It started out as watercooler talk. Maybe it’ll become as famous as the hallway conversation about “Who shot JR?” after the Dallas episode in 1979 or what the best Super Bowl add is each year. Although many consider watercooler moments mere chit chat, the one I had with Dr John Amory 3 years ago has dramatically changed the way I treat infertile men.
We had just finished attending a scientific session at the American Society of Andrology (read “sperm”) annual meeting and meandered outside to enjoy a cup of coffee in the lovely San Diego weather. I had a “dawn patrol” longboard surf session in La Jolla that morning and felt particularly relaxed and philosophical. John then told me the story of how his decade of research on a form of vitamin A called retinoic acid (isotretinoin) had taken a 180-degree turn.
While retinoic acid’s importance to sperm production has been known for 100 years, he was having a heck of a time trying to use this to create a retinoic acid blocker as a novel male contraceptive. In a pivot, he began to study retinoic acid levels in infertile men and asked whether retinoic acid could be used to improve sperm production. And guess what? It does!
A Pill’s Tall Order
John wondered if I might consider studying isotretinoin in my severely infertile patients. After listening to John’s compelling story and knowing how exceptionally cogent and insightful he is, I simply said: “I’m in!”
This led us to develop a program at The Turek Clinic to offer retinoic acid oral therapy to infertile men with no sperm (azoospermia) or barely any ejaculated sperm (cryptozoospermia) with the explicit goal of helping them create reliable, motile ejaculated sperm counts for use with IVF-ICSI, without the need for invasive testicular sperm retrieval procedures.
Truth be told, no one has ever used that particular outcome parameter as a success measure for a fertility treatment in published literature. Ever. Moreover, I can’t think of an outcome for a male infertility treatment that is more patient-friendly that this one. If we can help an azoospermic man become a bio dad without operating on his testicles, who on this good earth wouldn’t prefer that to anything else available today?
Vitamin A Gets An A
In our recently published study, we assessed the ability of 3-6 months of twice daily oral isotretinoin to induce reliable motile ejaculated sperm in men with nonobstructive azoospermia and cryptozoospermia. Notably, these 30 men were “heavy hitting” patients, 90% of whom had already undergone testicular sperm procedures (mainly failed microTESEs) and 75% of whom had never seen a single sperm in their ejaculates.
To our delight, over one third (37%) of these men developed usable ejaculated sperm! And sperm appeared as soon as 3 months of therapy in most (82%) men! We followed those who went forward with IVF-ICSI and observed that the newly created sperm performed normally, leading to normal embryos and live births!
Yes, there were side effects on isotretinoin (which was FDA-approved in the past to treat difficult acne cases), which included chapped lips and dry skin. But no patient stopped the medication due to side effects. Truly, this pill has done something that little else has ever accomplished in the world of male infertility.
Contact The Turek Clinic
As a male fertility expert who encounters the most severe cases from around the world, I would call this little-pill-that-could nothing short of a “babymaker” for some couples. Contact us in Los Angeles or San Francisco at 1-888-TUREKMD, and we’ll see if you’re a candidate for treatment!