SPEAKER_01 0:01

Welcome back to the Fertility Suite Podcast Series 3, where we're bringing the fertility experts to you so you can make the most informed, educated choices about your fertility. Hi everybody, welcome back to another episode in series three of the Fertility Suite Podcast. And joining me today, I have the lovely Ian Stones from Test Him. Now, Ian is the founder of Test Him, and Test Him is a company that's dedicated to the men, supporting men through fertility issues, and they offer testing and all-round general support and practice. And Ian will talk a little bit more about what they do. But do you want to just say hi to everyone, Ian? And yeah, interviewing.

SPEAKER_00 0:42

Yeah, hey everybody. Thanks, Rachel, for inviting me on to chat with you. Any opportunity to talk about the men and sperm and what we can be do to supporting the men is really important. But yeah, I'm I'm one of three founders for Test Tim. That's myself, Michael Close and Toby Trice. Michael and Toby both have been, unfortunately, on the receiving end of treatment. You know, Toby had success. He's got a little son now. Mike, unfortunately, not so, because he really wasn't, you know, very well supported. Neither of them were. And the three of us got our heads together and thought, right, okay, we need to do something. And that's you know why we created Test In to change that narrative around support for men. But but I guess ultimately that that entire narrative around fertility, because there's so much pressure and focus on the woman, which is not necessarily the right thing to be doing.

SPEAKER_01 1:28

Yeah, exactly that, right? Look, it's great to have a company that's got purpose behind it. And I think when someone's got personal experience with these things, it really drives that purpose. And like you said, there was a massive need for this sort of support for male fertility. There was a huge gap, and you are definitely closing that gap, which is brilliant. So today we are going to talk a bit more about something called sperm DNA fragmentation. For anyone listening, you know, if you've been struggling with fertility as a couple, you may have heard of this, you may even have considered running the testing. But we're going to talk a little bit more today about exactly what it is and how it affects fertility and miscarriage and how you investigate it, and then more importantly, practical steps to helping to make improvements to help you have a healthy pregnancy. So let's sort of just dive straight in, Ian. So do you want to just sort of start off by explaining exactly what sperm DNA fragmentation is? Like what does it mean?

SPEAKER_00 2:24

I'll do my absolute best as a non-clinician and to but also importantly, probably explain it in the simplest of terms. Hopefully, that's what I will try and do. And I guess it's important to say that you know this is one element of male facility. Like we said just before we hit record, there's so much we could cover on the male perspective. This is one element that has to be taken into context or in context of everything else for the man that's going on. So sperm DNA fragmentation testing refers to the uh a test, or there's a number of ways of testing it, but it's a test that looks at what's going on in the head of the sperm. So, you know, if we think about what a sperm is, it's a single cell, the smallest cell in the body, and its sole purpose is to deliver DNA to the egg. That's its only job. And that DNA is very tightly packed within the head of the sperm. The midpiece in the tail are just the the kind of battery cell and the and the propulsion method. That literally, that's all it is, that's all the sperm is about. It's get that little DNA in the head of the sperm all the way to the egg. Now, when sperm are made, what's absolutely fascinating, and I'm I'm still kind of learning about this and get my head around it, there's this process that goes on where the DNA is very, very tightly packed and wound down and crunched up right inside the head of the sperm. And and there's a process that goes on there. I I I don't know the medical term, I'm I'm not gonna risk guessing it and getting it wrong. I I think I know it, but I'm not gonna risk. But actually, that's that DNA gets broken and then put back together in that process. And sometimes what can happen is that so we all we're all fairly well aware of the you know the double helix, you know, that is the DNA. That's getting squashed and compressed and twisted and and really tightly packed into the head of that sperm. And what can happen is the strands within that that DNA can sometimes get broken, they can get misaligned, or they can get so they're not packed back together properly, or in that process they get damaged, or there are then other external factors that can damage that that DNA at a later date during the kind of as the sperm mature and and head towards kind of the epididymis and then ultimately ejaculation. So when we look at sperm DNA fragmentation, we're looking at what's going on to that DNA in the head of the sperm.

SPEAKER_01 4:49

So even though it's the smallest cell in the body, it actually has one of the most important jobs for mankind, right?

SPEAKER_00 4:55

The most the most important job, isn't it? Because if that is not there or it's broken, then you know we're we're not gonna be able to reproduce. And I think what's worth mentioning is how this is very different to a semen analysis. Because a semen analysis is is does a certain amount on a microscopic and a macroscopic level. So, you know, a semen analysis, we look at how much ejaculate a man produces. We can look at the concentration of sperms, how many there are per milliliter of fluid, we can look at how well they're swimming, and we can kind of do a little bit of a beauty assessment of how good they look. But that's it. It doesn't, a semen analysis doesn't tell you anything about that DNA integrity in the head of the sperm, and that's where this DNA fragmentation testing comes in.

SPEAKER_01 5:40

And I guess when you have a semen analysis, that is kind of helpful if you're not falling pregnant easily, because those sorts of parameters may be things that impact someone's ability to conceive, but actually it doesn't really well, it doesn't give you any information about what's going on at a deeper level, which may be relevant for perhaps couples who've suffered with recurrent miscarriage. So, yeah, it how does it actually really in terms of DNA fragmentation, then how does it affect fertility and miscarriage? Like what would it look like in a couple potentially?

SPEAKER_00 6:15

So, I mean, I can I can look at Toby as a case in point. So him and his partner were trying to conceive for six years, maybe possibly longer, they had two rounds of IVF. His semen analysis was absolutely fine, and I think this is a really important point for for anyone listening to to notice or take note of. So, as far as he was concerned, there was no problems. It was only when we looked a little bit deeper for him and he did a DNA frag test that it came back quite bad. So actually, it was impacting their ability to conceive naturally, but what we also saw with the their IVF round was that the embryos weren't developing very well. They were struggling to get to day five, where they did manage to get one for transfer, it then didn't take, and they unfortunately miscarried. So, what we often see, and there is increasing data and studies on this, where a man has high DNA fragmentation, we are seeing potentially recurrent pregnancy loss, recurrent miscarriage, poor embryo development, delays to conception because that DNA is not there. I think what's really important to note as well is, and this still blows my mind to this day, the egg, you know, I think still has the final say, right? The the egg has this incredible ability to repair sperm DNA fragmentation. Because obviously, what happens is you take half of the DNA of the egg, you take half the DNA of the sperm, you put those together, and that's your that's your embryo, you know, that's your DNA for blueprint for for the next life. And so the the egg's able to look at this DNA and say, hang on a minute, this bit's a bit mismatched, and we're going to change that, and da-da-da. I don't know how it does that. That will depend on the level of the DNA fragmentation on the male side, but it'll also depend on the age and the quality of the egg as well. And so where we might have perhaps a slightly older woman and maybe a guy with high DNA fragmentation, your chances of conceiving naturally and your chances of success with IVF may well be impacted as a result of that.

SPEAKER_01 8:23

Yeah. And this is something I think I probably reiterate on every single podcast I do when we're talking about fertility, is that it's so important that as a couple you're looked at as an individual. But I think going back to sort of how does it affect fertility and miscarriage, so it's fair to say then it can affect not only natural conception and miscarriage within a natural conception pregnancy, but also the ability of an embryo to develop within IVF and the ability to achieve genetically normal eucaloid embryos in an IVF cycle, which is all areas of fertility, really, isn't it?

SPEAKER_00 9:08

So exactly, yeah. The yeah, the impact cannot be underestimated in terms of what the sperm brings to the party here. You know, you know, there's there's increasing data showing now the impact of sperm health and DNA integrity on the woman's pregnancy, in terms of then how her morning sickness is and the long-term pregnancy. But also actually, you know, we don't want to be alarmist here, but also it's actually also the long-term health of the offspring. You know, so yeah, we've had some some wonderful guests on our podcast, and and one of them recently said, you know, for a lot of men it's a case of, you know, what you're not willing to do for yourself, perhaps you're willing to do for your future child. And so, you know, when we're talking about sperm health and DNA fragmentation or something and the other, it's not always just about you and your sperm. This is about future generations.

SPEAKER_01 9:57

Yeah, absolutely. And I think when you explained how the sole purpose of the sperm is to carry the DNA to the egg, like that it reiterates that even further, doesn't it? Like you're literally passing down your DNA, like this is going to be what you said, like the blueprint, and you're quite right, you know, it it is. So yeah, it's really, really important. So you touched on the fact that Toby had like a perfectly normal semen analysis on when he ran DNA fragmentation testing to have high levels. So, how would somebody know like when to run this testing? Like for anybody listening who's thinking, well, I've perhaps not got to that point yet, but you know, do I run this test or not? Like, how yeah, what would be the sorts of things you would say to people in terms of like, do I test or do I not test?

SPEAKER_00 10:41

Yeah, that's a really good question. And it and it also begs the question or almost kind of throws up the question of should we bed in this routinely? You know, should sperm DNA fragmentation be done routinely? And you'll get very different opinions on that, and while you'll get very different opinions on sperm DNA fragmentation testing full stop, let alone whether you do it routinely or not. Now, for you know, for let's let's take a couple six months into trying to conceive, nothing's happened, they're starting to think about getting some tests done, they're considering to go to see their GP because maybe they're that that little bit older, then you know, perhaps not throwing the kitchen sink at it is is necessary. You know, go and get a semen analysis. We would always recommend for a guy that your semen analysis is your starting point, you know, and then it might be you come to some advanced testing further down the line. It does depend, like you said, Rachel, it's kind of it depends on the clinical history, it depends on the couple's age, it depends on many different factors. So it's not a one-size-fit all, it's not a test for everybody, and it's got to be done at the right time with the right clinical oversight, but really it's that history that that dictates when a test might be appropriate. So, you know, have you been tried for a long period of time? You know, 18 months, you know, are you a little bit older? Is time not on your side? Have you had, you know, any miscarriages? Any have you had any IVF with poor embryo development? Have you had IVF and then, you know, succeeded with transfer but miscarried? There are some trigger sort of warnings, I suppose, some red flags. And when you start ticking some of those off, then we would always recommend digging a bit deeper on the male side. And sperm DNA fragmentation testing may be part of that testing in amongst a whole load of other stuff that also needs to happen at the same time.

SPEAKER_01 12:36

Yeah, absolutely. It's often just not one thing, is it? So if people again are listening and they're thinking, okay, I've already decided I tick some of those boxes. So as a couple, we're gonna go and we're gonna run this testing and see what comes back. Like, what is the access? Because I think this is a huge problem. Current fertility services generally is like access to testing, like knowing what is available on the NHS, what's not available, who can run this testing. Actually, how is it even tested on a really basic level?

SPEAKER_00 13:04

Yeah, really good. Well, actually, let's do how is it tested? That's quite an easy one to do. It's run off a semen sample. So, you know, a guy can go and give a semen sample, and we can do a whole load of tests off that semen sample of one sample. We can do oxidative stress, DNA fragmentation, we can do a semen analysis, we can do a semen microbiome, you can do semen culture, all of one single sample. So there's nothing special or different that has to happen in order to have this test. I think that's hopefully a reassurance for a lot of couples. I can't remember the other questions now.

SPEAKER_01 13:41

I think I asked about five in one go. Yeah, yeah. But I was just sort of saying like, what is the pathway to testing? Like, where is where is it available? Where is it not available? How would someone access a DNA fragmentation test?

SPEAKER_00 13:53

Yes, so this is yeah, another huge kind of area of sort of contention or bone c bone of contention. So currently, and most likely for quite some time, sperm DNA fragmentation testing is not recommended on the nice guidelines. Now, this is really interesting when you sit down with some of the top clinicians and talk about this, because most of them don't really care about the nice guidelines because they're working privately. So GPs do tend to look at the nice guidelines and will work towards them if they've not had any advanced training in infertility or maybe specifically male fertility. Now, the problem with the nice guidelines is the way they've looked at the data, the way they've actually carried out their assessment. It's been very much done on a sort of really kind of on a cost-benefit analysis rather than a clinical basis. And they have looked at sperm DNA fragmentation and the antioxidants is the treatment. Now, antioxidants is not the treatment for sperm DNA fragmentation unless you've got confirmed oxidative stress. So all of this relevant because it means if you go to your GP and say, Well, uh, I want to get a sperm DNA fragmentation test, I've been listening to some really good podcasts and it sounds really important. The GP will probably say, I've never heard of that. They'll then look it up on the nice guidelines and it'll say, Well, it doesn't recommend it here, off you go. So then as a patient, you're like, Well, where do I go? What do I do? Which is obviously part of the question. Now, some IVF clinics will offer some of this testing. And that depends where you're going, who's the overseeing consultant, and the experience of the clinicians that you're seeing. We're not here to rubbish anyone, but what you might find is if you go and have it done at some clinics, they may just say, Well, look, okay, we're going to do this test, and then we've decided because of this test, we're just going to do IXE. So they're just they're not really assessing the man and looking at the whole picture. They're doing a test and then they're throwing an intervention at it that may not necessarily be the right intervention. But you know, you can potentially access the test that way. Really, the best way to try and access these tests, and unfortunately, it it it does make it sometimes prohibitive prohibitive for some people, is through a urological consultant who's got male fertility expertise specifically. Because not all urologists will know a lot about male fertility. Then by going to see a urologist with male fertility expertise, they're going to be able to take that history, they're going to be able to understand the female's history and what relevance that has within the case. They'll be able to do a physical examination, maybe a hormone blood profile. Uh, they may request an ultrasound, they may do uh an infection screening, they may want to do a whole raft of tests, which includes spinal DNA fragmentation, and they can then give you kind of an informed picture as to where you are. That is going to give you the best way to access the tests that's got the proper clinical oversight rather than just going and doing it and hoping for the best, you know.

SPEAKER_01 16:53

Yeah, absolutely. I think with any fertility testing, that is the important bit, right? Is having someone to help you put that into context to your clinical picture and more importantly, create an action plan off the back of it. And there's no point running a test if it doesn't change what you're gonna do. So, yeah, like really, really important to mention. And like you said, a fertility urologist is in a really good place to do that. And just to put this into perspective for anyone listening, you know, fertility urologists, there's not a lot of them. No, they are quite hard to find. So it's not something that your GP is gonna sort of readily have access to or be able to sort of really support you with. A lot of this is gonna be like you researching. So, you know, I'll link this in the episode notes. But Ian, your website will be a great place for people to start with sort of yeah, just getting a handle on what their next steps might be for sure. But yeah, they're not, I mean, they are amazing, but you might wait for an appointment with them.

SPEAKER_00 17:45

They're a bit like rocking horse shit. They are honestly, it's absolutely obscene. If you look at how many gynecologists there are out there that are specialised in fertility, it runs into the thousands. If you're looking for a male fertility expert urologist, you'll be lucky if it runs into a hundred. It really doesn't. It it runs into twenty, thirty, forty. You know, we've got a list on our website, and and it's not it's not you know massive. So yeah, they are hard to come by.

SPEAKER_01 18:14

It's that divide, isn't it, that we talked about at the beginning. Like you are filling that gap is still smaller than it was 10 years ago. But yeah, it's a big it's a big gap to start with to fill, but we're getting there slowly. Um, you touched on it a little bit in in what you've just answered, but say, for example, a couple have run the test and the DNA fragmentation comes back high. What sorts of things could have caused that DNA fragmentation to be high? And this is probably one of the most common questions I get asked in clinic.

SPEAKER_00 18:45

That's a very good question because there are multiple causes to sperm DNA fragmentation. One of the biggest and most obvious, I suppose, is lifestyle and diet. And this is really the biggest and strongest way we can influence sperm health. And there's kind of two things that I almost always say that all men need to consider and do and sort out. One is that they've got to go and see their GP. That's always got to be their first port of call. You know, regardless of of how good or bad GPs may be seen, you've still got to go and do that. You know, go and do the absolute basics and essentials. The other basic and essential is your lifestyle and diet. You know, so you know, we're talking all the headline stuff, which I'm sure you've covered on many other podcasts. But yeah, smoking, alcohol, vaping, it you know, for male facility in particular, heat, heat stress, so sorners, jacuzzi, cycling, loose-fitting underwear, laptops on the lap, all of that kind of stuff. Anything that you've heard, men, and anything that you've been told by your partner, chances are it's correct. You know, don't store it up, ejaculate regularly, all of those things, keep hydrated. Those are an absolute essential in terms of your sperm health and sperm function, and they will most likely improve your sperm DNA fragmentation if oxidative stress is at play. So oxidative stress is one of the major contributors to sperm DNA fragmentation. So this is where we talk about the balance between free radicals and antioxidants. So this is why you know your ultra-processed foods, your processed meats, your smoking and your alcohol, they introduce a lot of prooxidants, so the free radicals, and your dark leafy greens, your Mediterranean-style diet, they bring in a lot of the antioxidants and that balances things out. So this is what we're talking about with oxidative stress. This is why healthy love cycle and diet is so important. So that's one of the key factors. However, oxidative stress isn't the only driver for sperm DNA fragmentation, and it's not directly correlated. So you can have high oxidative stress and not DNA fragmentation, and you can not have oxidative stress and have high DNA fragmentation. I hope you're all keeping up here because I'm I'm I'm managing to keep up with myself just about. So that's that element, oxidative stress, and that's where antioxidants will come in as well. Ideally, what we want to be doing, and this is something that we now offer through our lab, is for couples or for guys that have our DNA fragmentation test, we will always include an oxidative stress test reading as well, so that we then know if oxidative stress is at play. So that's one element. One of the other biggest drivers has got to be varicacyl. So varicacyl is an enlarged vein within the scrotum. I liken it to having a little hot water bottle sitting next to your testicle. Your testicles are outside the body for a reason. That's to keep them two to three degrees cooler than core body temperature. Now, when that temperature raises, increases, it denatures the protein in that is DNA. DNA is protein. So it denatures it, it breaks it down. So varicacyl, 15% of the male population will have one, 40% of men struggling to conceive will have a varicacyl. So actually, this is one of the very Very strong reasons to have a DNA fragmentation test is when you've got confirmed varicocil. Because sometimes people don't know whether to treat or or not treat that varicocyl. Now, if you have a varicocyl and you then do a DNA frag, and that DNA frag is bad, chances are, or there's a higher chance that that varicoseil is the is one of the contributory factors. So that's another thing that needs to be discounted. We've touched on kind of semen microbiome and infection. So actually things going on in the genito-urinary tract that can be causing, usually causing oxidative stress, actually. So again, that can go on to lead to DNA fragmentation. But these can be low-lying infections that you've got no idea are going on. There's no outward symptoms, nothing unpleasant. But actually it's creating enough of an imbalance in that area that it can cause inflammation, it can cause oxidative stress, and that can lead to DNA fragmentation. The other sort of final one that kind of needs to that people need to be aware of but not too alarmed about is actually it can be a genetic factor. So going back to that explanation of how the s the the DNA is broken, put back together, and then compressed into the sperm, what can happen is that can go wrong. And that can go wrong because of I I kind of like an it-you know, the sperm the the testicles are a factory. And if something's not right in that factory, if if something's wrong with that production line, you're going to be churning out, you know, damaged goods. And so what can happen is that that DNA can become fragmented and that becomes more common. What we tend to see, and this is very, very new, this is literally only been discussed probably not even within the last year, maybe in the last six months, and Jonathan Ramsey is very much leading the charge on this, is double strand DNA fragmentation breaks, and they tend to be more common. So this is where the the the strands are completely broken. And I believe, like I say, I'm not a scientist, but from what I've heard from Jonathan and some others, what we're beginning to believe is that this is more common as a genetic factor. And so with double strand breaks, you're definitely more prone to recurrent loss and delays to conception. And it may be, and this is where a clinician may choose one test over another because they want to specifically look for these double-strand breaks and whether there's a genetic factor. Single-strand brakes are more likely to be oxidative stress in in nature. So when you if you have a test and and you know you you've not necessarily differentiated between the brakes, but you've got high oxidative stress, that should improve things if you if you work that out. So has that answered the question? Have we covered everything there?

SPEAKER_01 24:46

Yeah, it's brilliant. And I think it really, really highlights how a consultant saying to a patient, you don't need to bother with DNA fragmentation because you're already taking supplements for lifestyle or you're already eating well, it just can't wash because you don't have that answer without running the oxidative stress testing or running further investigations. You know, it really in this is something I hear time and time again. You know, this is not occasionally, this is happening all the time where people say, no, don't waste your money. And it's you know, categorically incorrect information. And I think the double strand, this is something that's been on my list to read about more for the last sort of couple of months. I haven't got around to it yet. So it's really interesting you mentioned that because I've definitely worked with couples where you know we've screened for varicacy or we've screened for infection, you know, they still can't improve their DNA fragmentation levels, so there had to be something, and I'm you know, Jonathan is the person to find it right. So yeah, this is really interesting, and it shows how quickly as well, like we're moving in terms of research, like in all fertility, but particularly in male fertility, I think we're constantly having to keep up to date and we're finding out new things. So perhaps if you are listening and you have had a fertility journey where you know you're still not pregnant and you've been trying for some time, you know, it doesn't mean that all is lost because we're constantly learning more and we're constantly finding out new things when it comes to fertility. But I mean the stats that you know, you talk about 40% of couples, there's a male factor issue. We've got people saying, Oh, don't bother with a DNA frag, it's crazy.

SPEAKER_00 26:22

Yeah, and it's uh you know, you sort of say we're kind of progressing and research and all this, that, and the other, but DNA frag testing's been around for like 40 years, you know, and we're still arguing about it, which test is best and when to use the test and this, that, and the other. And I think unfortunately the problem is that not all of the research gets reviewed and and read by everyone that perhaps needs to read it. And what often happens is couples go to a clinic and and they present, and they might have had the test externally somewhere else and they present with it, and the clinic just uh they d they don't know what to do with this this data. They don't understand what to do with this information. So it's not you know, they're not necessarily being belligerent or, you know, sticking the head in the sand or ignorant or anything like that. It's just they haven't they don't understand the the mechanisms of what's going on because we kind of you know we we haven't the the problem is Jonathan Ramsey always talks about kind of Ixy. Ixy came along in the nineties and kind of killed urology, it killed varicocil treatments, it killed this kind of testing because well we'll just do Ixie, we'll just sperm in the egg and that will do the job, but it doesn't, you know. And I always sort of say, you know, anyone that's listened to me before on this subject, I talk about the barrel of apples and this kind of idea that if you've got a a barrel with a lot of rotten apples in it and you can't see that rot because it's right at the core, you know, you you the chance of you picking out a duff one is is much higher. Whereas actually if you've done all that you can to improve those apples, grow them well, you know, nourish them, give them daylight and and and water and and all something the other, then you're gonna be picking from a better bunch, you know.

SPEAKER_01 27:59

I like that analogy.

SPEAKER_00 28:00

It's simple. Like I said right at the beginning, yeah. I'm gonna keep trying to keep this simple, my my level. And this this is the other thing for men, is like, you know, you're not you're not out of control here. You know, you can actually have a huge influence on your sperm health. And you know, it goes back to what we said earlier and and the the and the health of your offspring. So it is really, really important that you do all that you can to try and improve your sperm health and and your DNA quality. It's really, really important.

SPEAKER_01 28:28

So just to kind of recap then, because one of my sort of final questions was things that people can do at home or just day to day in their lifestyle. And you have kind of touched on it already, but just to sort of pull it all together. So looking after your nutrition and your lifestyle, not doing excessive sort of anything that's going to heap testicles up. Regular ejaculation has been shown to reduce DNA frag. And then on top of that, sort of getting the right screening and seeing a fertility urologist who can run the right testing. Is there sort of anything else that we've not really covered from sort of a lifestyle holistic perspective that you would recommend?

SPEAKER_00 29:06

Or no, I think we've kind of covered it, haven't we, really, in the broadest possible terms. I think, you know, I think for guys, just don't be shy about it, you know. Like, you know, make sure you're checking your balls regularly for any lumps or bumps. You know, the number of guys being like, oh yeah, no, I do get an ache, or does feel like a little bag of worms down there at times. It's like, okay, that's probably a varicose hill, you know, just go and get it bloody checked. You know, the there's I think there's a there's a lot of fear and and perhaps kind of concern from men about, you know, oh I've got to go and get my knob out in front of somebody or I've got to go have an ultrasound scan. It's like, you know, the the worst possible thing that I think any guy's gonna have to face is a micro TZ, which is where they try and extract sperm directly from the testicle, which is not a standard treatment for DNA fragmentation, let's put that out there. But this is in a very extreme case. So like if that's as bad as it can get, like anything else is is is usually pretty tolerable. I think there's just this belief that oh my god, if we talk about my nuts, it's gonna be painful and hideous and embarrassing. But you know what? There are some incredible clinicians out that can really look after you and and help you. But it's never as bad as you think it is. You know, the number of guys that we've seen come through our support group are like, oh, so pleased I went to CX1Z. Thank God I did that. It was just I needed a course of antibiotics and that was it, you know.

SPEAKER_01 30:29

Yeah, yeah, you're right. Like male fertility testing generally is fairly uninvasive. Um, you know, the micro team is probably the only really invasive and and unless you had to have surgery for a varicoseal. You know, the initial testing is non-invasive, so it's just a case of sort of yeah, plucking up the courage to to go through with that. So talk a little bit more about your support group and your website. So, where can people find you then? What sorts of resources have you got available to help people?

SPEAKER_00 30:54

Loads, absolutely loads. Testhim.com and on Instagram at testhimlt. On our website, one of the first and easiest things you can do is our free questionnaire. This was actually kind of where we started with Test Him like four and a half years ago. And what we did was we just pulled together all the questions that we know aren't getting asked routinely elsewhere, not get asked by the GP. They might even get asked at an IVF clinic. And these will help men just pick out some of the key lifestyle and diet and fertility issues that they might need to think about. So it'll ask you about how long do you spend sitting, you know, how many units of alcohol do you drink, you know, what are you doing exercise-wise, what's your BMI. But it also it'll pick out kind of some of the red flags. So actually, did you have undescended testicles as a child, you know, major red flag? Have you had any STIs, things like that? It's a really quick, simple questionnaire. I think we've had over 2,000 men go through it now, haven't looked at the figures recently. But when you get to the end of that, it gives you instant health recommendations. So it will say to you, you need to lose weight, or it might say you need to increase your vegetable intake. But importantly, it will say you need to consider, or you might want to consider, getting this test done, that test done, or going to see urologist because of X, Y, and Z. So that's one of the best free resources we've got available.

SPEAKER_01 32:13

What is the resource, Ian? Because so many people ask all the time, should I what testing should I get done? And and trying to tie it back to their own symptoms and what's going on. So that's a really brilliant.

SPEAKER_00 32:23

Yeah, yeah. Yeah. We've got 37 podcasts out there now, plus a load of bonus content, and we've had all sorts on there. Emma the embryologist, Jas Kelsey, and Fatima Hossein, Jonathan Ramsey, Tim Child. The list goes on and on and on. And there are some absolutely mind-blowing episodes on there, I'll tell you. Absolutely really, really good ones. So well worth listening to. Loads of news articles on the website as well, all the podcasts are on the on the website. And then, yeah, we have a monthly support group as well, which is in some ways where it all started about six years ago. That's when me and Toby first met, was running the first ever support group for men. But we meet on a monthly basis on Zoom. I it's always quite funny, really, because guys join and you can kind of tell they're a bit sheepish, they're a bit like, oh, what's it gonna be like? Many of them have been sent by their wife or their partner, just go to this bloody group, would you? But once they're in and they've realized that it's not a oh, how are you today, Mark? You know, it's it's just a bunch of blokes. We have a bit of a laugh, we have a bit of a giggle, but we're also actually a brotherhood and we're there for each other. It's so incredible. I like I'm so honoured and sort of humbled to be able to have that opportunity to host that space with Mike and Toby for the other guys, and we have a spin-off WhatsApp group, and the guys are there in in seconds. Like, like we had one guy post something on there the other day, and you know, instantly people are replying, you know, have you thought about this, or I would do that, or got your mate? You know, Christmas was really interesting, people are up to, whether they're looking forward to it or not. So, yeah, we we've got loads of stuff. People can have a one-to-one call with me, they can book those as well. We've got testicular ultrasound scans, we've got our supplement M plus. So there's you know, loads, loads we can do.

SPEAKER_01 34:15

Not just the practical side of things, but like the emotional side of things, that support work as well, which is brilliant, which I think is probably the area where you know the most help is needed a lot of the time, right? So, yeah, what I'll do is in the episode notes, I'll link the website, but I'll also maybe link your questionnaire or the link to your group so yeah, people can get direct access to them. But yeah, thank you so much, Ian. That's been super, super helpful, and I'm sure anyone listening will have learned a lot about DNA fragmentation and uh whether they need to test or not from that. So, yeah, I really appreciate it. Thanks for joining me.

SPEAKER_00 34:48

My pleasure, thanks for having us, and I'm sure we'll be back again talking to sperm, right?