Host: We are going to talk about infertility, types of male infertility and in particular the zero sperm count which is called azoospermia. We are going to talk about both new researches by Dr. Mahmoud Abuelhija and psychological aspect by Wasem Birony.
Each one of these subjects complements the other. We are also going to talk about the actions of couples when they fail to get pregnant.
We will start with Dr. Abuelhija, you worked on different researches and during your PhD you worked on a new project that aimed to produce sperm cells in the lab from stem cells, can you give us more details about this project?
Dr. Abuelhija: This project was a breakthrough in male infertility; we cultured stem cells in lab conditions and successfully converted them into mature sperm. We worked on this project for many years in Ben Gurion University. The first goal of this study was to characterize the testis stem cells and understand the factor that may affect their divisions. The second goal was to find a new way of treatment for azoospermia patients.
We published this work and according to these new discoveries, and Prof Huleihel received a large grant from the ministry of health to continue this project and applied the new culture on human cells.
All the research was done on mice and now it’s time move on to human cells. We build new 3D environment that simulates the testis environment and therefore the stem cells divide, differentiate and produce sperm.
Host: It’s very interesting, lets continue and talk about general infertility, unfortunately, in the last few years the infertility problem was raised and more couples go to IVF, what do you think could be the reasons for this problem?
Dr. Abuelhija: In the last year 5% of total birth was from IVF, despite the development of medicine we find that not only is the infertility problem rising, but also different diseases like heart, diabetics, cancer and more. Going back to worldwide infertility problem, for example in Canada, statistics indicate rise of this problem from 6% to 15% in 30 years. US also the same, in Europe rise to 20% in here about 15% and it’s rising.
Most researches showed that the main reason is environment pollution and the increase in toxic substances in the air. The stress life and bad diet also take place in this. We have more processed food that contains higher concentration of chemicals and even hormones that harm our body.
Host: What about cellular device that we have today, can these technologies affect the infertility? What do you think?
Dr. Abuelhija: There is no significant data about this, it’s very difficult to know. We need many years of research to discover the effects of the current technology.
Host: In the same aspect, sometimes the couples do not suffer from any fertility problem but they fail to convene, what do you think are the reasons?
Dr. Abuelhija: We know that one third of the reasons are derived from male factors and one third derived from female and one third from both or from unknown reasons. That’s right, the husband does not have any problem also his wife but nothing happened. There is no consequence without a reason, but when we cannot explain this problem we say Unknown reasons. But if we look deeper we will find the reason. Sometime it may be psychological issues.
Host: Let’s talk about the absence of sperm in the semen, what are the reasons and the solutions that we have today?
Dr. Abuelhija: The absence of sperm in semen called azoospermia; there are different types of azoospermia. There is obstructive azoospermia and it happens because of a blockage in the tube that lead the sperm out of the testis, which can be caused by many reasons like: infection, torsion or the tube is missing because of some genetic issues.
If it’s an infection then we give antibiotic for long time, if it’s the other reason then we need to perform surgery to fix it or extract sperm from the testis for the IVF.
The other type of the azoospermia is the non obstructive azoospermia and it’s also divided for two types. The first one is failure in the hormones production called secondary testicular failure. There are three major hormones for the sperm productions FSH, LH and testosterone. The sperm production will stop if the person faced any problem in the secretion of these hormones, usually the solution will be hormones replacement therapy.
The second one is the SpermHope for non obstructive azoospermia, in this case the testis fails to produce sperm and it’s the most common type of azoospermia.
The primary testicular failure can happen for many reasons like: medications, Chemotherapy and radiations can also damage the sperm production. The sperm production process is very sensitive and the cells divide all the time so these cells are damaged quickly.
These are many medications that can damage the testis cells especially the strong antibiotics that have side effects and destroy the testicular cells.
Trauma can also cause azoospermia, the testis has blood barrier that prevents the immune system from attacking the cells inside the testis because it considers them as foreign cells. Trauma can cause damage to this barrier and then the immune system will destroy all the cells and cause azoospermia.
Host: Stress can make the patient try any medicine to solve this problem and we hear a lot about patients that try anything, how will this affect him?
Dr. Abuelhija: I faced many cases like this; the problem is that they don’t know that infertility can be from different reasons and different types of infertility. What happens is that person X has low sperm count because of bad diet and he takes natural treatment for few months, vitamins or folic acid and he got normal sperm count.
Host: Can the folic acid help men also, because we know it’s for women?
Dr. Abuelhija: Yes, it’s also for men.
Dr. Abuelhija: For example, if a patient hears that another patient took some medicine and was successful, he goes and asks about this medicine and starts the treatment after 3-4 months the treatment fails and so he moves on and tries a different thing which also fails, and he keeps trying for many years but with no success. If he has primary testicular failure, then we know from the beginning that he is wasting his time by trying different things, he needs to understand his problem first. For example, in his case he needs to perform biopsy for IVF or ICSI, because any treatment that improves hormones levels will not be useful in his case.
Host: Ok, so it’s wasting of time, what about the effect of these medicines?
Dr. Abuelhija: Usually the effect will pass after he stops the treatment, and the body will accept new treatments.
Dr. Abuelhija: So far we have talked about the failure to convene with Dr. Mahmoud Abuelhija and especially about azoospermia, doctor you gave our viewers a lot of hope, and we have also talked about the production of sperm in the lab conditions and about the psychology aspects.
Host: Dr. Mahmoud before the break we talked about the types and the reasons of azoospermia, can you tell us about new treatments?
Dr. Abuelhija: As we talked, the most common azoospermia is the Non-Obstructive azoospermia (primary testicular failure). Today the available treatment is the biopsy or micro TEST to extract sperm if we can find them for IVF or ICSI.
Dr. Abuelhija: Today, the trends are to find new methods to culture the stem cells in the lab and convert them to sperms, there is a big success in animals but on human cells it’s still under research. We hope soon for new finding.
Dr. Abuelhija: In other research, they take the stem cell from the patient and transplant it in the testis, by this method we increase the number of the stem cells and the success chances to find sperm. It’s also an on-going research, patients can sometimes call and join this group, and it’s more available in USA and Europe.
Host: You were on one of these researches in USA, can you tell us more?
Dr. Abuelhija: I was in a different kind of research; I was working in a hospital for cancer treatment (MD Anderson Cancer Center). After the chemotherapy or the radiation treatment, the man becomes azoospermic, but some of them recover after one, two or five years and others cannot recover and stay azoospermia.
We want to know why this happened. Why in such cases the stem cells divided and in others they blocked. The final finding was that testosterone blocks the stem cells division in these cases, and it’s very unusual because we know that testosterone is very important for the production of sperms.
Dr. Abuelhija: But if look of the other side, we find that after the birth of a baby boy he has many stem cells inside the testis, these cells divide and differentiate all the time but do not convert to mature sperm; in puberty, the testosterone rises and these cells mature to sperms. From this we can conclude that testosterone hormone is very important in the late stages of sperm formation.
Dr. Abuelhija: Based on this fact and others, we examined the suppression of testosterone in azoospermic rats for two months (can we show the picture)
Host: OK we will show it later
Dr. Abuelhija: Before treatment, the testicular tubules are empty, there is only sertoli cells (supportive cells) and stem cell. After the treatment, the stem cells divide and produce many germ cells. After we stop the treatment the testosterone levels rise again and these cells become sperms.
Dr. Abuelhija: Based on this, we developed new treatment called SpermHope, the treatment has the same idea that I explained before. The treatment will slightly reduce the testosterone for three months and in another three months it will increase testosterone levels to normal.
Dr. Abuelhija: The treatment contains three different stages: Stage one it’s push the stem cells to divide, stage two it’s for two months and it’s push the stem cells to divide and differentiate, and stage three it’s the conversion these cells to mature sperm.
Host: Do you believe in herbal treatments?
Dr. Abuelhija: Yes, all the active ingredients in SpermHope treatment are natural because it’s more safe and has no side effects.
Host: We want to show few slides on the screen, and show the messages that you got.
Dr. Abuelhija: In this slide, we see the tubules before the treatment is completely empty with only one nice stem cell inside. After treatment we see many cells in the tubules.
Dr. Abuelhija: There are 100 patients who tried this treatment.
Host: This what I would to talk about, so we can give our viewers a new hope, so what happened?
Dr. Abuelhija: Yes, 100 non obstructive azoospermia patients from all around the world tried the SpermHope, 22% of them started to produce sperms in the semen, we talking about a few sperms (hundreds or thousands) but it’s enough for IVF, and they succeeded and got kids.
Dr. Abuelhija: In 30% of the patients they didn’t find sperm in the semen after 6 months but they performed a biopsy (TESE or micro TESE) and succeeded to extract sperm for the IVF. It’s important to mention that this biopsy is not the first one, they have biopsies before but they fail to find sperm.
Dr. Abuelhija: And 48% didn’t succeed in finding sperm in semen or biopsy, we know that the reason in these cases are very difficult genetic problems.
Host: It’s very nice percentage, how many patients you said?
Dr. Abuelhija: 22% and 30% by biopsy.
Host: It’s very important to talk about the emails or messages that you receiving from the patients
Dr. Abuelhija: Unfortunately, I have pictures but the patients requested me not to share them, and they even asked me to hide their name from the emails, I want to share the messages that I got in Arabic so that the viewer can understand, the first one is from Algier and they are very thankful, the second one is from Jourdan.
Dr. Abuelhija: I am very happy when I see these messages.
Watch the meeting (In Arabic): https://www.youtube.com/watch?v=zkdGWDKek-A&feature=youtu.be