Male Infertility

DESCRIPTION
In the US, approximately 15% of all couples have difficulty conceiving a child. In about one-third of these cases, the man is infertile; in another one-third, both the man and woman are infertile; and in the remaining one-third, the woman is infertile. Current estimates suggest that 6% of men between the ages of 15 and 50 are infertile.

Male infertility is considered likely if, in the absence of female causes, a child is not conceived after 6 months of unprotected sex. In 90% of cases, male infertility is due to low sperm count. In an average ejaculate, a man will eject nearly two hundred million sperm, but because of the natural barriers in the female reproductive tract, only about 40 sperm ever reach the vicinity of the egg. A strong correlation exists, therefore, between fertility and the number of sperm in an ejaculate.

In about 90% of cases of low sperm count, the reason is deficient sperm production. Unfortunately, in about 90% of these cases, the reason sperm formation is low cannot be identified, so the condition is labeled idiopathic oligospermia (low sperm count for unknown reasons) or azoospermia (complete absence of living sperm in the semen).

Semen analysis for sperm concentration and quality is the most widely used test to estimate a man’s fertility potential. Total sperm count and quality have been deteriorating over the last few decades; men now supply only about 40% of the number of sperm per ejaculate compared to 1940 levels. Substantial evidence supports the theory that this downward trend is the result of environmental, dietary, and lifestyle changes in recent decades.

As sperm counts have dropped in the general population, a parallel reduction has occurred in the accepted diagnostic line differentiating infertile from fertile men on the basis of sperm concentration, which has dropped from 40 million/ml to 5 million/ml. One positive reason for this drop is that researchers have learned that quality is more important than quantity. Numerous pregnancies have occurred involving men with very low sperm counts; in studies at fertility clinics, 40% of those with sperm counts as low as 5 million/ml are able to achieve pregnancy. On the other hand, if the majority of sperm are abnormally shaped or non-motile (inactive), a man can be infertile despite having a normal sperm concentration. Therefore, in addition to conventional sperm concentration analysis, functional tests should be used to evaluate the sperm’s ability to achieve fertilization. One important test detects antisperm antibodies, which, when produced by the man, usually attack the sperm’s tail, lessening its ability to move and penetrate the cervical mucus. The presence of these antisperm antibodies in semen analysis is usually a sign of past or current infection in the male reproductive tract.

When the cause of oligospermia (low sperm count) can be identified, standard medical treatment is often quite effective. If the cause of azoospermia (no sperm in the semen) is ductal obstruction, new surgical techniques are showing good results. When the cause is unknown, the rational approach is to focus on those factors that promote the production of healthy sperm: scrotal temperature and nutritional status. These factors, along with herbs that have been shown to increase sperm counts are discussed below.

 

FREQUENT SIGNS AND SYMPTOMS

• Inability to conceive a child after 6 months of unprotected sex in the absence of female causes
• A total sperm count of lower than 5 million/ml
• The presence of greater than 50% abnormal sper
• Inability of sperm to impregnate an egg, as determined by the postcoital or hamster-egg penetration in vitro (test tube) tests
• The postcoital test measures the ability of sperm to penetrate the cervical mucus after intercourse
• The hamster-egg penetration test is based on the discovery that, under appropriate conditions, human sperm can penetrate hamster eggs. The sperm of fertile males exhibits a range of penetration of 10–100%. Less than 10% indicates infertility.
• Detection of antisperm antibodies in semen analysis:
• When produced by the man, these antibodies attack the sperm’s tail, impeding its ability to move and penetrate the cervical mucus.
• Antisperm antibodies usually indicate past or current infection in the male reproductive tract.

CAUSES

Possible causes of low sperm counts

• Increased scrotal temperature: normally, the scrotal sac keeps the testes at a temperature between 34.4 degrees C and 35.5 degrees C (94 - 96?F). Temperatures above 35.5 degrees C  greatly inhibit or stop sperm production completely:
• Infertile men typically have a higher scrotal temperature than fertile men.
• Scrotal temperature can be raised by tight-fitting underwear, tight jeans, hot tubs, and exercising (jogging, rowing or cross-country skiing machines, treadmills), especially if a man is wearing tight shorts or bikini underwear.
• Varicoceles (varicose veins that surround the testes): a large varicocele can cause scrotal temperatures high enough to inhibit sperm production and motility. Surgical repair may be necessary, but scrotal cooling (see Physical medicine below)should be tried first.
• Increased environmental pollution and cigarette smoking: many of the chemicals with which we have contaminated our environment over the last 50 years promote free radical production and/or are weakly estrogenic. Cigarette smoke is a significant source of oxidants (free radicals) and is associated with decreased sperm counts and motility as well as increased levels of abnormal sperm:
• High levels of free radicals are found in the semen of 40% of infertile men
• Sperm are extremely susceptible to damage from free radicals
• Sperm cell membrane is primarily composed of polyunsaturated fatty acids, particularly omega-3 essential fatty acids, which are especially vulnerable to free radical damage.
• Sperm themselves generate high quantities of free radicals to help break down barriers to fertilization.
• Sperm lack their own defensive enzymes, so are completely dependent upon antioxidants for protection.
• Exposure to estrogenic chemicals during fetal development and puberty inhibits the multiplication of the Sertoli cells, the sperm-producing cells of the testes.
• Heavy metals (lead, mercury, arsenic, etc.): sperm are particularly susceptible to the damaging effects of heavy metals. A hair mineral analysis for heavy metals should be performed on all men with reduced sperm counts.
• Organic solvents: increased free radical production can cause abnormal fetal development.
• Pesticides (DDT, PCBs, DBCP, etc.): these weak estrogens are resistant to biodegradation and are  recycled in the environment until they eposit in our bodies. For example, although DDT has been banned for 20 years, it is still frequently found in root vegetables, such as carrots and potatoes.
• Diet:
• Increased exposure to synthetic oestrogens:
• Diethystilbestrol (DES) was given to several million pregnant women between 1945 and 1971 if they had gestational diabetes or were likely to miscarry. DES given to pregnant mothers carrying a male fetus is now known to have caused developmental problems of the reproductive tract as well as decreased semen volume and sperm counts. DES and other synthetic oestrogens were also used for 20–30 years to fatten livestock and increase their growth rates.
• Although DES is now outlawed, many livestock and poultry are still hormonally manipulated, especially dairy cows, whose milk now contains substantial amounts of oestrogen. The rise in consumption of dairy products since the 1940s parallels the drop in sperm counts.
• Oestrogens have been detected in drinking water, presumably having been recycled from excreted synthetic estrogens (birth control pills) at water treatment plants
• Increased intake of saturated fats from animal products
• Oestrogens concentrate in the fat cells of animals.
• Healthy sperm membranes are primarily composed of very fluid fats (omega-3 essential fatty acids). In the typical Western diet, intake of saturated fats is high while that of essential fatty acids is very low. This results in the production of sperm that are much less motile due to their abnormally stiff membranes.
• Reduced intake of dietary fiber: without adequate fiber, excreted oestrogens are reabsorbed from the intestines.
• Reduced intake of fruits, vegetables, and whole grains: sources of dietary fiber.

Causes of temporary low sperm counts

• Increased scrotal temperature
• Infections:
• Infections in the male genitourinary tract (the epididymis, seminal vesicles, prostate, bladder, urethra) are thought to play a major role in many cases of infertility. Functional testing that reveals the presence of antisperm antibodies is a good indicator of chronic infection.
• A large number of bacteria, viruses and other organisms can infect the male genitourinary system, but the most common and most serious infection is caused by Chlamydia trachomatis, a sexually transmitted disease:
• Between 28 and 71% of infertile men show evidence of chlamydial infection
• Chlamydial infection of the prostate or urethra typically presents as pain or burning sensations upon urination or ejaculation.
• Chlamydial infection of the epididymis and vas deferens can result in serious scarring and blockage.
• During an acute chlamydial infection, antibiotics must be used. Chlamydia is sensitive to tetracyclines and erythromycin, but because it lives in human cells, it may be difficult to eradicate totally with antibiotics alone
• Chronic chlamydial infections of the urethra, seminal vesicles, or prostate may be present with few or no symptoms.
• The presence of antisperm antibodies may indicate a chronic chlamydial infection. Rectal ultrasonography and detection of antibodies against Chlamydia can confirm the diagnosis.
• If chlamydial infection is indicated, both partners should take the antibiotic
• Overuse of alcohol, tobacco, or marijuana: all of these drugs significantly increase production of free
  radicals. Sperm, which contain large amounts of essential fatty acids, are extremely susceptible to damage by free radicals
• Many prescription drug
• Exposure to radiation: generates tremendous amounts of free radicals.
• Exposure to solvents, pesticides, and other toxins: these substances are oestrogenic and/or increase free radical production.

RISK INCREASES WITH

• Standard Western Diet: a diet based on animal products and processed foods, with little consumption of fresh vegetables, legumes, fruits, nuts and seeds, and whole grains is low in factors necessary for the production of healthy sperm – fiber; antioxidants; essential fatty acids; vitamins C, E, B12 and folic acid; beta-carotene, and zinc – and high in damaging factors that elevate oestrogen levels and suppress immune function – saturated fat, sugars, pesticide residues, and chemical additives.
• Wearing tight-fitting underwear, shorts or jeans.
• Mother who was given DES during her pregnancy.
• Mother who consumed a high fat, low fiber diet during pregnancy.
• Multiple sexual partners: increased risk of sexually transmitted disease.
• Smoking, alcohol consumption, use of marijuana.
• Prescription drug use.
• Exposure to solvents, pesticides and other toxins.

PREVENTIVE MEASURES

• Take a cold shower after exercising and allow the testicles to hang free to allow recovery from heat build-up.
• Wear loose underwear made of cotton.
• Avoid activities that elevate testicular temperature, e.g., hot tubs.
• Maintain scrotal temperatures between 34.4 degrees C and 35.5 degrees C (94 and 96?F).
• Avoid exposure to free radicals
• Identify and eliminate environmental pollutants.
• Drink filtered water.
• Stop or reduce consumption of all drugs, especially antihypertensives, antineoplastics such as cyclophosphamide, and anti-inflammatory drugs such as sulfasalazine.
• Consume a nutrient-dense diet rich in whole, unprocessed, preferably organic foods, especially plant foods (fruits, vegetables, beans, seeds and nuts, and whole grains) and cold-water fish, and low in animal products and processed foods. 

Expected outcomes

Sperm production and motility should improve significantly within 1 month.

 
TREATMENT

Diet

• Consume the nutrient-dense diet of organically grown foods recommended above in Preventive Measures. Emphasize dark-coloured vegetables and fruits (good sources of protective antioxidant vitamins, carotenes and flavonoids), and nuts and seeds (good sources of essential fatty acids and zinc).
• Consume daily: 8–10 servings of vegetables; 2–4 servings of fresh fruits; 75 g (3 oz) of raw nuts or seeds. (Once removed from their shells, nuts and seeds should be refrigerated to prevent oxidation of their delicate essential fats.)
• Avoid hormone-fed animal products, especially cow’s milk and other dairy products.
• Avoid foods containing fats that have been cooked at high temperature, e.g., fried foods, grilled meats. When fats are exposed to high temperatures, large amounts of free radicals are produced.
• Avoid saturated fats, hydrogenated oils, trans fats, and cottonseed oil. Sperm membranes are composed of essential fatty acids, the most fluid of all fats. Excessive consumption of saturated fats, combined with inadequate intake of essential fatty acids, results in the production of abnormally stiff sperm membranes, which significantly decreases sperm’s mobility:
• Saturated fats are found in meat and animal products, coconut and palm oils, and trans fats.
• Cottonseed oil may contain toxic residues due to heavy spraying of cotton and its high levels of gossypol, a substance so effective in inhibiting sperm production that it is being investigated as a “male birth control pill”. Antifertility research on cottonseed oil began when it was discovered that men who had used crude cottonseed oil as their cooking oil had low sperm counts followed by total testicular failure.
• Increase consumption of essential fatty acids: best sources are cold-water fish such as salmon, and nuts and seeds. These oils, the primary constituents of sperm membranes, are vitally important for sperm formation and activity
• Drink purified or bottled water.
• Increase consumption of legumes, especially soy foods:
• Soy is a particularly good source of isoflavonoids Isoflavonoids are also called phytoestrogens because of their ability to bind to oestrogen receptors. Their weak oestrogenic action (0.2% of the oestrogenic activity of oestradiol, the principal human oestrogen) exerts an antiestrogenic effect by preventing the body’s own oestrogen from binding. In addition, phytoestrogens stimulate the production of sex hormone binding globulin, which binds to oestrogen, reducing its potency.
• Soy and other legumes also contain phytosterols (plant compounds similar in structure to human hormones), which may aid in the manufacture of steroid hormones, including testosterone.

Nutritional supplements

• A high-potency multiple vitamin and mineral supplement: this should include 400 ?g of folic acid, 400 ?g of vitamin B12, and 50–100 mg of vitamin B6. (Folic acid supplementation should always be accompanied by vitamin B12 supplementation to prevent folic acid from masking a vitamin B12 deficiency.) A daily multiple providing all of the known vitamins and minerals serves as a foundation upon which to build an individualized health-promotion program.
• Vitamin C: the primary antioxidant in all watersoluble compartments in the body, vitamin C (ascorbic acid) plays an especially important role in protecting sperm’s genetic material (DNA) from damage:
• Acorbic acid levels are much higher in seminal fluid than in other body fluids, including blood. When dietary vitamin C was reduced from 250mg q.d. to 5 mg q.d. in healthy human subjects, the seminal fluid ascorbic acid level dropped 50% and the number of sperm with damaged DNA rose 91%.
• Cigarette smoking greatly reduces vitamin C levels throughout the body. Smokers require twice as much vitamin C as non-smokers, and when smokers were given supplemental vitamin C in doses of either 200 or 1,000 mg q.d., their sperm quality improved proportional to the level of vitamin C given.
• Non-smokers have also been shown to benefit significantly from vitamin C supplementation. When 30 healthy but infertile men were given 200 or 1,000 mg of vitamin C daily, after 1 week the 1,000 mg group demonstrated a 140% increase in sperm count, the 200 mg group a 112% increase, and the placebo group, no change. At the end of 60 days, all of the men receiving vitamin C had impregnated their wives, compared to none of the placebo group.
• Vitamin C may improve fertility by reducing the number of agglutinated (clumped together) sperm. Sperm agglutinate when antibodies produced by the immune system bind to the sperm. Such antibodies are often associated with genitourinary tract infection. In the study cited above, initially all three groups had over 25% agglutinated sperm. After 3 weeks, the number of agglutinated sperm in those receiving vitamin C had dropped to 11%
• Vitamin C works synergistically with vitamin E and carotenes (its fat-soluble partners), as well as with antioxidant enzymes such as glutathione peroxidase, catalase, and superoxide dismutase. Vitamin C also regenerates oxidized vitamin E, enabling it to resume its antioxidant defense activities.
• Vitamin E: the primary antioxidant in all fat-soluble areas of the body including cell and sperm membranes, vitamin E has been shown to inhibit free radical damage of sperm membranes and to enhance the ability of sperm to fertilize an egg in test tubes. During the course of one study, 11 of 52 infertile men
  given vitamin E impregnated their wives.
• Beta-carotene: a powerful fat-soluble antioxidant that works synergistically with vitamins C and E;
• Folic acid: folic acid is involved in the reactions that lead to the synthesis of nucleic acids (the components of DNA and RNA) and is therefore essential for the production of all germinal cells, including sperm.
• Vitamin B12: B12 is used by all DNA-synthesizing cells to facilitate the metabolic activities of folic acid. A deficiency of B12 leads to reduced sperm counts and motility:
• Even in infertile men without B12 deficiency, B12 supplementation has significantly improved sperm
  counts (in one study, from under 20 million/ml to over 100 million/ml).
• Zinc: a cofactor in numerous enzymatic reactions, zinc is involved in virtually every aspect of male reproduction including hormone metabolism, sperm formation, sperm motility, and prostate health:
• Zinc deficiency results in many problems including decreased testosterone levels and sperm counts.
• Zinc levels are typically much lower in infertile men with low sperm counts.
• Studies show that infertile men with low sperm counts and low testosterone levels receive significant benefit from zinc supplementation. In one study that included 22 men who had been infertile for more than 5 years and whose sperm counts were less than 25 million/ml, zinc supplementation for 45–50 days resulted in an increase in mean sperm count from 8 million/ml to 20 million/ml. Nine out of the 22 wives became pregnant during the study. An additional 15 infertile men with normal testosterone levels participated in this study. Although their sperm counts increased slightly, no changes occurred in their testosterone levels, and no pregnancies occurred.
• Arginine: the amino acid arginine is required for cell replication. If sperm counts are higher than 20 million/ml, arginine may be of benefit, but arginine therapy should be reserved for use after other nutritional therapies have been tried
• Carnitine: a non-essential amino acid, carnitine is essential for the transport of fatty acids into the mitochondria, the energy production factories in the cells:
• Carnitine concentrations are very high in the epididymis and sperm, both of which derive the majority of their energy from fatty acids.
• After ejaculation, the motility of sperm correlates directly with their carnitine content. The higher the carnitine content, the more motile the sperm. Conversely, when carnitine levels are low, sperm development, function, and motility are drastically reduced.
• Carnitine supplementation was shown to increase sperm count and motility in 37 of 47 men with abnormal sperm motility.
  

Botanical medicines

• Panax ginseng: Chinese or Korean ginseng has a long history of use as a male tonic and, although no human clinical studies are available, it has been shown to promote growth of the testes, increase sperm formation and testosterone levels, and increase sexual activity and mating behaviour in animal studies. Panax ginseng is regarded as the more potent ginseng in its effects, particularly its stimulant effects:
• Eleutherococcus senticosus (Siberian ginseng): Siberian ginseng has been shown to increase reproductive capacity and sperm counts in bulls:
• Pygeum africanum: in men with diminished prostatic secretion, pygeum has led to increased levels of total seminal fluid as well as increases in alkaline phosphatase (an enzyme that maintains the proper pH of seminal fluid) and protein:
• Pygeum extract is most effective in cases in which the level of alkaline phosphatase is reduced (to less than 400 IU/cm3), and there is no evidence of inflammation or infection (i.e., the absence of white blood cells or IgA).
• Pygeum extract can sometimes improve the capacity to achieve erections in patients with benign prostatic hyperplasia.

Drug–herb interaction cautions

• Panax ginseng:
• Plus monoamine oxidase inhibitor, phenelzine: may produce manic-like symptoms
• Plus caffeine: long-term use (13 weeks) of large amounts (3 g q.d. on average) of ginseng may lead to hypertension in one person out of six
• Plus insulin: dosage may need adjusting because of ginseng’s hypoglycemic effects in diabetic patient
• Plus warfarin: anticoagulant activity may be reduced.
• Eleutherococcus senticosus (Siberian ginseng):
• Plus hexobarbital: when injected into the peritoneal cavity in mice, Siberian ginseng increases the effect of hexobarbital due to inhibition of its metabolic breakdown.
• Plus insulin: when injected into the peritoneal cavity in mice, Siberian ginseng extract has hypoglycemic
  effects, so insulin dosage may need adjustment.

Topical medicine

• Testicular hypothermia device: also called a testicle cooler, this device looks like a jock strap from which long, thin tubes have been extended. The tubes are attached to a small fluid reservoir filled with cold water that attaches to a belt around the waist. The fluid reservoir contains a pump that circulates the water, which evaporates and keeps the scrotum cool. The reservoir must be refilled approximately every 6 hours. Most users claim that the testicle cooler is fairly comfortable and easy to conceal. It should be worn daily during waking hours.

 

Physical medicine

• After exercising, take a cold shower and allow the testicles to hang free to allow recovery from heat buildup.
• Wear boxer-type underwear and periodically take a cold shower or apply ice to the scrotum.

ICIM Medics Approach

If you feel that this article relates to you then please make an appointment to see one of ICIM Medics Natural Medical Practitioners.

Some tests may be prescribed depending upon your individual case, the results from these can be used by one of our Natural Medical Practitioners who will help you with your individualised treatment plan. This may include dietary, nutritional and/or botanical advice.

This article is not meant to be used for treatment but for information purposes only. If you feel that this approach is appropriate for you please contact ICIM Medics on 045 844 819 or www.icim.ie e-mail : info@icim.ie  Appointments can be arranged for you.

Tags: Male Infertility, Semen, Sperm Count