Is Normal Always Normal?

What does “normal” really mean? Besides your grandmother, and maybe your parents, do you know anyone who is truly “normal?” There’s a list of normal Hollywood celebrities that includes Matt Damon, Johnny Depp and Jennifer Aniston, but are they really normal?
That famous, last-century psychoanalyst Sigmund Freud made a stab at defining normal: “Every normal person, in fact, is only normal on the average. His ego approximates to that of the psychotic in some part or other and to a greater or lesser extent.” Say what?

Normal Fertility?

When applied to fertility, the word normal is even more vague. Alexis and Gabriel are a couple that came to see me recently for fertility issues. Alexis is young, vibrant and in her early thirties. Gabriel is healthy as an ox and has had “normal” semen analyses for at least 3 straight years, well before they even started trying to conceive. As normal as any couple can be. Despite this, they are not parents yet. In fact, Alexis miscarried twice while trying to conceive at home and since then the couple failed three successive attempts at in vitro fertilization (IVF). You can follow their story on Alexis’s site or stay tuned to I saw the couple recently and was quite surprised to learn that, through all of their fertility care, Gabriel had never had a formal male evaluation. It was assumed that since his semen analysis was normal, his fertility was also normal. So why was I surprised? Ah, because normal isn’t always normal. Here are a couple of facts about the semen analysis:

  • Except for showing absolutely no sperm, the semen analysis is a terrible predictor of male fertility. As a fertility tool, it is a “blunt instrument.”
  • For years and until recently, “normal” semen quality was defined by “expert consensus” (i.e. knowledgeable professionals sitting around a table) and not by hard evidence.
  • Semen quality varies widely over time, even within an individual. A semen analysis is less similar to measuring blood glucose levels than it is to ordering stars in the sky.
  • A subset of men with “normal” semen analyses have subtle, occult functional sperm issues. It’s all about quality not quantity here. Sort of like the whole team showing up for the ballgame, but not playing very well on the field.

My evaluation of Gabe, soon to be revealed on The Doctors Show, was that his sperm might not be as healthy as previously thought. His sperm DNA is fragmented, he has a clinical varicocele and needs more antioxidants. Are these findings linked? Could be. Could these findings explain several years of infertility? You bet. Can they be helped? You bet. Can’t wait to see what happens…
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