If someone's listening and they're thinking, "This doesn't really apply to me because I'm not planning to, to have children," what other science establishes a, a relationship between semen parameters and things outside of, of fertility that might be of interest to s- a, a male listener right now that, that may promote them or inspire them, motivate them to go and get a sperm test?

I think this is such a fascinating line of research.

I mean, I obviously am biased, uh, given what I do.

But, you know, there's good data that, uh, s- semen quality really lets you know where you are currently, so there's strong links between semen quality and current health, but also, again, future health as well.

And it's just sort of this amazing marker of fitness, right? It's like a, almost like a check engine light, right? I mean, you're driving and a check engine light comes on, doesn't mean your car's gonna stop immediately, but there's some issue with, you know, a sensor or a valve or something.

So it's, in a similar fashion, I think, a semen analysis gives us that kind of window into many different things, metabolic health, immune health.

You know, men with lower semen quality have higher risks, psoriasis, rheumatoid arthritis.

So what is it that's affecting spermatogenesis such that populations of men today have lower sperm count, and is that, is that accurate?

We, we just don't know because we don't have the data to support that yet.

Yeah, I mean, I think just to add onto that, I think that we are continuing to learn new things, you know, about the role of the immune system within the testis.

You know, I think to your point, it was, um, I, I also found this, you know, review fascinating, and I was really delighted that Dr. Babcock, you know, led by, uh, Dr. Dufour, put this together for us 'cause I think it really is a, a nice summary of, you know, current state-of-the-art understanding of the blood-testis barrier.

But, you know, the, the role of the immune system within that really does, um, well, it is necessary for spermatogenesis, right? I mean, I think, you know, we learned about, you know, how as, you know, as Dr.

Lundy or Scott, you know, taught us how, you know, germ cells kind of progress down into the lumen.

You know, that sort of, that transit really involves the immune system and kind of opening and closing some of these junctions, you know, allowing this movement, and that is really overseen by, you know, cytokines, you know, that are involved in, you know, the system that we're talking about here.

And so, you know, I think without the immune system within the testicle, I don't think we would have spermatogenesis.

So I think he can probably speak about the importance of us as reproductive urologists examining patients holistically.

So what are your thoughts on young, healthy men getting a baseline semen analysis?

I love that idea.

I mean, I think, you know, women have, uh, a cycle, so they kinda know, you know, where they are from a fertility standpoint, and men don't get that feedback, right? I think we just talked about how you just look at your ejaculate.

You have no idea what's normal, what's abnormal.

So I do think that there's some value in that.

You know, both from a reproductive standpoint to kinda get a sense of where you are and if there's gonna be a problem.

You know, if there is a problem that we identify, giving us more time potentially to intervene and fix it, like if we identify a varicocele, which are dilated veins in the scrotum, that's something that can be fixed to prevent further decline or even improve counts.

So why is this happening?

Is that true?

(laughs) You know, it really is.

I think, you know, in the last few years, there's been a lot of consensus around that.

Uh, you know, one of the most famous studies that looked at this was published in the '90s, um, and, you know, when it was released, I've talked to some of the authors about it, there was a lot of fanfare around it.

You know, they had it in a big, um, media hall, there were television cameras, uh, but since then, there was a lot of controversy around it, um, you know, for a few reasons.

You know, there is...

You know, there are differences in semen quality around the world.

Does that mean then that most men who want to have kids and find out that they've got a varicocele should probably get it fixed?