Taking the Stigma Out of Fertility Tests

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News & Notes health expert Dr. Ivan Walks talks about blacks and fertility, plus a new do-it-yourself screening kit for men.


This is NEWS & NOTES. I'm Farai Chideya.

In this week's health segment, we look at men and fertility. How does a guy find out whether or not he's got a healthy sperm count? It used to mean a trip down to the fertility clinic. There you got a small canister and one of those magazines and a little private time in a room.

Now there's a new kid on the market that allows men to do their own tests at home. To find out more, we turn to our health expert, Dr. Ivan Walks.

Dr. IVAN WALKS (Chief Medical Officer, Washington D.C.): I think it's been difficult. It's not something that most men like to think about. There are a lot of those issues about being macho and being able to do whatever it is we want to do. But, it is a good question. A lot of the research shows that when couples are having issues with conception that the man is the problem and not necessarily the woman.

CHIDEYA: That hasn't been explored deeply. It's usually assumed that the woman is the problem. Now with women, there are all sorts of reasons for infertility. But certainly with age, women go through menopause and if you are pre-menopausal or peri-menopausal, you may not have the same fertility as you used to. What are the issues with men?

Dr. WALKS: Well, the issues with men tend to be quite, quite frankly that there are not enough sperm that are made, so that they can have a chance of getting all the way through the canal and getting to the act to fertilize it. And so it's sort of a numbers game literally.

And if you're not producing enough or if your sperm don't have appropriate motility, meaning they can't actually swim strongly and get to where they need to go. Those tend to be the issues.

CHIDEYA: Are there any health conditions that tend to be associated with these, you know, other health conditions that might contribute to it?

Dr. WALKS: Well, there are certainly a lot of health conditions that contribute to men being able to perform sexually. And so you have that as the beginning of the issue. Can you, in fact, perform in the activity that's needed to have conception, maybe(ph) the product?

And so if you have issues around diabetes, high blood pressure, those kinds of things can be an issue. And then unfortunately, the medications that you take if you have a chronic illness can sometimes make performance difficult, in particular, with men around hypertension. And then, with some of the mental health challenges in some of those medications, they can definitely have a problem so men cannot perform sexually.

CHIDEYA: So there is a new do-it-yourself test. What are we talking about here? Do-it-yourself test brings up, for me, images of some bad movie where the guy goes into the clinic and, you know, goes and sits around with some very blush-worthy magazines. I'm assuming that do-it-yourself is the same thing but at home?

Dr. WALKS: Well, it's one of the great things about having do-it-yourself at home is that you do avoid whatever sorts of public embarrassment there may be. And things have evolved over the years, so you, you know, privacy issues and those kinds of things have been addressed. But still, this is something that most men don't want to face and don't want to think about. And so being able to have at least an indicator in the privacy of your own home is a very positive step forward.

CHIDEYA: The kit that is the one that we're referencing foretell - actually, has a component for men and a component for women. Do you think that's a smart marketing move or a smart medical move or both?

Dr. WALKS: Well, I think - I would say both. I think that sort of the no-we're-in-this-together is certainly the way that we would want people to look at problems with conception or challenges with conception that it is two folks in there together. And so marketing it that way, I think, is positive.

However from a medical standpoint, the thing that I think is most exciting about this is that it gives you a chance to frame your questions. First of all, if you're going to use the product, you're going to go to the Web site, read about it. Learn about it. You're going to educate yourself on some of the potential challenges. And then, you come home and whatever your results are, you can take those results then with you and you can say when you go in to your doctor, this is what we did. This is what we think. And it can help guide that conversation and help people be more informed when they go to the doctor, which is always a good idea.

CHIDEYA: What would you say if - just playing devil's advocate - I say this is not a black person's thing, this is a white person's thing. You read about all these white career women who reached their genetic and biological wall and then they're all upset because they've spent their time working, but this is not a black people thing.

Dr. WALKS: No, this is definitely a black people thing. And we have to not pigeonhole ourselves into one kind of attitude, one kind of experience, one kind of lifestyle. More and more women are having children later of all different ethnic backgrounds. And that includes African-American women. And I've actually delivered a baby to a woman who had her first child when she was over 40. And I delivered her second child, and this was many, many years ago, and she was not a Caucasian woman. So I think that there may be a myth that, you know, only white folks do this and only black folks do that, but that is not indeed the case.

CHIDEYA: All right. Well, we'll certainly keep track of where this goes. But I want to switch gears in the time we have left. You, Dr. Walks, are going to be attending the NAACP's Annual Convention in Detroit. And one of the big issues on the table is America's health care system. You're going to be speaking at their health care forum. What do you want to get out there?

Dr. WALKS: Especially in light of all of the talk about health care, I've had a chance to attend the recent presidential forum where the Democratic candidates spoke and almost everyone talks about health care and about the expense of our health care system and the importance of good health policy going forward. I want to make sure that as we're talking about health policies of the country, that we don't forget health disparities and how important it is to not rush to a simple or simple-sounding answer for a very complex situation.

CHIDEYA: Now, there's a new documentary, Michael Moore, always controversial. His doc, "Sicko," tackles the issue. He says countries like France, Great Britain, even Cuba have better health care systems than us, the richest country in the world. You studied health care systems around the world, and what do you think of that assessment?

Dr. WALKS: Well, I actually have looked at some of the other systems and actually spent some time in England looking in depth at their system and talking some of the folks over there several years ago. And I think that different places do different things better. And if you look at some of the things that we do well here, when you look at the technological advances, the significant skill that we have in handling some of the tough things, that's one of the things that we do well here.

The other thing that we do here that is a little bit different is we allow people to try as hard as they can to remain alive for as long as they can. And that may not be the case in some other places where some of the medications, some of the treatment modalities that are available to extend life here may not be as readily available or just flat, may not be approved in other places.

So again, very simple-sounding answer - and I have actually seen Michael Moore's film and I think he makes a great effort in making his point. And he makes his point well. It's just not the only point that needs to be made. And clearly, it's a complex situation here and a lot of conversation needs to happen before we jump up and say, wow, that's the solution, let's do what they did over there.

CHIDEYA: Listening to you, it sounds like you think - and please correct me if I'm wrong - that the U.S. has some great advance medical care but doesn't always deal with simple things well.

Dr. WALKS: I think, that's a very good way of saying it, and I would not argue that. I think that health education is one of the simple things, not simple to do but very simple to understand the importance of. Preventive health is, again, very simple to understand the importance of and I think we could do those things a lot better.

We do a great job of taking care of you when you're sick. If you get sick, you want to get sick in America because we're going to - you're going to go to any emergency room, and if you're really very ill, they have to treat you by law and then find out later on if you can pay.

But if you want to stay healthy, we have a lot of challenge with making that a priority. And we need to do better and we can do better.

CHIDEYA: So when you have 40 to 50 million people who are uninsured in this country, more who are underinsured, those are the people who might not be able to get well care or be able to think ahead about their health.

Dr. WALKS: Well, and I think that you - we know, we talk about the 45 to 50 million people who are uninsured, there is probably another number, at least around 50 million or so, who are underinsured. And so you have a tremendous amount of opportunity for us to do better.

People that don't have insurance or don't have appropriate insurance sometimes can't get - not only the kind of general, you know, let's check your blood pressure and do a physical exam and see if you're okay, but also dental care, and then just the availability of the things that we need to stay healthy. For example, many communities across the country don't have grocery stores. Fresh produce is not available. Many children don't have breakfast in the morning, so they can't learn well at school. All - again, a very complicated set of circumstances that all need to be addressed.

CHIDEYA: Well, Dr. Ivan Walks, thank you so much.

Dr. WALKS: Good to be with you. Thank you.

CHIDEYA: Dr. Ivan Walks is chief executive officer of Ivan Walks and Associates and the former chief health officer of the District of Columbia. He joined us from our Washington, D.C. headquarters.

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