Podcast

The Fertility Test Most Men Are Never Offered | Dr Michael Eisenberg and Dr Natalie Crawford

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In this episode I’m joined by two clinicians who sit on either side of the same problem: Dr Michael Eisenberg, a urologist and Director of Male Reproductive Health at Stanford University, and Dr Natalie Crawford, a reproductive endocrinologist and co-founder of Fora Fertility in Austin, Texas. Natalie came on the show around six months ago to talk about female fertility, and a few things she said in passing about sperm health surprised me enough that I went away and started reading. The more I read, the clearer it became that sperm health influences far more than conception. It shapes fetal development, pregnancy outcomes, and appears to tell us something meaningful about a man’s long-term health. I also have a personal stake here, because my partner and I are planning to have children in the next couple of years.

Here’s the tension. Roughly one in seven couples are unable to conceive after a year of trying, and about half of those cases involve a male contribution. Yet in a quarter to a third of infertile couples, the man is never properly evaluated. Current guidelines ask couples to fail for a full twelve months before anyone looks at sperm under a microscope. As Natalie puts it, why are we making couples fail before they get the diagnostics? Time is the one resource in fertility you cannot get back, and this conversation is about how much of it is being lost to a test that costs very little and takes almost no effort.

What We Cover

  • Why being able to ejaculate tells you nothing about your fertility, and what a semen analysis actually measures
  • The Danish study that followed men for up to fifty years and found every semen parameter was associated with age of death
  • Michael’s claim that sperm count is a better discriminator of long-term health risk than obesity or smoking status
  • Why testosterone therapy has been trialled by the World Health Organization as a contraceptive, and what that means for the men buying it from app-based clinics
  • Are sperm counts really declining, and what the evidence looks like once you strip away the headlines
  • Cannabis, alcohol, heat, cycling, and finasteride: which exposures actually matter and by how much
  • The number most men never see on their report, and why total motile sperm count matters more than concentration alone
  • Paternal age, sperm freezing, and what happens to embryo quality after forty-five

This is the comprehensive male fertility resource I went looking for and couldn’t find. If you take one thing from it, let it be this: sperm turn over roughly every three months, which makes this one of the most movable metrics in all of health.

To connect with Dr Michael Eisenberg, find him on Instagram or LinkedIn. To connect with Dr Natalie Crawford, you can find her book The Fertility Formula at nataliecrawfordmd.com/book, listen to her podcast As a Woman, or follow her on Instagram, TikTok, YouTube, and LinkedIn.

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More about Dr Michael Eisenberg

Dr Michael Eisenberg is the Director of Male Reproductive Health at Stanford University and Chief Medical Advisor of SwimClub. He earned his bachelor degree from Rice University and his medical doctorate from Yale School of Medicine. He completed his residency in urology at the University of California, San Francisco and a Men’s Health and Microsurgery fellowship at Baylor College of Medicine. He is board certified in urology.

He joined Stanford University in 2011 to start the Male Reproductive Medicine and Surgery program. Dr Eisenberg serves as an editorial editor of Fertility and Sterility and associate editor of Andrology, on the editorial boards and as an ad hoc referee for dozens of leading medical journals and has himself authored numerous peer-reviewed articles. His NIH-funded laboratory seeks to understand the association between a man’s reproductive and overall health as well as the control of spermatogenesis. As an entrepreneur, he leads a team which has developed several devices to improve men’s health as well as advising multiple healthcare companies.

More about Dr Natalie Crawford

Natalie Crawford, MD is board certified in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility and is co-founder of Fora Fertility, a boutique fertility practice in Austin, Texas. Dr Crawford is CEO and co-founder of Pinnacle, a professional network for women in medicine focused on leadership and education. Dr Crawford completed her undergraduate education at Auburn University obtaining a degree in Nutrition Science, Medical School at University of Texas Medical Branch, Residency in Obstetrics and Gynecology at University of Texas Southwestern, and Fellowship in Reproductive Endocrinology and Infertility at the University of North Carolina, concurrently obtaining a Master of Science in Clinical Research. She is an Affiliate Clinical Professor of Women’s Health at the University of Texas Dell Medical School. Dr Crawford is a digital health educator on fertility and reproductive health on Instagram/TikTok @nataliecrawfordmd, twitter @ncrawfordmd, and You Tube “Natalie Crawford, MD,” and she is the host of the popular podcast “As a Woman” with over 6 million downloads. Her debut book, “The Fertility Formula”, will be released by Penguin Random House.

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