Male Fertility Issues

When I meet heterosexual couples and carry out an initial consultation, the focus is usually on the female. Quite often in fact, when a couple is struggling to conceive naturally, the female will make the initial visit on her own.  

We consider lifestyle and possible improvements, nutrition, what could be missing and ways in which supplements could assist with fertility, we look at holistic medicine and therapies. I consider each and every case individually and the spectrum of treatments that might help the couple conceive. 

However, to improve the chances of natural conception, it is always advisable for both partners to look at their diet and lifestyle. An unhealthy lifestyle can have a significant impact on a man’s fertility and healthy sperm production. 

The holistic therapies we undertake in our clinic follow the principles of Chinese Medicine. From this perspective, the main causes of male fertility issues fall into two categories: stagnation of blood and circulation; and deficiencies in other areas caused by lifestyle. 

A study conducted by The College of Shanghai University of Traditional Chinese Medicine reported that acupuncture treatment can enhance semen quality and quantity of sperm, while improving the spermatogenic environment and normalising sex hormones.

When I am advising my male clients to promote their fertility, I start with looking at their weight and taking a BMI estimate. I then look for good blood flow to the pelvic area and then other pathogenic factors that may cause stagnation, such as Damp and Heat. Doppler ultra sound scanning equipment can also look at the blood flow to the testicles. This may detect Varicocele, or other issues underlying the male fertility issue.

I always look at lifestyle, diet and supplements, as so much improvement can be made in just this one area alone. A low sperm count diagnosis is becoming far more common, with environmental factors influencing the quantity and quality of the sperm being produced. 

Sperm production is a complex, daily process that takes about 100 days from beginning to end. On average it takes 74 days to mature the sperm and a further 20 days for the sperm to become capable of fertilising an egg. This process takes place in the testicles, and the fragile tubes that transport the sperm to mix with the semen. It also involves the hypothalamus and pituitary glands. If there is an issue with any one of these systems, it will have a detrimental impact on the sperm.

More is being understood about male weight influencing sperm quality through changes to hormone levels. Male obesity can come with complex issues around self-esteem and masculinity. It is much easier to brush aside the man’s weight being an issue, than confront it as a potential cause.  

The HFEA has made a suggestion, that when clinics request NHS funded IVF, then the male BMI should be less than 30. Over 30 and the male is considered obese and this could have a detrimental effect on a positive successful outcome of IVF treatment. The HEFA goes on to conclude that 32% of unsuccessful outcomes are due to male health issues.

Obesity in the male population worldwide has tripled in the past 30 years and this coincides with male infertility levels. Ongoing research is finding that the effect of obesity not only negatively impacts male fertility but there are also suggestions that it can also reduce implantation chances, embryo development and even the reproductive health of the offspring.¹

In an initial research paper from 2012, entitled ‘Impact of obesity on male fertility, sperm function and molecular composition’, the authors concluded:

“There is emerging evidence that male obesity negatively impacts fertility through changes to hormone levels, as well as direct changes to sperm function and sperm molecular composition. Studies showing that simple diet and exercise interventions can be used to reverse the damaging effects of obesity on sperm function, understanding the impacts will be important for the development of public health messages for men considering fatherhood.”

A study from Harvard School of Public Health (HSPH), found that overweight and obese men are more likely to produce lower numbers of sperm, or even no sperm at all. 

The researchers combined data from 14 studies comparing sperm count in overweight, obese, and normal-weight men, along with data from an infertility clinic. They found that overweight men were 11 per cent more likely to have a low sperm count and 39 per cent more likely to have no sperm in their ejaculate. Obese men were 42 per cent more likely to have a low sperm count than their normal-weight peers and 81 percent more likely to produce no sperm.²

In the first study (Jacqueline, do you mean research cited in ‘Impact of obesity on male fertility’ or Harvard above?) researchers looked at the sperm quality of nearly 1,600 young Danish men who volunteered as they took a physical to enter military service.

The study showed that the overweight men who had a BMI over 25 (which is considered overweight, 30 is obese), had nearly 22 per cent lower sperm concentration and 24 per cent lower total sperm count, compared to healthier weight men.

Researcher Tina Kold Jensen, MD, PhD, of the University of Southern Denmark concluded: "Body mass within the ideal "normal" range was associated with higher sperm concentration, higher total sperm count, and a lower percentage of abnormal sperm." 

The study also showed that as a man’s weight increased, blood testosterone levels decreased.

Low testosterone can create a lower libido, losing interest in having sex and having weaker and fewer erections. It affects your fertility, by impacting on hormonal balance that is vital for healthy sperm production. 

There is still a lot of research to be done into this area, but it goes without saying that a healthier weight and lifestyle is a great way to improve your health and libido.

There are also some other basic improvements that that all men can do to improve their chances of conception. I advise to stop smoking, to be aware of medications that may affect the endocrine systems and to avoid recreational drugs and limit alcohol. Another important factor is sunlight. Filling up on Vitamin D. For men who are interested in supplementing their diet with anti-oxidents to boost their fertility, we advise considering an increased intake of:

Vitamin E 

A fat-soluble vitamin and the main anti-oxidant in sperm membranes. Vitamin E is found in a wide variety of foods, with the richest sources being plant oils, such as soya, corn and olive oil. Other good sources include, nuts and seeds and wheat germ, found in cereals. 

Vitamin C

Vitamin C is a water-soluble vitamin and its most important role in male fertility is the prevention of agglutination – when sperm clump together. It is also a powerful anti-oxidant and present in high levels in seminal fluid. Over heating and smoking easily destroy it, so wearing loose clothing, cutting out cigarettes and increasing consumption of oranges, red and green peppers, strawberries, blackcurrants, broccoli, sprouts and potatoes which all rich sources of Vitamin C, will help. 

Zinc

Zinc is a trace mineral, and perhaps one of the most well-known nutrients in male fertility. Zinc deficiency decreases both testosterone and sperm counts. It is highly concentrated in the seminal fluid and significantly correlates to sperm density, motility and viability. However be careful not to over-do consumption with too many supplements as this can have a detrimental effect on your health. Instead, look for zinc in foods such as meat, shellfish, dairy, bread and wheat germ.

Other vitamins to look out for include: vitamins B12, found in meat, seafood, milk products, poultry and eggs; folic acid, found in lentils, dried beans and peas, broccoli, asparagus and spinach and citrus fruits. 

L-Arginine

This is an amino acid that may affect both sperm count and motility. The heads of sperm contain large amounts of L-Arginine and abnormal sperm counts often indicate a deficiency of arginine in the semen. Find it in red meat, chicken, fish and dairy. The amino acid taurine found in meat and fish is also thought important for fertility.

Dietary and lifestyle changes can make a significant, positive impact on the chances of a couple conceiving naturally, so it is worth making these small changes to your diet as you embark on creating a family together. 

But of course this is a journey for both partners and can be more fun if you share the effort together. After all, you both have a lot to gain from enhancing your fertility. 

References:

1. Impact of obesity on male fertility, sperm function and molecular

Composition: Nicole O. Palmer (School of Paediatrics and Reproductive Health; The Robinson Institute; Discipline of Obstetrics and Gynaecology; The University of

Adelaide; Adelaide, SA Australia; Hassan W. Bakos, School of Medicine, Discipline of Medicine, The University of Adelaide, Adelaide, SA Australia; Tod Fullston, Repromed; Dulwich, SA Australia

2. March 2012 Archives of Internal Medicine.

3. References:1. Stanislavov, R. & Nikolova, V. Tribulus terrestris and Human Male Fertility: I. Immunological Aspects. Comptes Rendus de l’Academie Bulgare des Sciencesi, vol. 53, p.10:107 (2000). Retrieved from: http://articles.adsabs.harvard.edu/full/2000crabs..53j.107s/J000107.000.html

2. MacKay D. Nutrients and botanicals for erectile dysfunction: examining the evidence Alternative Medicine Review. 2004;9(1):4-16.

3. Horowitz S. Treating infertility Altern Complement Med. 2006; August:165-171.l

Nice Guide lines 2003 /2004 : 1.3 Investigation of Fertility problems and Management strategies 

1.3.1 Semen analysis

1.3.1.1

The results of semen analysis conducted as part of an initial assessment should be compared with the following World Health Organization reference values [2]:

4. semen volume: 1.5 ml or more

5. pH: 7.2 or more

6. sperm concentration: 15 million spermatozoa per ml or more

7. total sperm number: 39 million spermatozoa per ejaculate or more

8. total motility (percentage of progressive motility and non-progressive motility): 40% or more motile or 32% or more with progressive motility 

9. vitality: 58% or more live spermatozoa 

10. sperm morphology (percentage of normal forms): 4% or more. [2004, amended 2013]