Paul J. Turek

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Paul Turek
Dr paul turek 2009.jpg
Paul Turek in 2009
Born (1960-07-08) July 8, 1960 (age 64)
Manchester, Connecticut, USA
Alma mater Yale College, New Haven, CT
Occupation(s) Physician, TV Personality and Medical Expert on Men's Reproductive Health
Known for FNA Mapping, Men's Fertility Research, and Male Reproductive Health
Scientific career
Institutions Men's Reproductive Health Clinical Research Center
The Turek Clinic
Website http://www.theturekclinic.com

Dr. Paul J Turek (born July 8, 1960, Manchester, Connecticut) is an American physician and surgeon, men's reproductive health specialist, and businessman. [1] Turek is a recent recipient of a National Institutes of Health (NIH) grant for research designed to help infertile men become fathers using stem cells. [2] [3] [4] [5]

Contents

Early life

Turek was born in Manchester, Connecticut, to immigrant parents. His mother was the administrative secretary in the Manchester public school system, while his father was a sheet metal mechanic and welder. He attended Manchester High School and graduated salutatorian in 1978.[ citation needed ]

Education and Training

At Yale College he graduated summa cum laude, Phi Beta Kappa, received the Henry J. Belknap Prize in the Biological Sciences, and co-authored several scientific publications from work in the laboratory of Dr. Robert Handschumacher in the Department of Pharmacology at the Yale School of Medicine. While at Stanford Medical School, he participated in immunology research and developed an interest in the surgical discipline of urology. He pursued his internship and residency training in urology at the Hospital of the University of Pennsylvania. During this time, he developed an interest in urologic microsurgery and reproductive medicine and soon after pursued fellowship training in microsurgery and male reproductive medicine under the guidance of Dr. Larry Lipshultz at Baylor College of Medicine in Houston, Texas. After completing his fellowship, he was recruited to the faculty of the University of California San Francisco (UCSF).

Medical background

Turek is a board-certified urologist and microsurgeon, specializing in male fertility. He has performed and published research in men's reproductive health issues including genetic infertility, ejaculatory duct obstruction, immunologic infertility, quality of life issues with infertility, testis cancer and stem cell science, and has developed several techniques for evaluating and treating male infertility. While at UCSF, he was Director of the Male Reproductive Clinical Laboratory, Program Leader of PROGENI (The Program in the Genetics of Infertility), Director of the UCSF Men's Reproductive Health Clinic and Research Program, and the director of a National Institutes of Health grant to train new faculty in men's reproductive health. He has authored more than 175 publications on clinical and scientific issues in reproductive health. Through his published work, he is a proponent of the theory that male infertility is an early marker for other diseases that occur later in life. He became a full professor, with an endowed chair in teaching funded by the Academy at UCSF, a chair he later abandoned in favor of starting his own private clinic. [6]

He is now Director of The Turek Clinics, medical centers in California that specialize exclusively in men's reproductive health care. He was President in 2011 of the American Society of Andrology and the Society of Male Reproduction and Urology in 2013.

Research and inventions

Turek has designed and led in numerous key research programs, as well as inventing several procedures, that have had significant impact on the science of men's reproductive health. Turek is an advocate for men's general health, and speaks about on the topic on television and at companies such as Google. [7] [8] He is on the medical advisory board for Fertile Hope, a LIVESTRONG Foundation initiative. [9]

FNA Mapping

Turek is the inventor of Fine Needle Aspiration (FNA) Mapping, also known less formally as sperm mapping, testicular cartography, or "GPS for the testis." FNA Mapping is a non-invasive office procedure that can be performed in a standardized, template fashion to identify men who qualify for, and assist in the planning of, sperm retrieval for IVF-ICSI. [10] This technique has been important because it has improved identification of men who are likely to have a successful sperm retrieval while at the same time avoiding costly and unnecessary assisted reproductive techniques. FNA Mapping has become a fundamental procedure in the profession and has been adopted at most reproductive centers around the world. [11]

The success of assisted reproductive techniques such as intracytoplasmic sperm injection (ICSI) encouraged reproductive clinicians to look beyond the ejaculate and into the male reproductive tract to find sperm. In men with no sperm count (azoospermia), it soon became clear that sperm could be found in the testes and used with ICSI, but sperm production was characteristically "patchy" or "focal" in azoospermic testes. FNA Mapping was designed to diagnose the degree of "patchiness" of sperm production in azoospermic men and determine, among other things, whether a sperm retrieval would succeed in a specific patient. [12] Prior to FNA Mapping, testis biopsy was the major procedure for determining the quality of sperm presence. Testis biopsy is a more invasive procedure than FNA Mapping, and studies have shown that FNA Mapping provides better and more complete information about sperm presence. [13]

In addition, FNA Mapping has been used to determine the effectiveness of mapping in patients after sterilizing chemotherapy, [14] the ability to find and diagnose small testis tumors, [15] and the ability of mapping to precisely define subsets of infertile men for more accurate phenotyping for molecular biology and genetic studies., [16] [17]

Ejaculatory duct obstruction and ejaculatory duct mamometry

In a series of papers, Turek and his team made a significant advancement in the diagnosis of ejaculatory duct obstruction (EDO) as a cause of male infertility by studying and investigating the approach and limitations of current treatments for this condition., [18] [19] This led to a prospective, comparative study of currently used techniques to diagnosis EDO [20] followed by the invention and publication of a dynamic, physiologically relevant test, termed ejaculatory duct manometry, to definitively diagnose this surgical condition. [21]

Evolving the hypoosmotic swelling test

The Hypoosmotic Swelling Test is a laboratory test to measure the functional integrity of the human sperm membrane. In this test, the sperm is exposed to a hypososmotic solution consisting of a 50:50 mixture of 150 mosmol fructose and 150 mosmol sodium citrate. The tails of normal sperm will swell when exposed to this solution, whereas damaged sperm with low motility will not swell measurably.

Although a moving or motile sperm was traditionally required for use with this technique, some infertile men have genetically immotile sperm and are unable to take advantage of this technology to become fathers. [22] In early research in this area, Turek tried to understand more about how sperm "viability" relates to "motility." [23] Subsequently, his team evolved the Hypoosmotic Swelling Test into a therapeutic tool that harmlessly and physiologically "pokes" a non-moving sperm to determine whether it is alive and therefore able to be used for ICSI. [24] This technique was subsequently applied to men with genetically immotile sperm with success [25] and this technique is now used routinely in many reproductive centers worldwide.

New approach to genetic testing for male infertility

Concerned about the risk of transmitting genetic male infertility or other genetic issues to offspring with the use of modern assisted reproductive techniques such as ICSI, Turek founded a unique, trademarked program called PROGENI (Program in the Genetics of Infertility) at the University of California San Francisco. PROGENI's methodology is based on the classic genetic counseling philosophy that advocates non-prescriptive testing for genetic disease (an approach which is based on informing the patient of risks and then letting the patient decide whether he will undergo testing to delineate risk). Turek has published over a dozen papers on improved patient outcomes and decision making from over 800 patients that have entered the program since inception., [26] [27]

Using testis stem cells to create embryonic stem cells

The debate about the use of embryonic stem cells for research has been loud, acrimonious, and highly politicized with the result that embryonic stem cells were effectively banned for research uses in the United States. To solve the problem of limited embryonic stem cell availability, Turek and his colleagues invented a process by which the early germline stem cells from the normal adult testis, called spermatogonia, can be coaxed into becoming true, embryonic-like stem cells when placed in an appropriate culture environment. [28] This finding has been independently confirmed by other research groups in the world and opens up the possibility of making embryonic stem cells for regenerative, cell-based therapy for men in the future without the need for embryos and all of the political and ethical issues that the use of human embryos engender.

Identifying lifestyle issues which affect male infertility

Throughout his career, Turek has been interested in defining common exposures that may lead to male infertility. He has published studies on the effects of hot baths [29] and anabolic steroids [30] on male infertility and opined about the boxer-brief controversy [31] and the ability of the standard male infertility evaluation to detect toxic insults. [32] He has examined the toxic effect of medications such as the antioxidant selenium [33] and the anti-inflammatory drug class called biological response modifiers on male fertility. [34] He has also tried to better delineate the reproductive and general health risks posed by a common birth defect in boys, the undescended testicle., [35] [36] [37]

Academic honors and awards

Turek has receive numerous honors throughout his career, including the Henry Weyrauch Award from the Western Urologic Forum and James L Goebel Grand Prize from the American Urological Association. Other organizations that have recognized his work include the Philadedelphia Urological Society, the American College of Surgeons, the American Society for Reproductive Medicine, and the Academy of Medical Educators.

Related Research Articles

<span class="mw-page-title-main">Testicle</span> Internal organ in the male reproductive system

A testicle or testis is the gonad in all male bilaterians, including humans, and is homologous to the ovary in females. Its primary functions are the production of sperm and the secretion of androgens, primarily testosterone.

<span class="mw-page-title-main">Intracytoplasmic sperm injection</span> In vitro fertilization procedure

Intracytoplasmic sperm injection is an in vitro fertilization (IVF) procedure in which a single sperm cell is injected directly into the cytoplasm of an egg. This technique is used in order to prepare the gametes for the obtention of embryos that may be transferred to a maternal uterus. With this method, the acrosome reaction is skipped.

<span class="mw-page-title-main">Ejaculatory duct</span> Male anatomical structures

The ejaculatory ducts are paired structures in the male reproductive system. Each ejaculatory duct is formed by the union of the vas deferens with the duct of the seminal vesicle. They pass through the prostate, and open into the urethra above the seminal colliculus. During ejaculation, semen passes through the prostate gland, enters the urethra and exits the body via the urinary meatus.

<span class="mw-page-title-main">Male reproductive system</span> Reproductive system of the human male

The male reproductive system consists of a number of sex organs that play a role in the process of human reproduction. These organs are located on the outside of the body, and within the pelvis.

<span class="mw-page-title-main">Spermatogonium</span> Undifferentiated male germ cell

A spermatogonium is an undifferentiated male germ cell. Spermatogonia undergo spermatogenesis to form mature spermatozoa in the seminiferous tubules of the testicles.

<span class="mw-page-title-main">Azoospermia</span> Medical condition of a man whose semen contains no sperm

Azoospermia is the medical condition of a man whose semen contains no sperm. It is associated with male infertility, but many forms are amenable to medical treatment. In humans, azoospermia affects about 1% of the male population and may be seen in up to 20% of male infertility situations in Canada.

Terms oligospermia, oligozoospermia, and low sperm count refer to semen with a low concentration of sperm and is a common finding in male infertility. Often semen with a decreased sperm concentration may also show significant abnormalities in sperm morphology and motility. There has been interest in replacing the descriptive terms used in semen analysis with more quantitative information.

Aspermia is the complete lack of semen with ejaculation. It is associated with infertility.

Hypospermia is a condition in which a man has an unusually low ejaculate volume, less than 1.5 mL. It is the opposite of hyperspermia, which is a semen volume of more than 5.5 mL. It should not be confused with oligospermia, which means low sperm count. Normal ejaculate when a man is not drained from prior sex and is suitably aroused is around 1.5–6 mL, although this varies greatly with mood, physical condition, and sexual activity. Of this, around 1% by volume is sperm cells. The U.S.-based National Institutes of Health defines hypospermia as a semen volume lower than 2 mL on at least two semen analyses.

Male infertility refers to a sexually mature male's inability to impregnate a fertile female. In humans, it accounts for 40–50% of infertility. It affects approximately 7% of all men. Male infertility is commonly due to deficiencies in the semen, and semen quality is used as a surrogate measure of male fecundity. More recently, advance sperm analyses that examine intracellular sperm components are being developed.

Spermatogenesis arrest is known as the interruption of germinal cells of specific cellular type, which elicits an altered spermatozoa formation. Spermatogenic arrest is usually due to genetic factors resulting in irreversible azoospermia. However some cases may be consecutive to hormonal, thermic, or toxic factors and may be reversible either spontaneously or after a specific treatment. Spermatogenic arrest results in either oligospermia or azoospermia in men. It is quite a difficult condition to proactively diagnose as it tends to affect those who have normal testicular volumes; a diagnosis can be made however through a testicular biopsy.

<span class="mw-page-title-main">Testicular sperm extraction</span> Surgical procedure

Testicular sperm extraction (TESE) is a surgical procedure in which a small portion of tissue is removed from the testicle and any viable sperm cells from that tissue are extracted for use in further procedures, most commonly intracytoplasmic sperm injection (ICSI) as part of in vitro fertilisation (IVF). TESE is often recommended to patients who cannot produce sperm by ejaculation due to azoospermia.

Azoospermia factor (AZF) is one of several proteins or their genes, which are coded from the AZF region on the human male Y chromosome. Deletions in this region are associated with inability to produce sperm. Subregions within the AZF region are AZFa, AZFb and AZFc. AZF microdeletions are one of the major causes of male infertility for azoospermia and severe oligozoospermia males. AZF is the term used by the HUGO Gene Nomenclature Committee.

<span class="mw-page-title-main">Sertoli cell-only syndrome</span> Medical condition

Sertoli cell-only syndrome (SCOS), also known as germ cell aplasia, is defined by azoospermia where the testicular seminiferous tubules are lined solely with sertoli cells. Sertoli cells contribute to the formation of the blood-testis barrier and aid in sperm generation. These cells respond to follicle-stimulating hormone, which is secreted by the hypothalamus and aids in spermatogenesis.

FNA mapping is an application of fine-needle aspiration (FNA) to the testis for the diagnosis of male infertility. FNA cytology has been used to examine pathological human tissue from various organs for over 100 years. As an alternative to open testicular biopsy for the last 40 years, FNA mapping has helped to characterize states of human male infertility due to defective spermatogenesis. Although recognized as a reliable, and informative technique, testis FNA has not been widely used in U.S. to evaluate male infertility. Recently, however, testicular FNA has gained popularity as both a diagnostic and therapeutic tool for the management of clinical male infertility for several reasons:

  1. The testis is an ideal organ for evaluation by FNA because of its uniform cellularity and easy accessibility.
  2. The trend toward minimally invasive procedures and cost-containment views FNA favorably compared to surgical testis biopsy.
  3. The realization that the specific histologic abnormality observed on testis biopsy has no definite correlation to either the etiology of infertility or to the ability to find sperm for assisted reproduction.
  4. Assisted reproduction has undergone dramatic advances such that testis sperm are routinely used for biological pregnancies, thus fueling the development of novel FNA techniques to both locate and procure sperm.

Ejaculatory duct obstruction (EDO) is a pathological condition which is characterized by the obstruction of one or both ejaculatory ducts. Thus, the efflux of semen is not possible. It can be congenital or acquired. It is a cause of male infertility and/or pelvic pain. Ejaculatory duct obstruction must not be confused with an obstruction of the vas deferens.

<span class="mw-page-title-main">Ashok Agarwal</span> Medical Scientist

Ashok Agarwal is the Director of the Andrology Center, and also the Director of Research at the American Center for Reproductive Medicine at Cleveland Clinic, Cleveland, USA. He is Professor at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, USA. Ashok is a Senior Staff in the Cleveland Clinic's Glickman Urological and Kidney Institute. He has published extensive translational research in human infertility and assisted reproduction.

Marc Goldstein is an American urologist who is the Matthew P. Hardy Distinguished Professor of Reproductive Medicine, and Urology at Weill Cornell Medical College; Surgeon-in-Chief, Male Reproductive Medicine and Surgery; and Director of the Center of Male Reproductive Medicine and Microsurgery at New York Presbyterian Hospital. He is Adjunct Senior Scientist with the Population Council's Center for Biomedical Research, located on the campus of Rockefeller University.

Antisperm antibodies (ASA) are antibodies produced against sperm antigens.

Ranjith Ramasamy is a consultant urologist at Jumeirah American Clinic in Dubai, UAE, and the former Director of the Reproductive Urology Fellowship program at the University of Miami's Miller School of Medicine.

References

  1. ↑ Christian, Spencer (2005-10-31). "Myth Busting on Male Fertility" . Retrieved 11 February 2009.
  2. ↑ "Artificial Testicle Could Make Sperm for Infertile Men". 2012-01-27. Retrieved 11 May 2012.
  3. ↑ Lorie A., Parch (2012-01-27). "Artificial testicle could help infertile men". Archived from the original on 12 February 2012. Retrieved 11 May 2012.
  4. ↑ "Doctors in the News". 2012-04-07. Retrieved 11 May 2012.
  5. ↑ Nancy, Lamontagne (2012-04-04). "Small business explores new approaches in reproductive toxicology" . Retrieved 11 May 2012.
  6. ↑ http://www.cpmc.org/providersearch/?sitecfg=49&vs=detail&action=providerdetail&masterid=19709&isLevelOne=1&recId=ps99848sp9984838171778&healthplans=0&physname=Paul J. Turek, M.D.|
  7. ↑ "@Google Talks: Dr. Paul Turek - "A Guy's Guide to Maintaining Sexual Health"". 2011-07-11. Archived from the original on 2021-12-21. Retrieved 11 May 2012.
  8. ↑ "The Turek Clinic YouTube Channel" . Retrieved 11 May 2012.
  9. ↑ "Fertile Hope Medical Advisory Board" . Retrieved 11 May 2012.
  10. ↑ Turek PJ, Givens C, Schriock ED, Meng M, Pederson RA and Conaghan J. Testis sperm extraction and intracytoplasmic sperm injection guided by prior fine needle aspiration mapping in nonobstructive azoospermia. Fertility and Sterility. 71: 552-8, 1999|
  11. ↑ Shefi S, Kaplan K and Turek PJ. Analysis of spermatogenesis in nonobstructive azoospermic and virtually azoospermic men with known testicular pathology. Reprod Biol Med Online. 18: 460-64, 2009.|
  12. ↑ Turek P.J, I. Cha, Ljung, B-M., and Conaghan J. Diagnostic Findings From Testis Fine Needle Aspiration Mapping in Obstructed and Non-Obstructed Azoospermic Men. Journal of Urology, 163: 1709-1716, 2000.|
  13. ↑ Turek PJ, I Cha, and Ljung, B-M. Systematic Fine Needle Aspiration of the Testis: Correlation to Biopsy and the Results of Organ "Mapping" for Mature Sperm in Azoospermic Men. Urology. 49: 743-748, 1997.|
  14. ↑ Damani MN, Master V, Meng MV, Turek PJ, Oates RM. Post-chemotherapy ejaculatory azoospermia: Fatherhood with sperm from testis tissue using intracytoplasmic sperm injection. J Clin Oncology 20: 930-936, 2002.|
  15. ↑ Freedland SJ, Cha I, Turek PJ. Non-Palpable Leydig Cell Tumors Diagnosed by Fine Needle Aspiration. Journal of Urology, 158: 543-544, 1997|
  16. ↑ Black LD, Nudell DM, Cha I, Cherry AM and PJ Turek. Compound Genetic Defects as a Cause of Male Infertility. Human Reproduction. 15: 449-51, 2000. |
  17. ↑ Nudell DM, Castillo M, Turek PJ, and Reijo Pera, R. Increased frequency of mutations in DNA in infertile men with meiotic arrest. Human Reproduction. 15: 1289-1294, 2000.|
  18. ↑ Turek PJ, Magana JO, Lipshultz LI. Semen Parameters Before and After Transurethral Surgery for Ejaculatory Duct Obstruction. Journal of Urology, 155: 1291-3, 1996|
  19. ↑ Kadioglu A, Cayan S, Tefekli A, Orhan I, Engin G, Tellaloglu S and Turek PJ. Does response to treatment of ejaculatory duct obstruction in infertile men vary with pathology? Fertility and Sterility. 76:138-42, 2001 |
  20. ↑ Purohit R, Wu D, Shinohara K, and Turek PJ. A comparison of three diagnostic methods in the evaluation of ejaculatory duct obstruction. J. Urol. 171: 232-36, 2004 |
  21. ↑ Eisenberg M, Walsh TJ, Garcia M, Shinohara K and Turek PJ. Ejaculatory Duct Manometry in Normal Men and in Patients with Ejaculatory Duct Obstruction. J. Urol. 180: 255-60, 2008. Published online 20 May 2008 |
  22. ↑ Turek PJ and Smikle CB. Viability of Non-Motile Sperm. Assisted Reproduction Reviews. 7: 34-38, 1997 |
  23. ↑ Bachtell N, and Conaghan J. and Turek PJ. The Relative Viability of Human Spermatozoa from the Testis, Epididymis and Vas Deferens Before and After Cryopreservation. Human Reproduction. 14: 101-104, 1999 |
  24. ↑ Smikle CB and Turek PJ. Hypoosmotic Swelling Can Accurately Determine the Viability of Nonmotile Sperm. Molecular Reproduction and Development. 47: 200-203, 1997 |
  25. ↑ Cayan S., Schriock E, Conaghan J, and Turek PJ. Birth after intracytoplasmic sperm injection using testicular sperm from men with Kartagener/immotile cilia syndrome. Fertil Steril. 76: 1-3, 2001 |
  26. ↑ Black LD, Nudell DM, Cha I, Cherry AM and PJ Turek. Compound Genetic Defects as a Cause of Male Infertility. Human Reproduction. 15: 449-51, 2000 |
  27. ↑ Cayan S, Erdemir F, Ozbey I, Turek PJ, Kadioglu A, Tellaloglu S. Can varicocelectomy significantly change the way couples use assisted reproductive technologies? Journal of Urology 167:1749-56, 2002 |
  28. ↑ Kossak N, Meneses J, Shefi S, Nyugen HN Chavez S, Nicholas C, Gromoll J, Turek PJ and Reijo Pera R. Isolation and characterization of human spermatogonial stem cell-derived pluripotent cells. Stem Cells. 27(1):138-149, 2009. Epub 18 Oct 2008 |
  29. ↑ Shefi S, Tarapore PE, Walsh TJ, Croughan C, Turek PJ. The reversibility of hyperthermia on semen quality in infertile men. Int Braz J Urol. 33:50-6; discussion 56-7, 2007 |
  30. ↑ Turek PJ, Williams RW, Gilbaugh JH, Lipshultz LI. The Reversibility of Anabolic-Induced Azoospermia. Journal of Urology, 153 (5): 1628-1630, 1995 |
  31. ↑ Turek P.J. Boxers and Biopsies: Separating Fashion From Fact in Male Infertility. Journal of Urology. 160: 1337, 1998 |
  32. ↑ Turek PJ. Does the Male Infertility Clinical Evaluation Adequately Assess Toxiciological Exposures? Fertil Steril. 2008, 89(2 Suppl):e69 |
  33. ↑ Hawkes WC and Turek PJ. The effects of dietary selenium on sperm motility in healthy men. J. Androl. 22: 764-771, 2001 |
  34. ↑ Mahadevan U, Terdiman J, Aron J, Jacobsen S and Turek PJ. Infliximab and semen quality in men with Inflammatory bowel disease. Inflam Bowel Dis. Apr;11(4):395-99, 2005 |
  35. ↑ Walsh TJ, Dall’era MA, Croughan M, Carroll PR, Turek PJ. Cryptorchidism: prepubertal orchidopexy may prevent testis cancer J Urol. 178:1440-6; discussion 1446, 2007 |
  36. ↑ Walsh TJ, Davies BJ, Croughan MS, Carroll PR, and Turek PJ. Racial disparities among boys with testicular germ cell tumors in the United States. J Urol. 2008, 179(5):1961-5. Epub 2008 Mar 20 |
  37. ↑ Shefi S, Kaplan K and Turek PJ. Analysis of spermatogenesis in nonobstructive azoospermic and virtually azoospermic men with known testicular pathology. Reprod Biol Med Online. 18: 460-64, 2009 |
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