Brainstorm Health 2024: Advancing Male Reproductive Health
Khaled Kteily, Founder and CEO, Legacy Dr. Brian Levine, Founding Partner and Practice Director, CCRM Fertility of New York Pamela Pure, Co-founder and CEO, Posterity Health Dr. Neel Shah, Chief Medical Officer, Maven Clinic Moderator: Deena Shakir, General Partner, Lux Capital; Co-chair, Fortune Brainstorm Health
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00:00 Hello, everybody.
00:01 Welcome.
00:02 It's such a pleasure to see so many familiar faces here
00:05 and to meet some new ones.
00:07 And we're kicking it off today talking about everyone's
00:11 favorite topic, sex.
00:14 And even digging a level deeper, we're
00:16 going to talk about sperm.
00:17 So let's keep it spicy.
00:19 The topic today is actually on male reproductive health.
00:22 So often we think about fertility
00:24 as a woman's health problem.
00:26 But we know that it takes two to tango.
00:28 And among me on the stage today are some of the foremost
00:31 experts in the field.
00:33 So I want to start by kicking it off with Khaled over here
00:36 to my right, the founder of Legacy Health.
00:40 Are we experiencing a sperm-pocalypse?
00:44 Sperm-pocalypse is one way of putting it.
00:46 Spermageddon is another.
00:47 Sperm count zero is my preferred term of choice.
00:51 The reality is this.
00:52 Sperm counts have gone down by 50% to 60%
00:54 over the past 40 years.
00:56 That already in and of itself is cause for concern.
00:59 A meta-study came out, I believe, last year
01:01 showing that the decline in sperm counts
01:03 is actually accelerating and is now looking more like 26%
01:07 each decade versus 10% each decade over the past 40 or 50
01:11 years.
01:12 And so if you follow the trend, not only is it accelerating,
01:16 but it's very clearly moving towards sperm count zero.
01:19 And of course, we can't predict exactly what's
01:21 going to happen to sperm.
01:23 And the reality is in our industry,
01:25 we often say it only takes one.
01:27 So of the typically millions of sperm that are produced,
01:30 it only takes one, which you can usually
01:32 use for assisted reproduction.
01:34 So it's unlikely that we will become functionally infertile
01:37 as a species.
01:38 However, it is extremely possible
01:42 that we will be within a matter of just decades in a world
01:45 where we are unable to conceive naturally
01:47 and have to use assisted reproductive techniques.
01:51 Speaking of assisted reproductive techniques,
01:53 Dr. Brian Levine, who is a good friend and the founding
01:57 director of CCRM in New York, you live and breathe
02:00 fertility care.
02:02 How often do you hear patients coming in and asking
02:05 about male fertility?
02:06 Or is there still a perception that this
02:08 is a woman's health problem?
02:11 So the entry point of coming into a fertility clinic
02:14 typically is the female partner.
02:16 And we actually call the male partner the silent partner.
02:19 Because frequently, people think, OK, my friends
02:21 are having trouble getting pregnant.
02:22 Let's go check my blood work.
02:24 Let's go get an ultrasound.
02:25 And then everything looks great.
02:27 And they're like, we're perfect.
02:28 There's nothing wrong.
02:30 And it's only then when I say, well, look,
02:31 you've got to get your boyfriend or your partner
02:33 or your husband to come in and get them checked.
02:35 And the question is always, why?
02:37 And what we have is an education problem here.
02:39 People actually don't understand that 1/3 of the time,
02:42 it's a female problem.
02:44 1/3 of the time, it's a male problem.
02:46 And 1/3 of the time, it's combined together.
02:48 And one of the issues that we've seen actually after the pandemic
02:51 because so many people now access their fertility
02:53 doctors through telemedicine, where you'll
02:56 have the male partner on the screen,
02:57 but then getting the male partner to come into the clinic
02:59 to get testing is a problem, which
03:01 is why legacy is such a big deal.
03:03 Because we're actually able to get people at home testing.
03:05 And we're identifying even earlier
03:06 that people have fertility problems on the male side.
03:10 So once a family gets pregnant, they go and see their OB/GYN.
03:15 So Dr. Neil Shaw, who is not only a leading OB/GYN,
03:18 but also the chief medical officer of Maven Clinic,
03:21 who in full disclosure, I am on the board of.
03:23 So don't mess up, Neil.
03:26 Maven Clinic is known for women's health.
03:28 Why the interest in male fertility?
03:31 Thanks for the question.
03:32 So first of all, I think this is not how it should be.
03:34 But it is how it is.
03:36 Male fertility has become a women's health issue
03:40 for all the reasons that we've been talking about.
03:42 Men are the silent partner, but they're
03:44 half of the diagnostic equation.
03:46 And usually, women have to carry the treatment burden.
03:49 But I'm really coming at this as both a man and as a feminist.
03:53 And there's not a shred of doubt in my mind
03:55 that women are suffering disproportionately
03:59 and made vulnerable by a system that's
04:00 not designed for their needs.
04:02 And also, men deserve a lot more of our empathy
04:05 than they're getting.
04:06 Men don't engage with primary care.
04:07 They don't engage with mental health care.
04:09 They definitely don't engage with reproductive health care.
04:11 We talk about sex, Dina, but we don't talk about fertility.
04:14 And we live 5 and 1/2 years less long.
04:19 And I think the reason is, as an OB/GYN,
04:21 I've been thinking about this.
04:22 Women have a cyclical event every month
04:24 that's tied to their fertility and actually tied
04:27 to their overall wellness.
04:28 And so if a woman has an abnormal period,
04:31 that could be a signal to go see a doctor.
04:33 But men have no equivalent check engine light.
04:36 And I actually think one of the most important opportunities
04:38 we have to improve not just men's health or women's health,
04:41 but population health, is to figure out
04:43 how to engage men better.
04:45 And I think there are good ways of doing this
04:47 and very bad ways of doing this.
04:48 So I'm hoping that we're going to get into that a little bit.
04:50 - Absolutely.
04:51 Pam, as the woman on the men's fertility panel,
04:54 tell us a little bit about the work
04:55 that you lead at Posterity.
04:57 - Yeah, so thanks for having me.
05:00 We're really focused on making it easy for males
05:03 to seek treatment and get the support that they need
05:07 if there is a male factor involved.
05:09 I think one of the big things we are working
05:12 with this team on is awareness,
05:14 because it starts with the testing.
05:16 And we want to make sure that when males
05:19 do have an abnormal semen analysis or a fertility issue,
05:23 it's comfortable and it's easy to see a very scarce group
05:27 of reproductive urologists.
05:30 I think many people don't understand that 50% of the time,
05:34 there is a male factor issue.
05:36 And in most cases, sperm quality can be improved.
05:40 So we want the male to feel like they're part
05:43 of the reproductive journey,
05:45 and that it is a couple's journey.
05:48 - And audience, we will be turning in a few minutes
05:50 to you for questions.
05:51 So start thinking through them,
05:53 and we'll have folks coming around with mics.
05:55 But in the meantime, I want to double click
05:57 on this question of sort of the cultural stigma and bias.
06:01 And Khaled, this is something that I know you,
06:03 in the early days, really focused on breaking.
06:06 And you've now made extraordinary breakthrough
06:08 partnerships with groups, including the VA.
06:11 You've brought some celebrities on board.
06:12 Tell us how you went about making sure
06:15 that you could actually reach men and have their ears.
06:19 - Thank you, it's a phenomenal question.
06:21 When it comes to sperm, I mean, your sperm,
06:24 for someone who has it, is in many ways
06:27 how you define your virility,
06:29 your, potentially, your masculinity, right?
06:32 And so how do you approach a topic
06:33 where you're telling people,
06:34 "Hey, have you thought about testing your sperm?
06:38 "Have you considered whether you are fertile,
06:39 "sub-fertile, or potentially infertile?
06:42 "Have you thought about what this might mean
06:43 "for your future desire to have a child?"
06:46 Now, I want to take you all back a few years
06:49 to when I'm in Coronado, California,
06:51 and I am presenting to the Navy SEALs about their sperm.
06:55 Please imagine the room of 50 freshly graduated Navy SEALs,
06:59 any one of whom could have snapped me over their knee
07:02 in any moment.
07:03 And I'm sitting there, and you can imagine
07:04 the kind of jokes that are coming out of that, right?
07:07 "You're telling me to do what with my jizz?"
07:09 Right?
07:10 "You're telling me to do what, where?"
07:12 Right, but by the end of that conversation,
07:14 they realize that sperm was not just something
07:15 for them to joke about.
07:17 And what we often say is that sperm is funny
07:19 until it's not.
07:21 And so in this world, you have to approach sperm
07:23 from a clinical perspective,
07:25 make it clear that it's serious,
07:26 and what you will learn very quickly
07:28 is that someone will match your tone.
07:30 If you're going in there
07:31 and you're cracking jokes about sperm,
07:32 believe me, there is nothing more
07:33 that any man wants to do more
07:35 than make jokes right back at you.
07:37 But if you go in there and you're talking about sperm
07:39 in a serious way, as a serious topic,
07:41 they will match your tone, and that's true
07:43 for a couple that's struggling to conceive,
07:45 just as it is true for a Navy SEAL
07:47 or a man in the military,
07:48 people who you would typically think of as being
07:50 kind of the quote-unquote very masculine folks
07:53 who don't want to talk about more serious healthcare topics.
07:55 And so all that to say,
07:57 when it comes to the way that you approach this topic,
07:59 the branding of the topic, of a topic like sperm,
08:02 you have to come at it in a way
08:03 that is approachable for someone who's in the military
08:07 in a very serious and masculine way,
08:08 but also approachable for someone
08:10 who's struggling to conceive,
08:11 where there's a lot of anxiety and mental health
08:13 that goes into that as well.
08:14 - Absolutely.
08:15 I want to talk a little bit about the role of technology,
08:17 and we talked a little bit
08:18 about assisted reproductive technologies,
08:20 but in a problem that is very much biologic,
08:24 there are also some interesting
08:25 deep technology applications that are out there,
08:27 and from telemedicine to AI-assisted IVF.
08:32 What are some of the technologies
08:33 that you are most excited about?
08:35 Perhaps I'll start with you, Pam.
08:37 - Yeah, I think we're starting with the basics,
08:40 which is creating a digital patient experience,
08:43 so males can, from home, not only get tested,
08:47 but have their first encounter with a specialist,
08:50 making it a very convenient experience,
08:53 and really being able to automate the whole process,
08:57 making it easy for them to stay compliant.
09:00 We're doing some early work with AI
09:03 to really trying to understand who are these people,
09:06 and how can we help them, how can we find them proactively,
09:10 and what type of issues can we attack,
09:13 really at the fundamental level, to start changing things.
09:17 You know, crazy things, 10% of our patients
09:20 are on testosterone, which stops sperm production,
09:23 so can we find those patients?
09:25 40% of our patients have hormone deficiencies.
09:29 Can we find those patients?
09:31 And using AI to get that data
09:33 allows us to really help people proactively.
09:37 - Brian, you're pitched all sorts of technologies
09:39 at your clinic.
09:40 How do you separate the wheat from the chaff?
09:43 - So I ask about the utility, and actual function.
09:45 So back to sperm, what a lot of people don't realize
09:48 is that the world's smallest surgery,
09:50 and you can all go home and tell your friends this,
09:53 is actually injecting a single sperm inside a single egg.
09:56 So the sperm is the smallest cell in the human body,
09:58 the egg is the largest cell in the human body,
10:00 and something called ICSI,
10:02 or intracytoplasmic sperm injection,
10:03 where we inject a single sperm inside a single egg,
10:06 world's smallest surgery.
10:08 Done by embryologists who are scientists,
10:10 but there's a problem.
10:11 We grade that sperm morphologically,
10:14 or by vision, on how pretty they are.
10:16 But pretty sperm does not mean pretty DNA.
10:19 And so when people pitch me on their technology
10:21 of doing better ICSI, or doing better fertilization,
10:23 I say, well, is that a better baby?
10:25 What is the outcome of measure here?
10:27 And I think that's what we have to look at right now,
10:29 is we're looking at all these different technologies,
10:31 and all the things that we're looking to invest in,
10:32 or deploy in our own clinics.
10:34 And to me, if someone can say to me that
10:36 if a woman only has a finite number of eggs,
10:38 and a man's gonna produce millions of sperm,
10:41 how do we identify the right sperm
10:43 so that I don't waste her eggs?
10:45 And that's what I'm hoping for, to find one day.
10:48 - Yeah.
10:49 Before we turn to the audience for questions,
10:51 Neil, I wanna talk a little bit about health equity
10:53 in the context of male health and male fertility.
10:56 And you and I have spent a lot of time talking about
10:59 the black maternal health crisis,
11:00 and how women of color in this country
11:02 are three to four times more likely to die in childbirth.
11:05 But even less discussed is the impact
11:08 of underrepresented communities
11:10 in the context of male fertility.
11:12 Can you share a bit about your perspective on that?
11:15 - Yeah, sure.
11:15 I mean, I think, so at Maven Clinic,
11:19 we don't have a waiting room.
11:21 Like, I don't have a captive audience.
11:23 So I earn the opportunity to make people healthier
11:25 by engaging them in the right way.
11:27 And I think something that Legacy has proved out
11:30 is men are very interested in their sperm.
11:32 You know, you don't,
11:34 pretty much since we invented the 300X zoom lens,
11:39 the first microscope, we've been looking at sperm.
11:41 And it turns out sperm is very, very sensitive
11:45 to almost everything that we care about.
11:48 So if you think about what we put women through
11:49 for pap smears and mammograms,
11:52 sperm is a pretty decent screener for testicular cancer
11:55 and prostate cancer.
11:56 It's not perfect, but neither is a pap smear.
11:58 It's very sensitive to metabolic health.
12:01 You know, I'm an Indian man,
12:03 so I'll probably be on statins in a couple of years.
12:06 But when I look at my cholesterol,
12:09 it's just letters and numbers.
12:12 It turns out, it takes six months of changing my diet
12:15 to see an impact there.
12:17 But sperm, you know, I ended up quoting somebody
12:21 in a deep dive that we did recently into sperm
12:23 who said that their sperm went from being a graveyard
12:26 to a rave based on changing their diet.
12:29 And it turns out we actually do have a monthly event.
12:31 We generate sperm every month.
12:33 And within a month of changing your diet,
12:35 you can see that improvement.
12:36 And potentially, as Pam was saying, avoid all that IVF.
12:40 The way this ties back to health equity
12:41 is that almost every condition in public health,
12:46 we see massive disparities along geographic lines,
12:49 along racial lines, and all of these things are sensitive
12:52 to fertility and sperm.
12:54 So I actually think every man
12:56 should probably get a semen analysis.
12:59 Not just, and now especially,
13:00 'cause we have the technology to do it at home,
13:02 preferably with a human being to help interpret it,
13:06 then ideally to connect them to primary care.
13:08 - All right, I promised audience engagement,
13:11 so we'll start with the first question.
13:13 And it looks like we've got one over here from Nick.
13:15 - Hey there, Dina.
13:16 Hey there, I'm Nick St. Fleur.
13:18 I'm with STAT.
13:19 So my question for you all is kind of
13:21 what is the big why behind sperm again?
13:24 There was an earlier session where one of the panelists,
13:28 Dr. Jane Van Des, was talking a bit about
13:30 a study where they found microplastics
13:32 in the testes of men.
13:34 What exactly does that mean in this conversation?
13:37 And also, as a young guy who's considering having kids,
13:42 what can I do to, I don't know,
13:44 take better care of my sperm?
13:45 - Who wants to take that one, Khalid?
13:47 - Oh, I would love to.
13:49 First of all, young, good-looking man,
13:50 freeze your sperm, my friend.
13:51 Freeze it right away.
13:54 Look, I have theories from the conspiratorial
13:57 all the way to the more science-backed.
13:58 I'll start with the more science-backed,
14:00 which is the level of chemicals, phthalates, BPAs,
14:04 forever chemicals in our bloodstream is terrifying.
14:08 The FDA found that every single American
14:10 has a measurable level of phthalates in their bloodstream.
14:15 A study that came out, I think, today or yesterday,
14:17 found in a study of 50 men's testicles,
14:20 every single one of them had forever chemicals
14:23 that is in their testicles, in their bloodstream.
14:25 This to me is terrifying, and from my perspective,
14:28 having been in the field for some time now,
14:30 is the main reason why sperm counts are on the decline,
14:33 why testosterone levels are on the decline.
14:35 It's very likely that chemicals
14:36 are actually causing all of this,
14:37 and the regulatory landscape is so far behind
14:41 where it needs to be.
14:42 - So what can folks like Nick do?
14:44 - So I'll tell you from a very biased perspective,
14:46 'cause I run a company that does sperm testing
14:48 and sperm freezing, and we let you do it from home.
14:50 I'll tell you what I did when I was 26, I froze my sperm.
14:53 I tested it, I froze it, that is the best semen sample
14:57 that I have ever produced.
14:58 I am probably the most unhinged person ever,
15:00 because on LinkedIn a few weeks ago,
15:01 I actually posted my semen analysis results over time,
15:06 and you can actually see, first of all,
15:08 the overall quality declines over time.
15:10 Second of all, when we're fundraising,
15:11 my semen analysis scores plummet.
15:14 (laughing)
15:16 - It's very sensitive.
15:17 (laughing)
15:18 - But a couple months after we're done,
15:20 where I'm on the beach, you know, in south of France,
15:23 they shoot right back up, and it's testament,
15:25 first of all, to the fact that the older you get,
15:27 the more your sperm quality declines,
15:29 the more DNA damage in your sperm accumulates,
15:32 the more likely you are to have an unhealthy pregnancy,
15:34 a child born with congenital conditions.
15:36 You don't want any of that, especially in a world
15:39 where chemicals are making us all infertile.
15:41 So what I would say is freeze your sperm now
15:44 while you're young, good looking, and healthy.
15:45 - There you go.
15:46 So Nick, me and Kyle have a little bit
15:48 of a difference of opinion here.
15:49 So I don't know if I subscribe
15:52 to the sperm count zero hypothesis.
15:54 I am worried about the environment,
15:55 I am worried about toxins, and it's definitely clear
15:58 from the evidence that toxins have an impact on fertility.
16:01 What we're seeing, though, across the world
16:03 is that fertility rates are declining, right?
16:05 And we're all reading about that.
16:06 And my personal take is that it's a sociological phenomenon
16:09 as much as it's a biological one.
16:11 And it's something that we're gonna have
16:13 to contend with on multiple levels.
16:15 I think fundamentally where Kyle and I agree for sure
16:18 is that every man deserves a semen analysis,
16:21 probably on a regular basis to have a better understanding
16:24 of their health picture.
16:25 And probably what you'll find is that your sperm
16:27 is more sensitive to being in the south of France
16:30 versus being in a fundraise than necessarily the environment.
16:33 But those things really matter during the moment
16:35 where certainly you wanna build a family,
16:38 but probably they matter in terms of the long term
16:40 of your health because probably from your semen analysis,
16:43 we can figure out are you on the pathway
16:45 towards developing diabetes?
16:46 Are there other sort of things going on in your environment
16:49 that we can correct for to make you a healthier person?
16:53 - And I would add there are tremendous lifestyle
16:55 and behavioral changes that we all can make
16:58 that impact semen analysis results in overall health.
17:03 Diet, obesity, smoking, marijuana, all of those things
17:09 have a dramatic impact on sperm production
17:13 and sperm quality.
17:14 So there are things we can take on ourselves.
17:18 Yes.
17:19 - Hi, Sarita Finney with Bayer Consumer Health
17:24 and at the risk of TMI as someone who didn't make her babies
17:27 the old fashioned way.
17:29 I salute you innovators.
17:30 So on one hand, you've got spermageddon
17:35 and sperm count zero.
17:37 And on the other hand, you've got a political environment
17:40 that's attacking assisted reproductive technologies.
17:43 So what role does public policy have?
17:47 How are you looking to shape it?
17:48 Any comment on that?
17:49 - That's a great question.
17:51 - I'll go straight to Neil.
17:52 (laughing)
17:55 - So I don't think actually the political system
17:58 is attacking assisted reproductive technology.
18:01 One of the fastest political about faces I've ever seen
18:04 was probably in Alabama took two weeks.
18:07 That being said, what I am concerned about politically
18:10 and this goes back to how we engage men in their health,
18:12 which is I think probably the most important conversation
18:14 for us to have.
18:15 There are many aspects of male identity that are online.
18:20 One of them that's quite popular,
18:23 pegs declining fertility to the feminization of men.
18:27 There is networked misogyny out there.
18:30 And I think all of us who are interested in supporting men
18:33 and improving fertility have to be very mindful
18:35 because I think actually, Sean Duffy put this very well
18:38 on the first panel.
18:40 In order to support people, you have to meet them
18:43 at their truth and then connect that to something
18:45 that can help them.
18:46 And nobody is a monolith.
18:48 They have multiple truths.
18:50 But one of the things I'm very worried about
18:52 is this weird intersection of politics and fertility,
18:55 especially as fertility rates are going down
18:58 and it becomes increasingly a global political issue.
19:01 - Yes.
19:04 - Harvey Karp, happiest baby.
19:09 - This issue of unexpected intersections,
19:14 I think is really important.
19:15 And men, of course, there's a lot of thinking
19:18 about your testes and your sperm,
19:21 but there's another connection between the sperm
19:23 and the brain, which as a pediatrician is concerning.
19:27 And I think as we're thinking broadly about healthcare,
19:29 and that is the increase in neurological disorders
19:32 in young children.
19:33 We've seen the number of children
19:35 with autistic spectrum disorder go up and up every year.
19:37 It's about one in 26 boys.
19:40 Now it used to be one in 100, before that one in 500,
19:42 before that one in 1,000.
19:44 And the reason I'm just bringing this up for conversation
19:46 is that the phthalates and chemicals like that,
19:50 which are endocrine disrupting chemicals,
19:52 are primarily estrogenic, which may have
19:56 some inhibitory effect on sperm and testicles.
19:59 But in the CNS of a developing baby,
20:02 they have an androgenic effect.
20:04 And so they may indeed be accelerating attention deficit
20:07 or autism, which are primarily male disorders.
20:11 So just as we're thinking broadly about it,
20:13 it really becomes much more compelling
20:15 besides freezing sperm, but really trying
20:18 to reduce the poisoning of our population.
20:20 - Go ahead, Colin.
20:22 - I'd love to comment on that, and thank you for the note.
20:24 One thing we don't talk enough about is,
20:26 not only first of all, we talk about fertility
20:28 as a women's issue, which is a point of view
20:30 that is outdated and is wrong, to Brian's earlier point,
20:33 but actually we don't talk enough
20:34 about advanced paternal age, and that's older dads.
20:37 And when you look at the stats around just how much
20:39 DNA damage accumulates in your sperm as you get older,
20:42 and the kind of negative outcomes that has,
20:44 both on the pregnancy as well as on the partner,
20:46 as well as on the child, that's everything
20:48 from gestational diabetes risk to the carrying partner,
20:52 all the way through to a number of congenital conditions,
20:54 autism spectrum disorder being one,
20:56 bipolar disorder being another.
20:57 I mean, the list is actually quite long.
20:59 My personal theory is that part of the reason
21:02 for the rise in rates of things
21:04 like autism spectrum disorder is actually
21:06 that we have older dads, to Neil's earlier point
21:09 around how we're just having kids later in life,
21:11 and in fact, one of the biggest challenges
21:13 we face in the world of male fertility
21:15 is that celebrities are having kids
21:17 much, much later in life.
21:18 I mean, Robert De Niro, I think, just popped one out.
21:21 I mean, well, his partner did, but you know what I mean.
21:24 Right, and I think he was 79,
21:26 but what actually gets grossly underreported
21:29 is just how many older celebrities
21:31 who are having kids at an older age
21:33 actually have children born
21:35 with these types of congenital conditions.
21:36 So I think it's widely underreported,
21:39 underdiscussed, and understudied
21:40 is older dads in advanced maternal age.
21:43 - We have about a minute left,
21:44 so Brian, maybe a final comment.
21:45 - So I was gonna say, there's one other thing
21:47 we don't talk about, which is what happens
21:48 when you have bad sperm?
21:50 So we actually have a shortage of sperm donors
21:52 in this country that we actually do not discuss.
21:55 So for single mothers by choice
21:56 or couples that have profound male infertility
21:59 where you actually cannot surgically extract sperm
22:01 or induce sperm to be formed through hormonal therapies,
22:04 we actually have a shortage.
22:04 So we actually only have about 1,200 active sperm donors
22:07 in the entire country of America right now.
22:09 - Wow.
22:10 - So if you wanna go find a black donor
22:12 or a Jewish donor or a Middle Eastern donor
22:14 or an Indian donor, good luck,
22:16 'cause there's less than five of each of those today
22:17 commercially in the banks that are available.
22:20 And what that means in plain English
22:22 is that we need to work on our sperm health
22:24 because we actually don't have a life raft
22:26 to help other people find a viable sperm source
22:28 for the baby that they hope to have.
22:31 - All right, well, this brings us to the end of our session.
22:33 I wanna thank my panelists and thank all of you.
22:36 (audience applauding)
22:39 [BLANK_AUDIO]