Dr. Vladimir Kotlik: "In the Modern World, Men Rapidly Lose the Ability to Conceive Children"
Career, money, sexual victories, sports and good physical shape for many men are much more important issues than the need for procreation. This territory is unofficially assigned to women. Meanwhile, in the past 20 years, the number of men in the world, who are not able to conceive children is rapidly increasing, despite the visible signs of success and well-being.
We talked with Dr. Vladimir Kotlik, who is the head doctor at the Network of the Reproductive Medical Centers “Mother and Child” with over 20 years of relevant professional experience about the spermogram, female and male physiology, as well as about the scope of capabilities of the modern reproductive medicine.
There are no expensive accessories and objects of modern art in the office of the head doctor of the clinic “Mother and Child”. A calm working environment reigns here, favoring the patient's confidential conversation with the doctor. And instead of paintings on the walls, there are many photos of happy parents with small children. All the people in the photos are patients and “children” of Dr. Vladimir Kotlik.
Dr. Kotlik, in recent years the number of infertile couples has been growing, what it is connected with, is it true that these problems are largely related to the male factor?
In the modern world, men, unfortunately, quickly lose their fertility. I note, we are not talking about potency, fertility is the ability to conceive children. Research data suggests that the ability of men to conceive children is rapidly decreasing. Twenty years ago, when I started working in the field of reproductive medicine, the male factor occurred in 10-15% of cases. Today - it is 50 to 50, in other words half of infertility cases of married couples are attributable to male problems. These are not entirely correct numbers, because before that there was no accurate diagnostics and even theoretical chances to “cure” infertility, therefore, some couples were not always taken into account in the “problem” statistics.
Nevertheless, there are disappointing statistics accumulated in the process of research, which we conduct daily in the clinic. For example, spermogram. These are quantitative and qualitative indicators of sperm, showing their fertilizing ability. Today, normal semen is a rarity. Just 15 years ago, the optimal rate of concentration was 120 million sperm cells per 1 ml of ejaculate, but over the past 15 years, the rates have been revised three times towards decreasing.
At the same time, only a few sperm cells are sufficient for conception using IVF. At the same time, I strongly emphasize that inability to conceive and erectile dysfunctions are completely different, unrelated phenomena, which practically do not overlap.
Can you name the reasons for the decline of reproductive abilities in men?
There are no obvious, identified reasons for the massive decline in male fertility. There are only theories. For example, the theory that spermatogenesis is negatively affected by carbon dust, all sorts of artificial materials, mobile phones, and in general the fact that our civilization increasingly depends on technology and "gadgets." There is an opinion that makes feminists rather rub their hands, that the Y chromosome, which determines the male sex, is gradually degrading, and this affects the quality of sperm in men. There are many theories. But there is no right answer to your question. We can only treat the cause.
However, there is what we know for sure. For example, active bodybuilding with the use of anabolic agents is a powerful blow to spermatogenesis. Paradox. Men tend to look as masculine as possible. In all cultures and animal communities, males do this to attract females. The purpose of such changes, in fact, is to leave behind as many offspring as possible. But as a result, such "super men" with a set of muscles have problems with hormonal activity, and their ability to fertilize the "female" tends to zero. Such cases are exactly an example of the fact that instincts sometimes prevail over the common sense.
Of the traditional proven factors affecting male fertility - complicated viral parotitis (mumps) and some other infections. The promiscuous sex life may in the future backfire with sterility. However, this concerns not only men, but also women. In women, a common cause of reduced fertility is complications after chlamydia, in men, chronic, often invisible, but under-treated sexually transmitted infections.
Interestingly, the factor of fertility is not always associated with age, potency, and overall general health. Young sportive guys may have zero sperm cells.
At the same time, an ordinary man aged 50-55 years in terms of reproductive functionality can be absolutely normal, and even "excellent." The famous saying “the old horse will not spoil the furrow” can also be relevant in the modern world.
In any case, only a doctor can figure out the extent to which a man is "macho" in terms of his ability to spread his genes. I highly recommend to pass the sperm count test before marriage. It will be fair to the future spouse and to the man himself. In addition, the sooner the problem is detected, the bigger chances are to treat it by taking appropriate measures. But do not forget that the fluctuations in the spermograms are very natural, so do not panic too early.
In what cases, or perhaps at what age, a man needs to freeze his sperm?
In recent months, an increasingly big number of men who are going to the war zone in Eastern Ukraine ask me to cryopreserve their sperm, or, more simply, “to freeze it.” They need a guarantee that even if they return from a war with a severe wound, they will be able to become fathers of “native” children in the future. Cryopreservation of sperm is a simple, reliable procedure that became almost a routine for many doctors.
In general, the cryopreservation of genetic material, the backup for the future is an important and actively developing area of reproductive medicine. This is especially true for women who have a limited time frame. At the age of about 35 years, the quality and number of ovules is significantly reduced in women. In men, as I said, impaired spermatogenesis is not directly related to age. If a man leads a normal life, then up to 50-60 years of age his spermatogenesis should not be compromised.
However, there are situations when “freezing” is simply necessary so that a man can have healthy children. For example, today, as you know, there is an increase in the number of oncological diseases. Fortunately, they are already fairly well treated. However, the consequence of this treatment is the death of reproductive cells. Such patients, having recovered, have the opportunity to use their frozen sperm or eggs, which can be stored for years and at the same time not lose their properties.
As a practicing physician, obstetrician-gynecologist and fertility specialist, you graduated from university in 2005 with a degree in medical psychology. What was the reason for this?
Initially, I wanted to become a psychiatrist, but in the end I chose gynecology and reproduction. Nevertheless, I still have an interest in psychology, and I even wrote my Ph.D. thesis on the topic that interconnects gynecology and psychology.
The doctor must also be a psychologist. Almost always a couple that face infertility, especially due to male reproductive issues, is experiencing problems in the relationship. The one in the couple, who was found “guilty” of the impossibility of having children, suffers from a sense of guilt and, possibly, inferiority. A partner is not always able to contain emotions. All this spoils the relationship of a couple. It should be understood that, in any case, the problem of infertility is the problem of the couple, the problem of two, and it is often impossible to identify the "guilty" party. There is such a type of infertility as idiopathic, that is, unexplained. Modern medicine cannot always detect the cause, and it can be purely psychological.
In addition to their problems, society is also putting some pressure on a childless couple. Not so long ago, infertility in marriage was perceived as the “curse of God.” Such couples are forced to answer unpleasant, sometimes tactless questions from their loved ones, listen to a lot of advice from incompetent relatives and feel like “white crows”. All this forms a lot of psychological problems.
When our patients, while in the treatment program, completely trust the doctor, then pregnancy occurs even in the most difficult cases. It happens that patients come with 15 years of experience of infertility, and the trust to the doctor helps them get pregnant quickly, and the medicine cannot always explain these phenomena.
Why do many patients wait for years and do not ask for help, perhaps in our society there is an ambiguous attitude towards children “from the test tube”?
We do not make children in test tubes - this is a common stereotype. And even the expression "artificial insemination" is not quite right. We do not fertilize with something artificial, do not synthesize children. We create the ideal conditions for fertilization by affecting the body of a woman with specially selected drugs and micromanipulations.
The myth of "artificial" children in Europe has long been destroyed, no one hesitates to say that children were born thanks to IVF, but this remains a secret with seven seals in Ukraine. Often one has to deal with the fact that myths about reproductive medicine prevent the patient from coming to the clinic. Absolutely inexplicable, irrational fears of a banal spermogram can paralyze a seemingly stalwart man, the breadwinner of a family, a successful businessman. Often, such patients first seek advice of healers, shamans, miraculous sources, grandmothers, etc. And only then, having spent a lot of time and money for nothing, come to us. Why? But, they say, "artificial children", "frozen cells". In fact, it has been proven that the mental and physical development of such children is no different from normal, and more often it is better. After all, the best embryo is selected for transfer to the uterus, and, secondly, the so-called “diamond children” are very desirable and the parents care more about such children.
Patients are alarmed by the fact that pregnancy with IVF does not always occur during the first time (in the “Mother and Child” clinic, in a number of programs, the fertilization rate reaches 60% per embryo-transfer). People just do not know that when trying “natural conception” the chance to get a pregnancy for one ovulation (that is within a month) in a young healthy couple does not exceed 20%!
We can solve the problem of non-occurrence of pregnancy with the help of "Assisted Reproductive Technologies" or abbreviated ART. In fact, there is little room for creativity in our field. Creativity mainly lies in the interpretation of the method of treatment, in contact with the patient, in working with the individual characteristics of the couple. Everything else: manipulations, doses of drugs, medium for growing embryos, etc. – are technologized almost like a spaceship. Each action is verified by standards, long-term practices, as in the famous song: “step to the right, step to the left - shooting on the spot”. All stages, all actions worked out to the slightest nuances and clearly written in the protocols.
As far as I know, you worked in Europe, in a famous Danish clinic. How different are the methods and approaches in European clinics from the Ukrainian realities?
Yes, I have been to many European clinics. Internship in Denmark, with one of the leading experts, Peter Humaidan, with Professor Griesenger in Germany, in the London clinic, the cradle of ART, in Bornholl. And I can say that there are few differences in the approach to medical care. In western clinics – there are the highest technological level, consistency, careful quality control, very stringent standards of work. However, there are also disadvantages in this: pedantic adherence to standards, where doctors have schemes and algorithms for all cases, makes work with patients more “cold” than in Ukraine. For example, a doctor is not required to answer patient’s questions. There are special people with often secondary medical education for such purposes. And the doctor will not deal with the psychological support of the couple either. There is a psychologist who gets paid for this.
We have a different mentality. Our doctors work more creatively, with an individual approach to the patient. In fact, we read educational lectures to our patients, calm them down, prepare them for treatment. The initial consultation with a doctor can last an hour and a half in our clinic.
In Europe, this is impossible. There, the doctor only gets acquainted with the documents and tells what medical treatment should be.
Fast. Technologically. Well, and probably "soulless." You know the anecdote about how a veterinarian on the farm carries out the artificial insemination of cows. After completing the work, he tries to leave, but cows surround his car, do not allow to leave. When he begins to resent - they resent: “How about the talk?” I think the Europeans would not understand this story.
Yes, a very clear example. And what can be said about the technological level, when compared with European clinics?
In terms of technological level, we have already aligned with European clinics. A decade ago, we were far behind. But 95% of our reproductive medicine is private. Therefore, there are no problems with financing and reproductive medicine in Ukraine is actively developing.
Our clients spend significant funds and are waiting for the appropriate level of technology and service, the same level as in Europe. Therefore, the selection of a clinic and a fertility doctor can be compared with a serious investment. It's very simple - by investing wisely, the family hopes to get high emotional dividends and even, I am not afraid to say, financial.
Six years ago, I and a group of doctors of the clinic underwent training, adopted the most modern European technologies and transferred it to the Ukrainian “soil”, using Western standards when creating the “Mother and Child” clinic. In addition to technology and innovation, we have accumulated the best managerial experience, having introduced an effective management model in the clinic. For example, now 10 top managers are included in the collective management system of our clinic, decisions are made collectively. Together we make decisions that help us develop quickly and efficiently. And this is an important component of the success of the clinic “Mother and Child”, which three years ago was little known, and today it is a leader in Ukraine.
If a couple lives in a marriage and not using the contraceptives, but they still have no children, when should they go to a reproductive specialist?
In a year. By and large, there are only a few days in a year when a pregnancy can occur. However, if a year has passed, and the pregnancy has not come, it is an alarming signal and it is better to contact a specialist and get tested. Do not be shy and afraid, there are more than 8 million children born by the method of IVF in the world currently. For example, in Denmark - the world’s leader in the field of reproductive medicine, every tenth child was born as a result of an IVF program. This, by the way, is one of the possibilities to improve the demographic problem in Europe, where in many countries
IVF is actively supported by the state. Unfortunately, in our country the problem of infertility is not highlighted as the state priority; therefore, each case of overcoming infertility in the family is a small victory for each individual couple.
I am not saying that modern medicine guarantees the birth of a child to each family. There are problems that cannot be eliminated, there are diseases that cannot be cured, but it is possible to “get around”. Have the courage to find out all possible solutions to the problem of infertility. Will it change your life? The birth of a child is not a guarantee of comprehensive happiness, but, undoubtedly, a full-fledged family will add to your confidence, inspire new men's accomplishments, without which our civilization simply would not have survived.
The technique itself is more than 30 years old. The first child, Louise Brown, was born in Britain as a result of the IVF program in 1978. This woman successfully gave birth to a child in a natural way, thereby refuting the myth that eco-children cannot give birth in a natural way. After Louise Brown, many people conceived "in vitro" gave birth to beautiful healthy children as a result of natural conception.
The issue of infertility remains acute and relevant today, but, fortunately, modern medicine has an extensive arsenal of tools to defeat this disease. Reproductive technologies, which are improving every day, are becoming a true salvation.