1
00:00:06,006 --> 00:00:10,844
[narrator] This is a 17th-century Dutch
scientist's sketch of a "homunculus,"
2
00:00:10,927 --> 00:00:13,638
a tiny, fully-formed human being
3
00:00:13,722 --> 00:00:16,182
that according to one popular theory
of the day
4
00:00:16,266 --> 00:00:19,227
was curled up
inside the head of each sperm.
5
00:00:19,936 --> 00:00:22,647
Once the miniature person
entered the woman's body,
6
00:00:22,814 --> 00:00:25,066
it grew into a full-size human.
7
00:00:25,400 --> 00:00:27,360
A competing theory at the time claimed
8
00:00:27,444 --> 00:00:31,197
that the miniature human actually lived
in the egg, not the sperm.
9
00:00:31,698 --> 00:00:35,702
For 100 years,
so-called "spermists" and "ovists"
10
00:00:35,785 --> 00:00:39,289
duked it out over who held the key
to creating new life,
11
00:00:39,414 --> 00:00:43,084
until both theories died
with more powerful microscopes.
12
00:00:43,168 --> 00:00:45,128
Then in the 19th century,
13
00:00:45,211 --> 00:00:48,423
a German zoologist discovered how babies
are really made:
14
00:00:48,506 --> 00:00:52,594
a sperm and an egg fusing together,
each playing an equal role.
15
00:00:53,261 --> 00:00:55,221
We'd solved the mystery of life.
16
00:00:55,638 --> 00:00:57,766
Well, at least one part.
17
00:00:58,183 --> 00:01:00,852
I will never forget
the phone call I received
18
00:01:00,935 --> 00:01:03,229
that kind of started this whole process.
19
00:01:03,605 --> 00:01:07,275
Immediately, I heard her crying,
and she said they didn't find sperm.
20
00:01:07,942 --> 00:01:09,611
She said they-- they found zero.
21
00:01:10,445 --> 00:01:11,321
And...
22
00:01:12,489 --> 00:01:13,948
that's when my heart dropped.
23
00:01:14,074 --> 00:01:18,453
I remember falling to the ground
in the lobby on my knees and just...
24
00:01:18,578 --> 00:01:21,498
You just don't want to believe
that it could happen to you.
25
00:01:22,207 --> 00:01:24,584
Male infertility around the globe,
26
00:01:24,667 --> 00:01:28,213
even though it's so important
in terms of infertility,
27
00:01:28,296 --> 00:01:30,757
is a hidden reproductive health problem.
28
00:01:31,341 --> 00:01:32,425
It was really hard.
29
00:01:33,093 --> 00:01:35,720
You go through really dark times
30
00:01:35,804 --> 00:01:39,015
when you see, you know,
your friends having kids,
31
00:01:39,099 --> 00:01:43,061
and here you are
almost six years down the road
32
00:01:43,144 --> 00:01:46,981
and... still trying to figure it out.
[chuckles]
33
00:01:47,065 --> 00:01:50,360
[narrator] Our species only exists
because we reproduce.
34
00:01:50,777 --> 00:01:52,987
So, why can't so many of us do it?
35
00:01:53,822 --> 00:01:56,741
What part of the mystery of life
is still unsolved?
36
00:01:57,659 --> 00:01:59,160
-Dad.
-Yes?
37
00:01:59,619 --> 00:02:01,204
Where do babies come from?
38
00:02:01,287 --> 00:02:03,206
[theme music playing]
39
00:02:03,289 --> 00:02:06,835
[man] The whole field of fertilization
has expanded and advanced.
40
00:02:06,960 --> 00:02:09,045
We help couples have babies in ways
41
00:02:09,129 --> 00:02:10,713
that we wouldn't have thought possible
years ago.
42
00:02:12,465 --> 00:02:15,135
[woman] I can't believe that she's ours
and that she's in our lives.
43
00:02:16,761 --> 00:02:19,973
The patients here, they say,
"Doctor, it's-- it's a crucial thing.
44
00:02:20,056 --> 00:02:22,016
I want to keep my fertility."
45
00:02:31,401 --> 00:02:34,028
[narrator] For most people,
if you have sex at the right time,
46
00:02:34,112 --> 00:02:36,739
there's a decent chance
this will happen...
47
00:02:36,823 --> 00:02:38,533
a sperm meeting an egg.
48
00:02:39,159 --> 00:02:42,412
But we're pretty bad at having sex
at the right time.
49
00:02:42,495 --> 00:02:46,958
The truth is that your egg is only good
for about eight hours after you ovulate.
50
00:02:47,041 --> 00:02:47,917
That's it.
51
00:02:48,001 --> 00:02:50,461
And you'll never get that timing right.
52
00:02:50,670 --> 00:02:52,589
It's impossible to get that right.
53
00:02:52,672 --> 00:02:55,091
You're better off just having
intercourse regularly,
54
00:02:55,175 --> 00:02:56,634
three times a week at least.
55
00:02:56,718 --> 00:02:59,804
After intercourse, the sperm are good
56
00:02:59,888 --> 00:03:02,724
for about three days
in the female's tract.
57
00:03:02,807 --> 00:03:05,977
So, you always want to have
sperm there when you ovulate.
58
00:03:06,769 --> 00:03:09,981
And that's because fertilization
isn't a sperm battle royal,
59
00:03:10,148 --> 00:03:14,319
a frantic sprint between millions
of aggressive sperm to penetrate the egg.
60
00:03:14,986 --> 00:03:19,240
It's more like the labyrinth
in the 1986 classic Labyrinth:
61
00:03:19,324 --> 00:03:22,827
full of obstacles that sometimes hurt
and sometimes help.
62
00:03:23,077 --> 00:03:24,579
I think I'm getting smarter!
63
00:03:24,954 --> 00:03:27,707
This is a piece of cake. [screams]
64
00:03:29,292 --> 00:03:30,835
Stop it! Help!
65
00:03:31,628 --> 00:03:33,087
What do you mean, "help"?
66
00:03:33,171 --> 00:03:34,631
-We are helping.
-[Sarah gasps]
67
00:03:34,714 --> 00:03:36,424
We're helping hands.
68
00:03:37,050 --> 00:03:38,801
[narrator]
And the labyrinth is unsolvable,
69
00:03:38,885 --> 00:03:42,680
except in that brief golden window
or terrifying window.
70
00:03:42,764 --> 00:03:45,016
Depending on whether or not you want
to get pregnant,
71
00:03:45,516 --> 00:03:48,937
a delicate hormonal cocktail
has put everything in place.
72
00:03:49,312 --> 00:03:52,106
First, the cervix,
the gatekeeper to the uterus,
73
00:03:52,190 --> 00:03:53,358
is slightly open.
74
00:03:53,524 --> 00:03:58,571
It denies entry to 99.9% of the sperm,
who die in the vagina.
75
00:03:59,155 --> 00:04:03,117
It's not necessarily the fastest sperm
who get in or the strongest.
76
00:04:03,326 --> 00:04:05,411
But you'll probably get kicked out
if you're a real freak.
77
00:04:05,495 --> 00:04:06,829
-[buzzer sounds]
-[sperm screams]
78
00:04:06,913 --> 00:04:08,706
[narrator] And it's not always a mad dash.
79
00:04:08,790 --> 00:04:12,168
Some sperm laze around for days
in a canal in the cervix
80
00:04:12,460 --> 00:04:14,128
in little inlets called crypts.
81
00:04:14,212 --> 00:04:17,715
It's a brief cervical Riviera vacation.
82
00:04:17,799 --> 00:04:20,426
And then the sperm begin their quest
into the uterus.
83
00:04:20,760 --> 00:04:25,014
But first, the cervix outfits them
with armor, a nutrient rich fluid.
84
00:04:25,265 --> 00:04:26,766
Without it, they'd all die.
85
00:04:27,183 --> 00:04:28,351
Once the sperm are in,
86
00:04:28,434 --> 00:04:31,437
they're not so much swimming frantically
as they are pushed.
87
00:04:31,521 --> 00:04:33,439
Sperm do crawl up the uterine wall,
88
00:04:33,523 --> 00:04:36,442
but they're propelled forward
by uterine contractions.
89
00:04:37,193 --> 00:04:39,279
So the ones that make it
to the Fallopian tubes
90
00:04:39,362 --> 00:04:40,947
may not be the fastest swimmers.
91
00:04:41,281 --> 00:04:43,199
They may have just gotten a good nudge.
92
00:04:43,783 --> 00:04:46,953
The tubes keep the sperm nice
and safe in their walls
93
00:04:47,036 --> 00:04:48,413
until the egg enters,
94
00:04:48,955 --> 00:04:51,291
-making the sperm hyperactive.
-[sperm exclaim]
95
00:04:51,374 --> 00:04:54,002
[narrator] And they get one last assist
from the labyrinth.
96
00:04:54,085 --> 00:04:56,671
Little hairs in the tube
point them the right way,
97
00:04:56,754 --> 00:04:58,214
and then they swim like hell.
98
00:04:59,090 --> 00:05:01,175
The ones that make it to the egg latch on,
99
00:05:01,509 --> 00:05:04,637
-and maybe one gets through.
-[sperm] Whoo-hoo!
100
00:05:05,054 --> 00:05:07,515
[narrator]
The lucky sperm is just that: lucky.
101
00:05:07,807 --> 00:05:10,018
"Powerball lottery winner" lucky.
102
00:05:10,101 --> 00:05:14,147
Literally,
their chances were one in 250 million.
103
00:05:14,564 --> 00:05:16,024
And it's tough for a reason.
104
00:05:16,357 --> 00:05:19,027
If more than one sperm manages
to fertilize an egg,
105
00:05:19,110 --> 00:05:21,487
the resulting embryo can't survive.
106
00:05:22,780 --> 00:05:26,367
That's why scientists think all these
obstacles evolved in the first place.
107
00:05:26,784 --> 00:05:29,746
And it's why it can take a little while
to get pregnant.
108
00:05:29,996 --> 00:05:33,166
There was no reason to believe
that we were gonna have any issues.
109
00:05:33,541 --> 00:05:36,002
[narrator] For an average couple
having unprotected sex,
110
00:05:36,085 --> 00:05:37,920
it happens within six months.
111
00:05:38,338 --> 00:05:40,381
Even after trying for a few months,
we just kept thinking
112
00:05:40,465 --> 00:05:41,966
that next month will be the month.
113
00:05:42,050 --> 00:05:45,345
Then next month turned
into six months later, turned into a year.
114
00:05:45,762 --> 00:05:49,849
[narrator] After 12 months, around 15%
of couples still aren't pregnant.
115
00:05:50,475 --> 00:05:51,434
I'd say around a year,
116
00:05:51,517 --> 00:05:54,062
we started to get concerned
that maybe something might be off.
117
00:05:54,145 --> 00:05:57,273
[narrator] And when a couple has tried
for a year with no success,
118
00:05:57,357 --> 00:05:59,734
most health officials
consider them infertile.
119
00:06:00,485 --> 00:06:03,404
But one half of the couple tends
to get most of the attention.
120
00:06:03,488 --> 00:06:05,740
There is a connection
between a woman's stress
121
00:06:05,823 --> 00:06:07,658
and her ability to get pregnant.
122
00:06:07,742 --> 00:06:12,080
[reporter] Fast food could be slowing down
how quickly some women become pregnant.
123
00:06:12,163 --> 00:06:14,332
We don't want women to panic,
but it is true.
124
00:06:14,415 --> 00:06:17,377
Just go and ask. Don't be scared
to ask the question and say,
125
00:06:17,460 --> 00:06:19,337
"Doctor, can you help me
figure out what's going on here?"
126
00:06:20,671 --> 00:06:22,340
[narrator]
One reason for the focus on women
127
00:06:22,423 --> 00:06:24,425
is that their bodies are the labyrinth.
128
00:06:25,051 --> 00:06:27,678
It keeps changing!
What am I supposed to do?
129
00:06:28,137 --> 00:06:31,015
[narrator] The sperm shoots in
at around 30 miles an hour,
130
00:06:31,140 --> 00:06:33,351
but sometimes they're doomed
from the beginning,
131
00:06:33,643 --> 00:06:36,062
like when the ovaries don't produce
an egg,
132
00:06:36,396 --> 00:06:38,564
perhaps because of a hormonal imbalance.
133
00:06:39,148 --> 00:06:41,484
If the ovary does release an egg,
134
00:06:41,818 --> 00:06:43,736
the sperm may not be able to get to it,
135
00:06:43,903 --> 00:06:46,489
because something made the labyrinth
impossible...
136
00:06:46,572 --> 00:06:49,492
-like a damaged or blocked tube.
-[sperm whimpering]
137
00:06:49,575 --> 00:06:51,702
[narrator]
And if the sperm does get to it,
138
00:06:51,994 --> 00:06:53,830
and a fertilized egg travels down
139
00:06:53,913 --> 00:06:56,165
to snuggle into the thick uterine lining,
140
00:06:56,416 --> 00:06:57,834
the lining might be damaged,
141
00:06:57,917 --> 00:06:59,168
so the egg can't stick.
142
00:06:59,919 --> 00:07:01,879
But it isn't just an issue
with the labyrinth
143
00:07:01,963 --> 00:07:03,339
that can cause infertility.
144
00:07:03,756 --> 00:07:07,301
In at least 40%
of the cases of infertility,
145
00:07:07,677 --> 00:07:09,137
there's a male factor involved.
146
00:07:09,387 --> 00:07:10,263
[narrator] For men,
147
00:07:10,346 --> 00:07:14,016
infertility basically comes down
to one thing: sperm.
148
00:07:15,726 --> 00:07:17,854
Chances of conceiving in a given month
149
00:07:17,979 --> 00:07:19,313
go up with sperm count...
150
00:07:19,814 --> 00:07:21,732
till about 40 million.
151
00:07:21,816 --> 00:07:24,986
After that,
there's not much extra fertility boost.
152
00:07:25,069 --> 00:07:26,779
And 15 million is a low count,
153
00:07:26,863 --> 00:07:29,323
according
to the World Health Organization.
154
00:07:29,407 --> 00:07:31,284
The morphology of a man's sperm,
155
00:07:31,367 --> 00:07:33,870
its size and shape, may also play a role.
156
00:07:34,579 --> 00:07:35,955
This is a normal sperm:
157
00:07:36,038 --> 00:07:37,915
an oval head with a long tail,
158
00:07:38,624 --> 00:07:41,794
while an abnormal sperm may have
a weird-looking head...
159
00:07:42,545 --> 00:07:43,504
or two tails.
160
00:07:44,046 --> 00:07:46,549
There's such a variety of normal sperm
161
00:07:46,632 --> 00:07:49,760
and abnormal sperm
in any particular ejaculate
162
00:07:50,136 --> 00:07:53,181
that it's really hard to say
morphology's a problem.
163
00:07:53,723 --> 00:07:55,391
Poor motility is very important,
164
00:07:56,142 --> 00:07:59,061
but poor motility is always associated
with a low count.
165
00:07:59,145 --> 00:08:02,732
So, if the actual numerical count
is good-- good enough,
166
00:08:02,982 --> 00:08:05,401
then even a low motility
doesn't mean anything.
167
00:08:05,485 --> 00:08:08,905
[narrator] On TV, low sperm count
is often treated as a joke,
168
00:08:09,071 --> 00:08:11,491
like the risk posed by hot tubs...
169
00:08:11,574 --> 00:08:12,867
-Mr. Truman.
-Yes.
170
00:08:12,950 --> 00:08:14,410
We need to talk about your sperm.
171
00:08:14,494 --> 00:08:17,705
[gasps] I knew it.
It's the Jacuzzi at the gym.
172
00:08:17,788 --> 00:08:19,207
He boiled them, didn't he?
173
00:08:19,415 --> 00:08:20,958
[narrator] ...and too-tight underwear...
174
00:08:21,042 --> 00:08:23,711
Look, you gotta help me.
I have to get off jockey shorts.
175
00:08:23,794 --> 00:08:26,088
-What, you have a low sperm count?
-Very low!
176
00:08:26,172 --> 00:08:28,007
[narrator] ...and excessive masturbation.
177
00:08:28,090 --> 00:08:29,383
Sample hardly had any swimmers.
178
00:08:29,467 --> 00:08:31,469
That's probably
from excessive masturbation.
179
00:08:31,552 --> 00:08:35,681
Guy's been outpacing
his ability to produce... sperm."
180
00:08:36,891 --> 00:08:39,852
[narrator] Daily ejaculation
has no major negative effect
181
00:08:39,936 --> 00:08:41,187
on semen parameters,
182
00:08:41,270 --> 00:08:43,189
as in sperm count or quality.
183
00:08:43,564 --> 00:08:45,233
As for tight underwear...
184
00:08:45,316 --> 00:08:49,362
one study found
"semen parameters gradually decreased
185
00:08:49,445 --> 00:08:52,240
while the subjects were
in tight conditions,"
186
00:08:52,782 --> 00:08:56,827
but they “gradually increased
while they were in loose conditions."
187
00:08:57,328 --> 00:09:02,124
And the "wet heat" of hot tubs
can also temporarily lower sperm count.
188
00:09:02,583 --> 00:09:05,503
But only DJ Khaled levels
of Jacuzzi time could do that.
189
00:09:05,795 --> 00:09:08,965
For the record,
DJ Khaled's sperm seems totally fine.
190
00:09:09,382 --> 00:09:10,841
See? He's got a son.
191
00:09:11,884 --> 00:09:13,970
But some things can cause lasting harm,
192
00:09:14,512 --> 00:09:18,224
like the kind of steroids sometimes used
by bodybuilders.
193
00:09:18,432 --> 00:09:21,602
Those steroids build muscle fast
because they pump you up
194
00:09:21,811 --> 00:09:24,272
with synthetic forms of testosterone.
195
00:09:24,355 --> 00:09:27,066
And studies have found
that heavy long-term use
196
00:09:27,149 --> 00:09:30,194
can cause
"some degree of gonadal impairment."
197
00:09:30,361 --> 00:09:34,907
So "the impact on male fertility
is not solely a transient condition."
198
00:09:36,409 --> 00:09:39,036
Male fertility can also be
permanently impacted
199
00:09:39,120 --> 00:09:41,289
by accidental exposure to chemicals,
200
00:09:41,372 --> 00:09:44,917
like the pesticide dibromochloropropane,
201
00:09:45,001 --> 00:09:48,963
or "DBCP," banned in the US in 1979.
202
00:09:49,422 --> 00:09:53,884
But banana plantations in the Philippines
and at least a dozen other countries
203
00:09:54,427 --> 00:09:57,346
still used DBCP well into the '80s.
204
00:09:57,680 --> 00:09:59,682
Thousands of workers were left sterile
205
00:10:00,391 --> 00:10:04,145
and sued the American companies
who made and exported the pesticide.
206
00:10:04,729 --> 00:10:07,607
[in Tagalog] After I started working
on the banana plantation,
207
00:10:07,690 --> 00:10:09,233
I wasn't able to have kids anymore.
208
00:10:09,317 --> 00:10:11,068
[interviewer]
What do you want to happen now?
209
00:10:11,152 --> 00:10:13,404
Since we are claimants
against that pesticide,
210
00:10:13,487 --> 00:10:16,532
we want to be paid
because of our sterility.
211
00:10:17,033 --> 00:10:19,577
[narrator, in English] The workers
in that lawsuit were eventually paid,
212
00:10:20,119 --> 00:10:22,455
depending on how low
their sperm count was.
213
00:10:22,913 --> 00:10:26,000
And it's not just men who work
with chemicals who are at risk.
214
00:10:26,083 --> 00:10:29,170
Their biologies are being exposed
to things
215
00:10:29,253 --> 00:10:31,589
that are not good
for male reproductive health.
216
00:10:32,173 --> 00:10:35,426
[narrator]
In 2017, researchers reviewed data
217
00:10:35,509 --> 00:10:37,219
from more than 50 countries
218
00:10:37,928 --> 00:10:42,141
and found that the average sperm count
has been dropping for decades.
219
00:10:42,600 --> 00:10:44,935
It's still above a totally fertile level,
220
00:10:45,019 --> 00:10:48,981
but the average man today
has half the sperm his grandfather did.
221
00:10:49,231 --> 00:10:53,361
So, the other important thing
about this is to ask,
222
00:10:53,444 --> 00:10:55,112
"Well, is it getting better?
223
00:10:55,988 --> 00:10:57,865
Is the decline stopping?"
224
00:10:57,948 --> 00:11:00,660
And so we looked at that,
and the answer is no.
225
00:11:01,243 --> 00:11:04,038
[narrator] One likely culprit-- plastics.
226
00:11:04,121 --> 00:11:05,539
[dramatic music playing]
227
00:11:05,623 --> 00:11:08,459
Production ramped up
during the Second World War...
228
00:11:08,542 --> 00:11:10,878
[man] Here is a plane containing hundreds
of plastic parts.
229
00:11:11,629 --> 00:11:13,506
[narrator]
...and it hasn't slowed down since.
230
00:11:13,881 --> 00:11:16,634
[man] Plastic. Plastic. Plastic.
231
00:11:17,426 --> 00:11:20,680
Gradually, there were signs
232
00:11:20,763 --> 00:11:23,265
that maybe everything was not... right.
233
00:11:23,474 --> 00:11:25,518
[narrator]
Phthalates are the group of chemicals
234
00:11:25,601 --> 00:11:28,062
that make some plastics soft and flexible.
235
00:11:28,145 --> 00:11:31,774
And another chemical, BPA,
is what makes other plastics strong.
236
00:11:32,191 --> 00:11:36,529
They get into our bodies through our food,
our skin, and even the air.
237
00:11:37,113 --> 00:11:39,532
And they can change
our body's hormonal balance,
238
00:11:39,615 --> 00:11:43,119
which can have an especially huge impact
on a developing fetus.
239
00:11:43,619 --> 00:11:45,121
In a six-week-old fetus,
240
00:11:45,246 --> 00:11:48,290
the cells that eventually produce
the testes and ovaries,
241
00:11:48,374 --> 00:11:50,251
germ cells, are identical.
242
00:11:50,459 --> 00:11:53,087
In the following weeks,
they usually pick a lane,
243
00:11:53,170 --> 00:11:56,716
their development guided by the balance
of hormones in the uterus.
244
00:11:56,799 --> 00:12:01,178
In the body, phthalates
and BPA can throw off that balance,
245
00:12:01,470 --> 00:12:04,890
potentially impacting the number
and quality of eggs that develop
246
00:12:05,516 --> 00:12:08,144
or the testes' ability
to produce sperm later.
247
00:12:08,352 --> 00:12:10,604
You can imagine that if you mess
248
00:12:10,688 --> 00:12:14,525
with that critical hormonal development
at that time,
249
00:12:14,608 --> 00:12:16,652
you will mess up a lot of systems.
250
00:12:16,944 --> 00:12:20,239
So, I like to think
of declining sperm count
251
00:12:20,322 --> 00:12:22,116
as the canary in the coal mine.
252
00:12:22,199 --> 00:12:25,661
Because they represent a disruption
that happened very early
253
00:12:25,745 --> 00:12:27,621
that disrupted a lot of things.
254
00:12:28,038 --> 00:12:30,249
[narrator] And the way germ cells develop
in the uterus
255
00:12:30,374 --> 00:12:35,379
also explains another huge factor
affecting fertility: age.
256
00:12:36,505 --> 00:12:40,426
Male germ cells in the testes
don't start producing sperm until puberty.
257
00:12:41,343 --> 00:12:44,346
A germ cell divides
into two identical copies.
258
00:12:44,847 --> 00:12:46,015
One keeps dividing,
259
00:12:46,432 --> 00:12:47,933
and those cells become sperm.
260
00:12:48,434 --> 00:12:50,144
But the other stays a germ cell,
261
00:12:50,436 --> 00:12:51,562
so they don't run out.
262
00:12:52,354 --> 00:12:54,732
And a man can produce new sperm
until old age.
263
00:12:55,733 --> 00:12:57,234
But in a female fetus,
264
00:12:57,318 --> 00:13:01,489
those germ cells in the ovaries start
turning into immature eggs right away.
265
00:13:02,490 --> 00:13:06,368
A 20-week-old fetus has
roughly seven million of them.
266
00:13:06,535 --> 00:13:08,454
But they quickly start wasting away.
267
00:13:08,829 --> 00:13:11,749
A female newborn is left
with about two million.
268
00:13:12,041 --> 00:13:14,668
And by the time the first one makes
its debut in puberty,
269
00:13:14,960 --> 00:13:17,797
she's down to 300,000 or 400,000.
270
00:13:18,172 --> 00:13:20,424
And then every month,
one egg is released,
271
00:13:20,633 --> 00:13:22,843
and a thousand or so more die off.
272
00:13:23,469 --> 00:13:25,554
And that's why most women
have a much harder time
273
00:13:25,638 --> 00:13:27,139
getting pregnant after 40
274
00:13:27,431 --> 00:13:30,059
and are pretty much out of eggs
by the time they're 50.
275
00:13:31,101 --> 00:13:34,522
Age also hurts male fertility,
though not as much.
276
00:13:34,855 --> 00:13:37,566
It takes older men longer
to get their partners pregnant
277
00:13:37,942 --> 00:13:39,944
especially after they turn 45,
278
00:13:40,110 --> 00:13:42,488
and that's controlling
for their partner's age.
279
00:13:43,030 --> 00:13:45,074
But flip through any tabloid magazine,
280
00:13:45,157 --> 00:13:47,827
and you can see
they can still have kids.
281
00:13:48,327 --> 00:13:52,665
Sperm production may not stop,
but sperm quality can change.
282
00:13:52,957 --> 00:13:57,169
We know there are some terrible,
terrible genetic mutation diseases
283
00:13:57,294 --> 00:14:00,172
that, uh, can occur from older sperm,
284
00:14:00,464 --> 00:14:03,384
because we know
there's about two mutations
285
00:14:03,884 --> 00:14:05,719
that occur every year.
286
00:14:06,220 --> 00:14:09,974
And so, over time, that builds up
and builds up and builds up,
287
00:14:10,516 --> 00:14:14,854
so that there will be more mutations
in a 60-year-old's sperm
288
00:14:15,104 --> 00:14:16,647
than in a 20-year-old's sperm.
289
00:14:16,981 --> 00:14:18,023
[narrator] But headlines
290
00:14:18,107 --> 00:14:20,901
about birth defects tend to focus
on older women.
291
00:14:21,485 --> 00:14:24,238
There just hasn't been
nearly as much research on men.
292
00:14:24,363 --> 00:14:27,533
Male infertility
has been poorly understood,
293
00:14:27,825 --> 00:14:31,829
and the public and even doctors
don't understand it very well.
294
00:14:31,912 --> 00:14:36,417
Most of the time, the quality
of the sperm and the quantity the sperm
295
00:14:36,500 --> 00:14:37,751
is genetically determined.
296
00:14:37,835 --> 00:14:40,254
Now we don't have all the genes
figured out, obviously.
297
00:14:40,337 --> 00:14:44,383
They diagnosed it:
non-obstructive azoospermia.
298
00:14:45,050 --> 00:14:48,554
Which I had to immediately look up
and see what that meant. [laughs]
299
00:14:49,179 --> 00:14:52,641
[narrator] Azoospermia is when there's
no sperm in the ejaculate.
300
00:14:53,350 --> 00:14:55,644
Sometimes it's because there's a blockage,
301
00:14:56,103 --> 00:14:58,772
but often,
it's because the testes aren't producing
302
00:14:58,856 --> 00:15:00,357
enough sperm to begin with.
303
00:15:01,191 --> 00:15:02,776
That's the case for Myles.
304
00:15:02,860 --> 00:15:05,237
Nothing came back,
“You'll never have kids.”
305
00:15:05,321 --> 00:15:08,282
Everything came back,
"Oh, there's a chance. There's a chance."
306
00:15:08,908 --> 00:15:10,784
[narrator] Myles had two surgeries
307
00:15:11,076 --> 00:15:13,954
to try to find any sperm
that might be in the testes.
308
00:15:15,039 --> 00:15:15,873
But no luck.
309
00:15:16,415 --> 00:15:21,128
It changes a couple
when you have an infertility diagnosis.
310
00:15:21,211 --> 00:15:24,423
It takes a toll on you, on your marriage.
311
00:15:25,507 --> 00:15:27,760
[Myles] When you love somebody
with all your heart,
312
00:15:27,843 --> 00:15:30,095
but you can't give them what they want...
313
00:15:30,179 --> 00:15:32,890
I was pretty destroyed
after the second surgery.
314
00:15:33,515 --> 00:15:38,187
There really isn't a lot of things
that treat azoospermia.
315
00:15:38,520 --> 00:15:39,521
[narrator] For centuries,
316
00:15:39,605 --> 00:15:42,274
because fertility research
has focused on women,
317
00:15:42,358 --> 00:15:44,193
so have fertility treatments,
318
00:15:44,318 --> 00:15:47,655
figuring out how to get around
different obstacles in the labyrinth.
319
00:15:47,738 --> 00:15:48,697
You don't, by any chance,
320
00:15:48,781 --> 00:15:50,449
know the way
through this labyrinth, do you?
321
00:15:50,658 --> 00:15:52,952
Who, me? No, I'm just a worm. [chuckles]
322
00:15:53,035 --> 00:15:55,496
[sighs] I have to solve this labyrinth.
323
00:15:55,788 --> 00:15:58,832
[narrator] One shortcut is
to let the sperm skip the cervix
324
00:15:58,958 --> 00:16:03,629
by putting them directly into the uterus,
called "intrauterine insemination."
325
00:16:04,338 --> 00:16:06,590
Later, scientists developed treatments
326
00:16:06,674 --> 00:16:09,051
that removed more barriers
from the labyrinth,
327
00:16:09,385 --> 00:16:12,638
drugs that stimulate the ovaries
into producing an egg,
328
00:16:13,847 --> 00:16:16,892
surgery to remove blockages
in the Fallopian tubes.
329
00:16:17,726 --> 00:16:22,731
Then in 1978, we figured out how
to skip the labyrinth entirely.
330
00:16:23,482 --> 00:16:26,318
[man] You are about to see
a historic birth
331
00:16:26,402 --> 00:16:28,362
following in vitro fertilization.
332
00:16:28,445 --> 00:16:30,781
[narrator]
The achievement was so historic,
333
00:16:30,864 --> 00:16:34,410
the entire birth was filmed
at the British government's request.
334
00:16:35,035 --> 00:16:37,454
[man] Heart sounds
and the lung sounds are normal.
335
00:16:37,538 --> 00:16:40,165
-[baby wailing]
-[man] Lovely pink color.
336
00:16:40,624 --> 00:16:42,501
Plenty of fat underneath the skin...
337
00:16:42,960 --> 00:16:44,294
Good mature baby.
338
00:16:44,920 --> 00:16:48,382
[narrator] In vitro fertilization comes
from the Latin "in glass,"
339
00:16:48,799 --> 00:16:51,010
otherwise known as "IVF."
340
00:16:52,094 --> 00:16:55,097
A doctor retrieves an egg
from the ovaries through the vagina
341
00:16:55,222 --> 00:16:57,474
and then mixes it with sperm in a lab.
342
00:16:57,808 --> 00:17:01,645
The fertilized egg is then implanted
directly into the uterus.
343
00:17:01,729 --> 00:17:05,441
And another major breakthrough happened
in the 1990s:
344
00:17:05,566 --> 00:17:09,820
"Intracytoplasmic sperm injection"
or ICSI.
345
00:17:09,903 --> 00:17:11,864
By using a delicate hollow needle,
346
00:17:11,989 --> 00:17:16,160
doctors can now pick up a single sperm
and implant it into the egg.
347
00:17:16,285 --> 00:17:20,789
I'm not talking about five million,
or 50,000, or 1,000, or 100...
348
00:17:20,873 --> 00:17:24,376
If he has two or three sperm
or one sperm, we can find it,
349
00:17:24,668 --> 00:17:26,587
and we can inject it directly
into the egg,
350
00:17:26,670 --> 00:17:28,505
and you have a normal pregnancy rate.
351
00:17:28,589 --> 00:17:30,132
[narrator]
We'd gotten around the labyrinth,
352
00:17:30,215 --> 00:17:32,926
but a couple still needs
to find that sperm.
353
00:17:33,010 --> 00:17:34,428
Give me the child.
354
00:17:34,511 --> 00:17:37,931
I figured there had to be a way somehow.
355
00:17:38,390 --> 00:17:41,268
So, I had done research from the start.
356
00:17:41,685 --> 00:17:43,979
[narrator] And she came across
a less common procedure,
357
00:17:44,063 --> 00:17:46,231
which could potentially locate sperm
358
00:17:46,315 --> 00:17:48,525
that the other surgeries might
have missed.
359
00:17:48,609 --> 00:17:53,238
She's like, "It's gonna be $13,000,
and it's a maybe,
360
00:17:53,655 --> 00:17:55,783
and we've already been told no twice."
361
00:17:56,200 --> 00:17:57,117
And I was like, "Wow."
362
00:17:57,201 --> 00:17:59,119
I knew, at this point,
it was the last hurrah.
363
00:17:59,203 --> 00:18:01,705
If-- If we got bad news,
that-- that was it.
364
00:18:01,789 --> 00:18:06,710
But, um, you know just, I'm also,
like, the epitome of optimism.
365
00:18:06,835 --> 00:18:09,546
So, I was like, "Oh, yeah,
we'll figure it out. This is gonna work."
366
00:18:09,922 --> 00:18:12,674
[narrator] All this technology
also opens up the possibility
367
00:18:12,758 --> 00:18:16,678
of biological parenthood
for couples where both partners have eggs
368
00:18:17,096 --> 00:18:20,891
or both partners have sperm,
and for people without a partner.
369
00:18:20,974 --> 00:18:22,935
A changing face of parenthood
is emerging
370
00:18:23,018 --> 00:18:25,437
as more women are using
in vitro fertilization
371
00:18:25,521 --> 00:18:27,564
to become single mothers.
372
00:18:27,648 --> 00:18:30,818
Joseph Tito's journey to fatherhood
via surrogacy in Kenya
373
00:18:30,943 --> 00:18:32,820
is drawing attention to the diverse ways
374
00:18:32,903 --> 00:18:35,280
in which people may choose
to have children.
375
00:18:35,405 --> 00:18:37,574
We're able to take the eggs
from one woman,
376
00:18:37,741 --> 00:18:39,326
fertilize them with the donor's sperm,
377
00:18:39,409 --> 00:18:42,579
and transfer them
into her same-sex female partner.
378
00:18:42,704 --> 00:18:47,793
We both participated in our own ways
in creating her.
379
00:18:48,418 --> 00:18:51,213
This is Zachary. This is David,
380
00:18:51,630 --> 00:18:53,132
and we are very happy to be here.
381
00:18:53,215 --> 00:18:55,134
-[man] Hey!
-Hey, Zachary.
382
00:18:55,217 --> 00:18:57,761
[narrator] But the new tech doesn't come
with a guarantee.
383
00:18:57,845 --> 00:19:02,224
For example, IVF's success depends a lot
on the age of the eggs.
384
00:19:02,724 --> 00:19:06,145
For women under 35,
it works 29% of the time.
385
00:19:06,603 --> 00:19:10,566
For women 40 to 42, the success rate
is around one in ten.
386
00:19:10,983 --> 00:19:14,778
The chance of success goes up
when using eggs frozen at a younger age.
387
00:19:15,362 --> 00:19:16,905
But according to one study,
388
00:19:16,989 --> 00:19:21,493
the real way to maximize the chance
of success is to freeze a ton of eggs.
389
00:19:21,577 --> 00:19:23,078
For most women, 40,
390
00:19:23,328 --> 00:19:27,082
which would usually require several rounds
of egg extraction
391
00:19:27,166 --> 00:19:31,128
and months of hormone injections,
which can take a physical toll.
392
00:19:32,004 --> 00:19:34,882
Though you may not know that looking
at ads on social media,
393
00:19:34,965 --> 00:19:37,467
from boutique startups urging women
in their 20s
394
00:19:37,551 --> 00:19:39,845
to freeze their eggs
as an insurance policy.
395
00:19:40,470 --> 00:19:43,807
One compared egg freezing
to the cost of an acai bowl,
396
00:19:44,057 --> 00:19:48,478
as if the procedure was as easy
to buy into as any wellness trend.
397
00:19:48,562 --> 00:19:51,690
I think it's unfortunate
that it's become commercialized.
398
00:19:51,773 --> 00:19:55,110
So, there's a lot of really kind of
atrocious marketing going on.
399
00:19:55,194 --> 00:19:57,529
Because it's not a guarantee of anything.
400
00:19:58,113 --> 00:19:59,823
[narrator]
But there's a new promising therapy
401
00:19:59,907 --> 00:20:03,577
that could help even more women
transcend their biological clocks:
402
00:20:03,660 --> 00:20:07,414
not freezing their eggs,
but freezing a piece of their ovaries.
403
00:20:07,497 --> 00:20:08,999
[machine whirring]
404
00:20:09,082 --> 00:20:11,960
[narrator] This was originally developed
for cancer patients,
405
00:20:12,044 --> 00:20:15,589
whose ovaries can be destroyed
by chemotherapy or other treatments.
406
00:20:15,964 --> 00:20:20,510
So, we freeze the ovarian tissue,
and within a matter of days,
407
00:20:20,594 --> 00:20:24,056
they can start on their cancer treatment.
And then 20 years later...
408
00:20:24,640 --> 00:20:27,559
[narrator] The tissue is transplanted
onto the dead ovary,
409
00:20:27,643 --> 00:20:30,312
where incredibly, the transplanted tissue
410
00:20:30,395 --> 00:20:33,065
starts functioning like its own new ovary.
411
00:20:33,565 --> 00:20:35,317
And lo and behold, they start ovulating,
412
00:20:35,400 --> 00:20:38,278
and they get pregnant spontaneously
with no IVF.
413
00:20:38,987 --> 00:20:40,530
[narrator] As of 2016,
414
00:20:40,614 --> 00:20:44,243
84 babies had been born
through ovarian tissue freezing,
415
00:20:44,409 --> 00:20:46,411
two-thirds without IVF.
416
00:20:46,495 --> 00:20:49,915
And doctors hope that one day
this could be a mainstream therapy.
417
00:20:50,290 --> 00:20:52,000
And while each new technology
418
00:20:52,084 --> 00:20:55,170
is helping more and more people conceive
who couldn't before,
419
00:20:55,254 --> 00:20:56,797
some are always left out.
420
00:20:57,673 --> 00:21:01,635
As a black lesbian woman
who desperately wants to be a mother,
421
00:21:01,718 --> 00:21:04,554
I've had to look at, like,
"What does insurance provide?"
422
00:21:04,638 --> 00:21:08,475
How much money is this going to cost?
How accessible is this really for me?"
423
00:21:08,976 --> 00:21:10,102
[narrator] In most countries,
424
00:21:10,185 --> 00:21:12,980
a single round of IVF will run thousands
of dollars,
425
00:21:13,522 --> 00:21:16,316
and many people need multiple rounds
for it to work.
426
00:21:16,400 --> 00:21:19,152
It's a very expensive procedure,
427
00:21:19,236 --> 00:21:22,281
and we're talking about black women
only making 64 cents on the dollar.
428
00:21:22,823 --> 00:21:25,784
[narrator] And some countries can ban
certain groups from getting IVF
429
00:21:25,867 --> 00:21:27,536
or other fertility treatments.
430
00:21:27,619 --> 00:21:30,163
Because these aren't
just medical procedures,
431
00:21:30,247 --> 00:21:32,916
they challenge the traditional idea
of family.
432
00:21:33,875 --> 00:21:37,254
Remember, health officials have
long defined infertility
433
00:21:37,337 --> 00:21:41,425
as an inability to get pregnant
after one year of unprotected sex,
434
00:21:41,508 --> 00:21:44,177
which obviously doesn't apply
to single women
435
00:21:44,303 --> 00:21:46,596
or a lot of the LGBTQ couples.
436
00:21:46,680 --> 00:21:50,392
[in French] The route for single women
in France is an obstacle course.
437
00:21:50,851 --> 00:21:54,229
We're not accommodated
because it's been illegal up until now.
438
00:21:54,646 --> 00:21:57,899
And you have to go abroad.
You have to research a clinic.
439
00:21:58,275 --> 00:22:02,446
[narrator, in English] In 2017,
some doctors changed the definition
440
00:22:02,529 --> 00:22:05,615
to an impairment
of a person's capacity to reproduce
441
00:22:05,699 --> 00:22:09,578
either as an individual
or with his or her partner."
442
00:22:09,911 --> 00:22:13,332
Which may lead the way
to broader access to treatments.
443
00:22:13,832 --> 00:22:17,753
And no doubt, more research
and new discoveries will offer hope
444
00:22:17,878 --> 00:22:21,173
to more people who long
for a biological child.
445
00:22:21,673 --> 00:22:24,676
We had a bottle of champagne
in the fridge if the news was good,
446
00:22:24,801 --> 00:22:27,220
uh, and we probably
just would have smashed it
447
00:22:27,304 --> 00:22:28,764
on the floor if the news was bad.
448
00:22:28,847 --> 00:22:31,016
So, we get the call from the doctor,
449
00:22:31,099 --> 00:22:34,853
and he literally just said,
"Hey, you know, how have you guys been?"
450
00:22:34,936 --> 00:22:37,481
And then it was,
"I got some good news for you."
451
00:22:37,564 --> 00:22:41,234
And we both fell to the floor in tears.
I don't--
452
00:22:41,818 --> 00:22:42,986
I mean, it was just...
453
00:22:43,070 --> 00:22:45,489
it was probably one
of the best moments of my entire life.
454
00:22:45,572 --> 00:22:48,992
We still have a very long road ahead of us
with IVF and everything.
455
00:22:49,409 --> 00:22:53,288
And, um, we're hoping
to have our finances in place
456
00:22:53,372 --> 00:22:56,750
to go out in October
and hopefully get pregnant.
457
00:22:57,417 --> 00:22:59,294
-September.
-September.
458
00:22:59,378 --> 00:23:01,963
[both chuckle]
459
00:23:02,047 --> 00:23:04,049
[theme music playing]