If you want a complete picture of your fertility, you’ve got to take sperm into account. Did you know that a lot of “undiagnosed infertility” occurs simply because the testing is focused completely on women and their eggs?
I always say the more you know, the better decisions you can make. Today’s guest agrees with me, and I’m thrilled to have Dr. Kristin Brogaard back on the show to talk all about the Path Sperm QT.
Dr. Brogaard has a PhD from Northwestern University where she developed a novel epigenetic technology that allowed for a more accurate understanding of gene expression in healthy and diseased cells. She completed her post-doctoral research with Dr. Lee Hood, and later supported the launch and growth of Arivale, a revolutionary new wellness company that combines cutting-edge science, personalized data, and tailored coaching to help clients optimize wellness and avoid disease.
Now, Dr. Brogaard is the Chief Scientific Officer at Path Fertility, whose goal is to raise the standard in male reproductive health, starting with male infertility.
We cover the benefits of the Sperm QT, what the results can tell you about your fertility and how to put those results to work in your specific situation.
Dr. Aimee: I am so lucky to have Dr. Kristin Brogaard back again on today’s show. Welcome, Kristin.
Dr. Kristin Brogaard: Thank you so much, Dr. Aimee. It’s an honor to be back. Thanks for having me.
Dr. Aimee: Awesome. We’re going to talk about a new sperm assessment. It’s a test called the Path Sperm QT Test. I love the name. I know it’s QT, but I can’t help but say “cutie.”
I would love for you to tell us a little bit more about your background and connection to the fertility field.
Dr. Kristin Brogaard: I was originally in academics where my doctorate and post-doctorate were focused on developing personalized medicine technologies. From that, I took that education and started applying those personalized medicine technologies to people, actually commercializing them. In that time, I got older, I had friends who were older and family members who were older, and started seeing and personally experiencing a miscarriage, seeing family, friends, and coworkers starting to go through their own fertility journeys.
Through that, I learned that 30% of couples going through infertility treatment are diagnosed with something that is called unexplained infertility. That really blew my mind, especially being in the technology business. That just means there’s not the right technologies out there to complete the full diagnosis. That’s really what got me interested, and me and my co-founder started Path Fertility with our goal of really bringing personalized medicine to the fertility journey.
Dr. Aimee: What specifically led you to the male side of the equation?
Dr. Kristin Brogaard: One in eight couples experience some sort of infertility. During that, I was shocked to learn that really all of the procedures and treatments are almost entirely focused on the female. Women go through a very extensive and invasive set of procedures, and very little is actually focused on the male side, which just blew my mind when biologically we know that 50% of infertility is due to the male. The guidelines essentially say look at sperm under a microscope and count them and see how they’re moving.
We have the technology that really could blow that out of the water. It was just an opportunity to really improve this field. Also, lots of infertility goes undiagnosed because men go undiagnosed. When men go undiagnosed, women are put through procedures that will not work if a man is infertile. So, it really can save couples time, money, and just the stigma and the burden and the whole process if we can get better diagnoses up front.
Dr. Aimee: I love that. I’m just writing this down as you’re talking because I’m thinking I see a quote that we really need to push out to people. Lots of infertility goes undiagnosed because men go undiagnosed. That’s like a bumper sticker on my car, coming soon.
Dr. Kristin Brogaard: Absolutely.
Dr. Aimee: What have you found out about the sperm side of things?
Dr. Kristin Brogaard: It was a very standard thought process that sperm were just carriers of DNA to be put into the egg and that they didn’t really have anything complex. What we do know is that there are very complex processes, all the way from just the sperm being produced as spermatogenesis, to getting to the egg, to the penetration of the egg, and also the sperm do carry really important components after the fertilization, so it is a very complex system that really needs to be unraveled.
What we’re focusing on and what we have found out is that epigenetics actually is a huge component of what regulates sperm and is important for sperm to function normally.
Dr. Aimee: Wow. I’d love to talk more specifically about the Path Sperm QT test and your ideas and how that all works. Share that with us.
Dr. Kristin Brogaard: Path Sperm QT, and QT stands for quality test, but I love that you call it cutie. What this does is it focuses on a very specific type of epigenetic modification that we know is crucial for sperm function, and that’s called DNA methylation.
What we do in this test is we actually look under the hood. We’re not looking at sperm, how they move, what they look like under a microscope. We’re actually looking at the genes that are necessary for a sperm to be a healthy sperm regulated properly with this DNA methylation.
We could go into a lot of detail about that, but it’s really understanding at the molecular level how sperm are functioning, which is crucial for all of the processes to work right and to get fertilization and a baby.
Dr. Aimee: Epigenetics has definitely been a huge topic recently. Where does this particular test fit into a fertility assessment, and who should be doing this test? Do you think every patient–should it be part of my TUSHY method and my BALLS method? We can talk a little bit more about what those things are for people who don’t know. At what point should someone be telling their doctor, “I want the Path Sperm Quality Test, please order it for me.”
Dr. Kristin Brogaard: We have this now live in about a dozen fertility clinics throughout the US. Really with the goal of understanding where exactly in the fertility journey this adds the most value. What we’ve found from physicians and patients is that it is the most valuable with the initial assessment. When you combine it with the initial semen analysis, with the Path Sperm QT together, you actually get the most predictive results of the likelihood of pregnancy and live birth with timed intercourse and IUI cycles.
It’s a really important factor to do up front because it could actually rule in or rule out male factor infertility to a much higher degree than we have seen previously.
Dr. Aimee: What does the test tell you, how does the report look, how is it going to guide me as a doctor in terms of what changes can a patient make based on the results?
Dr. Kristin Brogaard: When we receive a semen sample, we analyze the DNA methylation patterns in a man’s sperm. What we find is we categorize it into three categories; one is excellent sperm quality, one is average sperm quality, and the other is poor sperm quality. What we know is there is a very statistically significant difference in pregnancy rates between those groups. This is for couples undergoing IUI specifically.
What this can direct is if you have an excellent sperm QT result and very good semen parameters, your likelihood of getting pregnant with an IUI cycle is much higher than what we see on average. If you have a poor score, this is indicating that compared to average you have much lower chances of getting pregnant. Controlling for some major female factors, obviously, but with assuming a healthy female partner, it actually shows that you’re much less likely to get a pregnancy and a live birth.
What this could do is when done up front you can direct to the treatment that will likely work best with them. What we find is that IVF actually overcomes the issues that are seen with Path Sperm QT. Or instead of trying three or four IUIs, you try one or two, and then you move onto the next treatment. Because chances are never zero and you can always try. For these couples, time is really of the essence. This can get you to what you think will work most quickly and following what you need in your life and financial situation.
Dr. Aimee: I’m excited to see what your ongoing studies show as well. I’m sure that you also have a lot of great success stories, too. Can you share some of those with us?
Dr. Kristin Brogaard: We have multiple research pilots ongoing, and also three clinical studies ongoing. We have two that I’ll share today of pretty neat stories that we received from two physicians who are using Path Sperm QT on the initial assessment.
Actually, one is using it on the initial assessment, and what we found, this is a group out of California, and this man had previous chemotherapy trauma and a stem cell transplant, and very low semen parameters. On paper, a urologist saw this and said, “I would direct you pretty quickly to treatments, because on paper you’re looking like you’re going to struggle to get pregnant.”
He sent a sample to us. He got a Path QT score of excellent, which the physician shared with the patients and said, “With this result, why don’t you give it a little bit of time and start trying naturally?” because they had been proactive because of all the cancer trauma. They tried on their own, and in less than three months they had conceived and are pregnant and expecting.
The physician said to us, “Typically, with our current standard of care, I wouldn’t have told them to try naturally for a few months.” They did, and they were able to conceive without having to go through any additional procedures.
We have one study from a clinical trial that we are doing with Baylor College of Medicine where we received the Path Sperm QT result of a man and looked retrospectively at what he had gone through. He was a 38-year-old man, very healthy BMI, very good semen parameters, but had been trying to conceive for almost two years and had failed six IUIs. If anyone has been through an IUI, that’s a lot and that’s hard to put the partner’s body through. What we found, they had a Sperm QT result of poor, and it was very poor.
In this case, if this test would have been part of the clinical practice and done up front, perhaps the couple would have tried one or two IUIs. Now in their clinical notes it says they’re going to stop trying and not do any more types of fertility treatment because they’ve really had enough. If it happens, it happens. If this was done earlier, it could have directed treatment to something that was more likely to get them a baby.
Dr. Aimee: That’s helpful information for me to hear, because, as you know, I’m a fan of your test. I’ve been doing it since we met, and I do find it to be incredibly helpful. I think sometimes when people see ‘poor quality’ they’re worried that IVF might not even work and that there is no hope. But the reality is not that. The reality is this is really a test to tell you that doing IVF does make sense in your case.
If someone does have a poor QT result, is there anything that they can do to modify or change that result so that maybe it can improve? Is there a situation where people should be repeating the test later, and at what interval?
Dr. Kristin Brogaard: Yes. Something very cool about DNA methylation and epigenetics is that it’s modifiable by the environment. We have several studies ongoing now to try to understand what that means specifically for the Path Sperm QT score. Antioxidant use, lifestyle changes, smoking cessation,… We have those tests ongoing and that is really where we want to go. We want to be able to tell somebody, “This is your Path Sperm QT result, but we know these specific lifestyle changes could actually improve it.” That’s where we want to go.
We do have anecdotal evidence that drug use and smoking actually affect it, but not enough to make claims. But we do know that DNA methylation in sperm is very affected by diet, exercise, toxins, chemicals, environment, stress, sleep, all of that. So, that’s something that is going to be a great focus of ours moving forward.
Dr. Aimee: Excellent. Then you have to come back again and talk to us about all of those things so we can teach people about what they can do to improve their DNA methylation in their sperm.
This test is great, I’m so glad that you’re doing this work, but I also can’t help but think that there might be some broader implications of this type of innovative test. What are they?
Dr. Kristin Brogaard: In addition to the lifestyle improvements, so really understanding how it’s related to your lifestyle, we are starting to understand that also sperm epigenetics in general has an association with longer term health outcomes. Really understanding what that means for longer term incidences of autoimmune diseases, cancers, because sperm is essentially a canary in the coal mine. A lot of other things going on in your body, and it’s just a way to see as a canary in the coal mine.
The broader implications are, one, understanding what is affecting it in your environment, and two, understanding the longer term implications of health.
Dr. Aimee: Got it. What about in offspring, is there any implication of health in the offspring if, let’s say you’re doing IVF even, and you’re using sperm that has a poor score?
Dr. Kristin Brogaard: DNA methylation patterns can be associated with different offspring outcomes, including higher incidence of certain neuropsychiatric diseases. We do not have any indication just because it takes time to start to collect that data of any implications of offspring health related to Path Sperm QT, but that is something that we definitely will be tracking.
Dr. Aimee: I’m sure some people are going to say, “I already did my sperm DNA fragmentation test. Why do I need a Path Sperm QT test?” How would you answer that question, how do they compare?
Dr. Kristin Brogaard: Totally different analyses of the DNA. DNA fragmentation looks actually at the stability of your actual chromosomes. If you have breaks in your DNA, it’s an indication that replication of those cells could be disrupted. Where Path Sperm QT looks at modifications that sit on top of your DNA and regulate gene expression. So, DNA fragmentation is very specific to understanding large stability of the actual DNA structure itself.
Dr. Aimee: Let’s say someone is listening and they want to order this test. For my patients, I order it for them. Take us through step by step what happens when someone or their doctor orders the test. What if you have a doctor that doesn’t know about the test yet? How does the process work?
Dr. Kristin Brogaard: It is an at-home collection kit that is a physician-ordered test that your physician can order, and we can ship you an at-home collection kit. In some cases, physicians have the kit on site if they want to hand it out. It’s an at-home collection kit that gets sent directly to our lab after semen collection. We analyze the DNA methylation patterns on your sperm, and then the report is sent directly back to the physician.
In cases where you don’t have… We have on our website PathFertility.com a physician portal or tab where physicians can actually download the requisition to order it directly or send us an email on the contact information. We’ve reached out to several physicians from that method.
Also, if you don’t have a physician at all, if you connect with us, we’re happy to link you up with one of the physicians in our network for ordering and consultation.
Dr. Aimee: That’s great. What is the amount of time that someone could expect that it will take for them to receive the results?
Dr. Kristin Brogaard: It is a two-week turnaround time, which is similar to the DNA fragmentation results, upon submission of the semen sample.
Dr. Aimee: If someone wants to learn more or order the test where it’s available, how can they access it again?
Dr. Kristin Brogaard: PathFertility.com will get you to all of the information about Sperm QT. Feel free to contact us through that website.
Dr. Aimee: Excellent. I think you guys need a Path Fertility line of supplements. I just love the name. Sperm cutie. How can you not like that? Take the Sperm QT test to complete your path to fertility.
Dr. Kristin Brogaard: Exactly.
Dr. Aimee: Maybe I should keep my day job. Kristin, thank you for coming on, thank you for sharing with us all of the exciting research that you guys are doing to help my patients become parents. I can’t say thank you enough for continuing to innovate and help us all. Thank you.
Dr. Kristin Brogaard: Thank you so much, Dr. Aimee. It was a real pleasure.
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