm itself. And so when we are thinking about the male sperm meeting in the fallopian tube and being able to successfully have a conception moment that happens, we have to think that there has to be enough sperm and the sperm has to have good motility or movement, which is related to its shape in order for it to make the long road to the fallopian tube. I mentioned in my female fertility podcast that it’s interesting with some of our health promotion because female pelvises have all of the eggs that they are going to have in their entire life by the time they are born. They do not develop more eggs. Eggs mature across cycles. That is not true for the male side of the physiology. For females, that means that health promotion is related to their entire lifespan. For males, that is 74 days. So the maturation cycle of the sperm is 74 days. What that means is the acts that you take, the health promotion incidences that you take when you are trying to conceive, what is really important is those 74 days are approximately three months prior to conception. So if you are a couple who is trying to conceive, your health promotion factors for the male in the three months prior to trying to conceive matter, okay? They matter. So when it comes to our sperm volume and motility, what we are seeing is that there is a large influence on motility for reactive oxygen species and low-grade inflammation. And you all are probably thinking, well, that’s good news because that means that our health promotion factors are going to be very relevant in male fertility. And you would be correct. OK, so when we’re looking at the magnitude of improvement in fertility for those that start taking on more lifestyle related factors, health promoting factors, it is significantly more beneficial for men who are trying to get pregnant or get their partner pregnant than it is for females because females it’s the accumulated reactive oxygen species of their entire life up to this point where it’s still going to be beneficial but the magnitude is not going to be the same as the 74 day cycle of the male sperm. What that means is that we have several modifiable risk factors that we can be educating on when it comes to our fertility. So heat stress, use of a sauna, is one modifiable factor that seems to degrade sperm quality. Another one is alcohol use. Alcohol use can negatively impact sperm and sperm-related factors, and it should be avoided or minimized for individuals, for the male partner, for the female partner too, but specific to the male when we are trying to conceive. Steroid use and use of testosterone replacement therapy is a big cause of male-related infertility. It is not everybody who is on TRT, but in our male pelvis, right, the exogenous hormones shut down some of our spermogenesis type of physiological pathways and our body or the male body isn’t producing sperm because there is an exogenous hormone that is coming in that says we’re good. Okay, we’re good. So individuals who are on exogenous steroids, so this is kind of our athletes. Pardon me, sorry. They’re on TRT. We’re seeing a lot of individuals who are topping up their T to be on the higher end of physiological normal. That may be a big contributing factor for them for their infertility. So asking about any supplements or any medical interventions that individuals are doing to top up their testosterone is a big factor. Smoking is another male related factor that can influence fertility. Smoking creates an increase in reactive oxygen species. creates chronic low-grade inflammation, this makes a lot of sense. The other one is obesity. Adipose tissue is low-grade inflammation tissue and can contribute to the burden of low-grade inflammation on the body. So a lot of these like heat stress saunas, alcohol use, TRT, smoking, and obesity are things that we can counsel on. Another very big influencing factor is a person’s exercise. So sedentary behavior is linked to lower fertility rates and those who are physically active in the three months leading up to their fertility journey, starting, trying to conceive, have a higher rate of fertility. So the influence here though is a little bit nuanced from what we’re seeing in the literature. So individuals who are active going into their conception journey. It doesn’t seem for those who are not struggling with infertility to influence how fast a person gets pregnant, but it influences if there is going to be a male factor fertility issue. That makes a lot of sense because it’s two people, right? We’re going to only be able to optimize the person that we are working with. being physically active, going into your conception is a good thing to do. Especially most of our evidence, you guys are not surprised based on where my research is, like a lot of this is in aerobics, so we’re trying to build up some of our resistance training literature. So being physically active, being less sedentary is good. The only flip side of that is for individuals who are really active. Okay, so for our highly, highly active, especially endurance, especially cyclists. Okay, so when we are working with individuals who are very highly active, especially our endurance trained individuals, we are seeing an influence on sperm motility for those who are cycling for more than five hours. And what that is, is the closeness of the testicles to the body when you’re on a bike that is putting the seat close to the body, because the heat can influence the sperm and sperm quality. It’s also some of the impact, mechanical impacts of the bike seat. We see that there are higher rates of erectile dysfunction and pudendal neuralgia, which can influence sexual response in our high-level cyclists. And we are recognizing that individuals who are in the endurance space, our male endurance athletes, are at risk for RITS, relative energy deficiency in sport. Our female athletes are much more sensitive to underfueling and that low fuel and energy availability and its impact on their physiology, but our males are not immune. And our endurance male athletes, in particular, appear to have a higher incidence of underfueling than we are recognizing. And so Exercise in general is very good for fertility. For those who are on the very high volume side of the spectrum, we may be counseling on type of exercise, fueling, and volume, and clearing for any types of sexual dysfunctions that may influence a person’s conception.

All right, I hope you found that helpful. I found this literature to be so fascinating. When I think about fertility and the male cycle, I just kept thinking, this really feels like a vital sign for health for our males, right? Like when I’m thinking about the sperm quality, reactive oxygen species load, like it almost feels like an HPA1C for health of the entire body. We use HbA1c to get a good idea of blood sugar responses over the last three months. We can get almost like an inflammatory load response for males in the previous 74 days with sperm analysis. Now, we’re not going to go and get pupils to have a sperm analysis every couple of months to take a look at their health, but I think it is fascinating to see how sperm-related parameters can really give us some insights into the overall health of the male that we’re working with. All right, if you are interested in learning all things about fertility, we dive into fertility management in our level two course across a variety of weeks. So we talk about fertility and influences for fertility. We talk about fertility related conditions that lead to infertility, and we talk about assisted reproductive technologies and the influence of different fitness forward modalities on ART technology. So if you are interested, our next level two, you have had to have taken our level one online course to get into that is in August. I have just been in Texas last weekend. It was so fun. You guys were so great. I’m so thankful for you all. Around learning about all things pelvic this weekend if you were looking to get into our live course Our next course is May 18th 19th in Kearney, Missouri Then I’m gonna be in Highland, Michigan June 1st and 2nd Alexis is gonna be up in Anchorage, Alaska and then June 8th 9th. I have a back-to-back I’m in Mineola, New York. So I’m at Garden City CrossFit close to New York City and I would love to hang out with you guys. We had so much fun at dinner. We were talking all things Pelvic health and we just had a great time. So if you’re interested in any of those courses

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