Male-Factor Fertility
Intro
When speaking about fertility, females are usually put under the spotlight. But, when couples start to experience difficulty conceiving, looking at both the male and female elements is important! The medical definition of “infertility” is the inability to conceive after 1 year of regular, unprotected intercourse. It is estimated that 72 million couples experience infertility, and a meta-analysis completed in 2015 estimates that 20-70% of infertility cases are solely attributed to issues with male fertility, illustrating how important it is to consider the male factor in infertility cases. These next 2 weeks, I will be speaking about fertility - this week is about the male factor and next week will be about the female factor.
In this blog post, you will learn:
Some of the causes of fertility issues in males
Evidence-based integrative options to support sperm quality
Note: This blog post is meant to be educational only, and is not meant to diagnose, prevent, treat, or cure. People should always consult their trusted licensed provider before trying any new treatments.
Causes of male FERTILITY issues
In regards to male fertility, it is all about understanding sperm - how it’s being made, how much is being made, how it’s being delivered, how well it’s shape is, how well it moves, how well its DNA is, and more. There are multiple causes of male infertility, and surprisingly, around 40% of male infertility cases have no clear cause! However, science does give us some answers as to why some males experience infertility, which you can find listed below:
Physical reasons
Physical issues with testicles, its blood vessels, and the tubes that transport sperm out of the testicles can play a role in male infertility. Varicoceles are considered a common physical cause of male infertility. A varicocele is a condition when veins are swollen and twisted around one or both testicles, which could lead to testicular dysfunction and suboptimal sperm production. Epididymitis is a condition when the epididymis (the tubing where sperm mature prior to ejaculation and the tubing that connects the testicles to the prostate, urethra, bladder) is infected or inflamed. Epididymitis can be caused by sexually transmitted infections (STI), and a study completed in 2013 revealed that STI-caused epididymitis led to reduced number of sperm, reduced sperm motility, and reduced semen volume in around 11% of cases.
Do note that there are many other physical causes of male infertility beyond varicoceles and epididymitis! So, work with a doctor who can figure out what could be going on.
Hormone issues
Hormone imbalance could play a role in male infertility. When there is a disconnect between the brain and the testicles, the body is unable to make testosterone and other sex hormones necessary for male sexual development and for the production of sperm. Additionally, prolactin is a brain hormone that could play a role in male infertility. Certain medications that increase prolactin levels have been shown to cause shifts in male hormones necessary for healthy production of sperm, and literature illustrates that these medications can lead to sexual impotence and low libido in addition to changes in sperm quality.
If you want to learn more about testosterone in males, click here to read my blog about it.
Sexual dysfunction
Erectile dysfunction could also play a role in male infertility, and there are many causes of erectile dysfunction. Sometimes, the cause can be psychological, and sometimes the cause can be biological. Beyond erectile dysfunction, premature ejaculation and inability to ejaculate are other issues that can arise in males.
If you want to learn about how metabolic issues found in “male PCOS” play a role in erectile dysfunction, click here to read my blog about it.
Genetics
Scientific evidence estimates that genetic factors play a role in 15% of male infertility cases. Chromosomal abnormalities are the main type of genetic abnormality that causes changes to sperm quality and sperm number.
Lifestyle & Environmental exposures
Exposure through toxicants and chemicals can happen with one’s regular lifestyle and when interacting with their day-to-day environment.
Alcohol & cigarette consumption: A study completed in 2010 indicates that high alcohol consumption and cigarette smoking both reduce sperm quality. Specifically, alcohol consumption negatively changed sperm shape and sperm production, cigarette smoking reduced sperm motility, and increasing intake of alcohol and cigarettes smoked led to progressive “deterioration in semen quality”.
Air pollution: Literature indicates that air pollution could play a role in male infertility with male subjects chronically exposed to diesel air pollution exhibiting “decreased motility and low sperm counts”.
Temperature: Science indicates that males who work in workplaces with high temperatures (such as bakeries) have increased rates of infertility
Laptop computers & mobile phones: An in vitro study revealed that when sperm were exposed to laptop computers connected to Wi-Fi for 4 hours, it lead to “a significant decrease in progressive sperm motility and an increase in sperm DNA fragmentation”. And since we have phones everywhere nowadays, a systematic review of scientific literature completed in 2014 revealed that exposure to mobile phones was associated with reduced sperm motility and reduced sperm viability. And remember, associations don’t tell us the full picture of the story, and usually entails that more studies need to be completed to better understand why this connection between sperm quality and mobile phone exposure takes place.
There are many more environmental exposures that could play a role in sperm quality, such as heavy metals, radiation, and plastics/endocrine disrupting compounds.
NOTE: Do Know that there are many other documented causes of fertility issues in males. People should always be working with a licensed provider who can do the necessary work-up to identify causes.
Integrative options for sperm quality
Licensed Naturopathic Doctors (NDs) are trained to provide integrative medical care, and there are specialized naturopathic endocrinologists that are board-certified by the Endocrinology Association of Naturopathic Physicians (EndoANP). This entails that licensed NDs are knowledgable in both pharmaceutical/conventional treatments and natural treatments. And, in regards to how licensed NDs treat their patients, they try to identify and treat root causes of their patient’s symptoms, which usually leads to more-holistic and personalized treatment plans. And since licensed NDs have knowledge in both conventional and natural treatments, licensed NDs can provide a balanced perspective on when to recommend natural and conventional treatments. Licensed NDs will refer out to reproductive endocrinologists, urologists, and other specialists for procedures and work-up that are out of their scope of practice. Below you’ll find some evidence-based natural and conventional options that a licensed provider might recommend to their patients.
TO LEARN MORE ABOUT NATUROPATHIC MEDICINE, NATUROPATHIC MEDICAL EDUCATION, AND NATUROPATHIC MEDICAL LICENSURE, CLICK HERE.
To learn about the endocrinology association of naturopathic physicians, click here.
to find a board-certified naturopathic endocrinologist, click here.
Foundations of health: Diet
Diet plays an integral and foundational role in overall health and wellness, and it has been shown to play a role in sperm quality. Literature indicates that excess consumption of saturated fats is associated with reduced semen quality, and that dairy consumption (specifically full-fat dairy) was associated with abnormal sperm shape and lower sperm motility. Moreover, dietary antioxidants have also been shown to play a role on sperm health. A study completed in 2019 on males who completed questionnaires about their dietary intakes and provided semen samples revealed that intake beta-carotene and vitamin C were associated with improved sperm DNA quality. In addition to this, antioxidant supplements have been shown to play a role in semen quality in infertile males, which is discussed in detail below.
In regards to dietary patterns, the Mediterranean Diet has been associated with improvement in sperm motility, which is characterized as a diet composed of “olive oil, fruit, nuts, legumes, vegetables and whole cereals; a moderate intake of fish, poultry and wine; and a low consumption of dairy products, red meat, processed meats, and sweets”. And, a cross-sectional study published in 2020 completed on more than 2900 Danish men revealed that “healthy dietary patterns” was associated with better semen quality, “with potentially more favorable fertility potential among adult men.” To provide more detail, this 2020 study found that “adherence to the Western [diet] was associated with the lowest total sperm count”, and a diet with “greater intake of fish, chicken, vegetables, fruit, and water” was associated with “the highest total sperm count”, which was then followed by a “vegetarianlike” diet, which is described as consuming “vegetables, soy milk, and eggs and avoidance of red meats and chicken.”
Given all of this, speak to your provider about your dietary options and see if adopting a Mediterranean Diet or a diet composed of greater fish, chicken, vegetable, fruit, and water intake would be best for your personal health and fertility goals.
Lifestyle medicine: Exercise, alcohol, & cigarettes
Lifestyle medicine is another aspect of foundational health that licensed NDs look at to support overall health and wellness, and as spoken above, alcohol and cigarette consumption have been shown to negatively impact male fertility. So, for those males looking to optimize their fertility, a licensed ND may recommend reduced consumption of alcohol and cigarettes. In addition to this, a licensed naturopathic provider may recommend targeted exercise routines as studies have shown that aerobic exercise improved semen quality in obese individuals and that certain types of exercise could actually play a negative role in sperm and semen quality.
Foundational health: Sleep quality
Sleep is another important element of foundational health that many people forget about. Researchers have concluded that sleep has been associated with changes to semen quality. A cross-sectional study completed in 2013 observed that men with higher levels of sleep disturbances had lower sperm number and lower numbers of normally-shaped sperm compared to men with lower levels of sleep disturbances. Additionally, a more recent study completed in 2020 revealed that “long and short sleep duration and poor sleep quality were associated with impaired semen quality parameters”, and more specifically, “men who slept less than 6.0 h/d had lower total and progressive sperm motility”. And another study completed in 2020 revealed that nighttime exposure to light emitted from media devices (such as phones, tablets, etc.) was associated with reduced sperm motility. Further studies need to be completed to understand that mechanisms involved in these associations between sleep and sperm quality. But, there have been studies that suggest that melatonin might a play in all of this.
Melatonin is an antioxidant hormone that is made in the pineal gland in the brain that plays a role in inducing sleep, and its production is affected by light and dark exposure. Melatonin is also made in areas outside of the brain, such as the eye, the gastrointestinal tract, the ovaries, and the testicles. A study looking at the connection between nighttime light exposure, melatonin levels in blood and in semen, and semen and sperm quality in males with a type of unexplained infertility (idiopathic oligoasthenoteratozoospermia) showed that: 1) all males with idiopathic oligoasthenoteratozoospermia (iOAT) had lower levels of melatonin in blood and in semen compared to normal fertile males; 2) males with iOAT exposed to nighttime light had lower levels of melatonin in blood and in semen compared to males with iOAT who were not exposed to nighttime light; 3) normal fertile males exposed to nighttime light had lower levels of melatonin in blood and semen compared to normal fertile males who were not exposed to nighttime light; and 4) there was a significant association between higher levels of melatonin in blood and improved sperm motility in all males with iOAT. These findings suggest that there is a possible connection between melatonin levels and sperm quality in the context of nighttime light exposure. In addition to this, an in vitro study revealed that sperm exposed to melatonin increased sperm motility and reduced the number of non-viable sperm. And, a study looking at melatonin supplementation in infertile males showed that “melatonin supplementation improves human sperm quality, which is essential to achieve successful natural and/or assisted reproduction outcome.”
Ultimately, more studies need to be completed to fully understand how sleep affects sperm quality. But, there is some emerging literature that suggests that endogenous and exogenous melatonin play roles in sperm quality.
Antioxidants: Dietary & Supplements
The use of antioxidants is playing an emerging role in the management of male infertility, as there is more evidence indicating that sperm are affected by free radicals and oxidative stress. Antioxidants are compounds that neutralize free radicals to reduce oxidative stress, and can be found dietarily and can be taken as a supplement. A small study completed in 2013 revealed that there is an association between low intake of dietary antioxidants and reduced sperm motility, reduced sperm concentration, and sperm shape. In regards to antioxidants, literature revealed that Vitamin E inhibited the production of free radicals in infertile males, and that Vitamin E supplementation with selenium could improve semen quality and sperm motility. Vitamin C is another antioxidant that is widely known, and studies show that semen is naturally high in this antioxidant and suggests that it’s protective for sperm quality.
CoQ10 is another antioxidant that has been studied in regards to sperm quality. Literature about CoQ10 and male fertility showed that 6 months of CoQ10 supplementation improved sperm motility in infertile male subjects; and that 26 weeks of CoQ10 supplementation was shown to “[improve] sperm density, sperm motility and sperm morphology” in males with unexplained infertility. Despite studies showing that CoQ10 could improve sperm motility, a meta-analysis reviewing the literature on CoQ10 and male fertility concluded that CoQ10 does not increase live birth or pregnancy rate.
With so many different types of antioxidants available, use of mixed antioxidants have also been studied by researchers. Literature revealed that mixed use of specific types of antioxidants led to improved semen parameters, significant increase in sperm number, and improved DNA quality of sperm. In some studies observing mixed use of antioxidants with spontaneous pregnancy and IVF success, there was no spontaneous pregnancy occurred after 12 months of mixed antioxidants, and there was a “statistically significant improvement in viable pregnancy rate” in couples doing IVF, but there was no significant changes to egg fertilization or embryo quality between males taking antioxidants and males not taking antioxidants.
All in all, scientific literature currently suggests that antioxidants could improve sperm quality, sperm motility, and sperm DNA, but there is currently limited evidence to say that antioxidants can improve live birth rates.
Varicoceles & Epididymitis
Varicoceles and epididymitis are some of the physical causes of male fertility issues. Varicoceles and epididymitis are best treated with conventional treatments, and should not be treated with natural approaches, as varicoceles can lead to testicular torsion, which is considered a medical emergency and needs surgical treatment. And, epididymitis needs the use to antibiotics if STIs are the cause.
Fertility assistance techniques
Fertility assistance techniques are described as a “range of methods generally used to treat infertility problems in humans and help infertile couples to have a healthy child”. And, for couples seeking assisted reproductive techniques, they should be working with a reproductive endocrinologist. Fertility assistance techniques could involve auxiliary fertilization and sperm recovery. Auxiliary fertilization involves the use of controlled ovarian stimulation to retrieve eggs, and once eggs are retrieved sperm recovery is completed for artificial insemination. Types of auxiliary fertilization include In vitro fertilization (IVF) and Intracytoplasmic sperm injection (ICSI). For infertile males, sperm recovery could be a challenge. Current techniques for sperm recovery in infertile males involve retrieving sperm from the testes and then doing ICSI, but this is only completed for some types of male infertility.
For more education on fertility assistance technology, consult a reproductive endocrinologist and/or visit the society for assisted reproductive technology’s website.
All in all, these are just some evidence-based integrative options that people can speak to their trusted licensed medical providers about, and do know that there are more options. Speak to your trusted licensed provider before trying any new treatments or supplements.
Do know that licensed NDs will refer out to reproductive endocrinologists for conventional treatment, such as fertility assistance techniques. Do also know that some conditions that cause male infertility are best treated with conventional medicine, and not natural medicine, such as varicoceles and epididymitis.
Summary & takeaways
It has been reported that around 72 million couples experience infertility, and around 20-70% of those cases are solely attributed to male fertility issues. And, this whole blog post was focused on male-factor fertility. In this blog post, you learned:
Some reported causes of male fertility issues involve physical reasons, genetics, hormones, lifestyle and environmental exposures, and more. But, do know that it has been estimated 40% of male fertility causes have no known cause
Scientific evidence indicates that lifestyle, diet, and environmental exposures may affect sperm quality and fertility by affecting the activity of free radicals. Antioxidants are starting to play an emerging role in supporting sperm quality, with studies indicating that some single antioxidants and mixed use of antioxidants improving sperm motility. However, more studies need to be completed in regards to antioxidants and male fertility.
For varicoceles, testicular torsion, and epididymitis, conventional management is necessary as these conditions may need surgical or antibiotic therapy.
Some couples may choose fertility assistance techniques, which is completed with a reproductive endocrinologist.
Remember, this blog post was meant to be educational only, and is not meant to diagnose, treat, prevent, or cure. And, remember to always speak to a licensed provider before trying any new treatments. Next week, I will be focusing on female-factor fertility here on my blog. So, make sure to sign up for my email newsletter to stay up-to-date about new blog posts!
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