Friday, June 11, 2010

The Turek Clinic and a Fascinating Look into the Male’s Experience with Infertility

A couple of months ago I spoke at the annual dinner of a Bay Area REI (Reproductive Endocrinology and Infertility) Nurses organization sponsored by Flora Koch of MDR Pharmaceuticals. One of the other speakers was nurse Paula Chavez, LVN, of the Turek Clinic and her talk gave us a fascinating glimpse into the male’s experience and emotions with infertility.

She talked about how the woman drives the process and men try to support and go along (no surprise there), how the men feel helpless in the process, like failures. Unlike women, men don’t share what they’re going through with their buddies; for them infertility is a very isolating experience. Men want to have babies too, they want their DNA to live on.

After her talk, I was hungry to hear more. I felt that if we women better understood what our male partners go through and how they handle and cope with fertility issues—which is very different than how we ladies cope—then we could find ways to lessen the tension that exists between couples struggling with fertility issues. We could create new pathways of communication, and we could learn ways to better support our male partners who, yes!, need our support too.

So, I made arrangements with Paula to speak to her and Paul Turek, MD and Medical Director of The Turek Clinic in San Francisco, which specializes exclusively in men's reproductive health care. As a distinguished and internationally recognized urologist and reproductive microsurgeon, Dr. Turek is very familiar with the unique needs of his male patients and how best to treat them.

Just walking into his clinic you can see even visually that Dr. Turek gets it. The lobby has a high-end, clean modern look, with a surfboard and a stunning, modern painting of a racing car which stretches throughout the room, giving the illusion of speed. It’s a place men can come and feel safe.

“Because there’s a sore need for it,” Dr. Turek responded. “Young men with reproductive health issues is the largest underserved population in America today.”

Dr. Turek and Paula explain that the natural path for an infertile couple is to go to a gynecologist and then to an IVF (In-Vitro Fertilization) center, and from there, straight to IVF, without an evaluation.

“When a couple is infertile each partner should be evaluated, and that’s not what’s happening. …In Massachusetts IVF is covered [by insurance]. They get six cycles: bam-bam-bam-bam, and after six cycles have failed the guy is finally evaluated,” Dr. Turek said.

Dr. Turek is concerned. “I’m publishing papers…that say these [infertile] men are getting higher rates of prostate cancer, testicular cancer… something is going on to show that infertility is a marker of a later disease.”

“I had a guy come in with low sperm count. They had gone for an IUI (Intrauterine Insemination) and it failed. It turns out he had prolactinoma, a benign brain tumor… and now his testosterone is low, and he’s feeling crappy. You don’t know what direction he’ll go in; he could go blind, get suicidal, depressed. So we scooped him up and got him going again. Happens regularly.

“My worry is that infertile men get terrible care because of IVF… Because [the clinics] just go right by them, ‘oh you have sperm, go to IVF’ and the guy never gets the exam.”

“There is none,” Dr. Turek said. “They don’t know how to deal with it. So that’s the secret to this practice. [We say] that it’s OK, you’re still a guy, nothing’s changed. Because this is something they assumed they’d have no trouble with, and a lot of it is genetics so this it isn’t something they’ve done. There’s a lot of guilt.”

What is the male’s experience and attitude as he goes through the infertility process?

“Here it is," Dr. Turek said. “Men are encouraged to work hard, shut up, be culturally invisible, get the work done, not complain and deal with it.

"So in the man’s world you see several reactions to infertility: deep depression, self blame and guilt – lots of guilt. Or you see men brush it under the rug with no idea of how to deal with it, and it comes back in a destructive way such as divorce.”

Paula added, “The wife is driving [the process] and [the men] just go along with the program to get things done… It’s kind of a denial issue, but they go through the emotions.”

“And then there’s the guy who takes the reins: I’ll go on a diet, lose 30 pounds, and we enable that,” Dr. Turek said.

“But there’s nothing in society that helps these guys. There’s no place to go. Paula is best friends with these guys, because she’s private, outside the house, one person they can confide in. She learns a lot about these guys that no one else knows. When they call, they want a person. They ask for Paula. …She’s better than anesthesia.”

“They get a serious amount of care here. They’re #1 and they know it. You get an hour with me, a super specialist and have total access to me.”

Dr. Turek also makes a point of treating men the way they’re built.

“Men are not women, they don’t follow up. This is a little of an insult to their manhood, so it’s something they want to go away. …I see them once and teach them everything on that one visit… how to examine themselves.”

“Men are supposed to be busy and working. Treat men in the environment in which they live. Don’t pull them out of their environment and expectant them to do miracles.”

“There are always conflicts! How about the patient who doesn’t tell his wife for a year that he’s had a vasectomy and she’s going through IVF?” Dr. Turek said.

Paula told a story of a guy who was doing a semen analysis and then heating it up, so the sample was bad. “He finally said that he really didn’t want to go through this process but didn’t have the balls to tell her.”

There are a lot of secrets, they explain to me. “Men aren’t as in touch. It’s hard for them to express themselves. We handle it by being open and forward about it.”

Paula shares the story of a guy going through IVF who can’t produce ejaculate at the critical moment. His wife was freaked out, screaming at him, which of course didn’t help.

Paula said, “I took him in the room, took his cell phone away… and said she can’t talk to him until he’s done. After talking to him for 20 minutes and letting him vent and catch up on gossip, I said OK I’m going to leave you alone.” Five minutes later, he emerged with cup in hand.

“This is a typical story,” Dr. Turek said.

There have been so many dramatic stories that a well-received play, Sperm Warfare, written by a former patient of Dr. Turek’s, was based on this clinic’s collection room.

Dr. Turek uses his experience and knowledge to solve problems. “A good urologist understands getting the kid is not the same as fixing the man.” He gave an example of a guy with low sperm count. “We could increase his sperm count, but with the time it takes to do that, her eggs get old, so we have to look at other solutions.”

Dr. Turek admits that in the end what he wants is the Christmas Card. The one with the baby in it.

"Quietly, secretly."

You also have to look at cultural and religious differences, Paula said. “There are some cultures in which it’s so intense that they have a baby that they don’t even tell their families they’re going through this because they’re afraid of the response. And some cultures don’t believe in IVF or any assisted reproduction, so they keep the secret between them because they don’t want the families to find out or else they’ll be disowned.”

Dr. Turek added, “There’s a measurable suicide rate among infertile Hispanic men. Divorce rates are definitely appreciable and suicide rates are measurable. …Same thing with the Middle-Eastern community.”

Dr. Turek relayed this story: “I’m treating this guy from the Middle East, and for 10 years he could not accept no. People took advantage of him and did a lot of IVF procedures.” When he came to Dr. Turek, he had to tell him he simply had no sperm.

“[Infertile men represent] a very quiet 15% of the population, much quieter than diabetics, which is about the same,” said Dr. Turek.

In his practice, Dr. Turek supports natural methods of optimizing fertility and health, recommending acupuncturists and others. His handout on a holistic approach includes maintaining a well-balanced diet low in fat and sugar, emphasizing whole grains, fruits and vegetables; antioxidants (vitamins A, C, E); stress reduction (massage, yoga, acupuncture, with biking being OK), and more.

Visit his website, and library of resources, to learn more! and his blog