Optimizing Male Fertility

Sometimes I think we miss the boat on male factor infertility.

Patients, and sometimes their doctors, forget about the husbands or partners of our female factor infertility patients. Seems that most times, the female half of the couple is the one seeking care. Statistically, male factor infertility is clearly involved in at least 40% of infertility cases, just like female factor infertility. The remaining 20% are unexplained infertility issues, and logically half of those are male factor. In many cases, both the male and the female in the couple have issues. And yet, 80% of our patients are female. I think it is important to remember that just because one person in a couple has a diagnosable issue, it does not mean that the other person in the couple does not have a problem that could be negatively impacting fertility.

Some of this discrepancy can be explained by the fact that, for couples undergoing IVF, ICSI can be utilized, virtually taking the male factor out of the equation. But for those not utilizing IVF with ICSI, a lot can be done to improve the quality of the sperm and semen. For that matter, wouldn’t it be best if, when the IVF clinic is doing ICSI, they had higher quality sperm to choose that special one from?

Like all human physiological functions, the production of sperm can be greatly influenced by environment and lifestyle. A diet high in saturated fats and salt can deplete sperm count, concentration, and morphology. Exposure to heat or a hot environment can deplete sperm concentrations, morphology, and motility. Obesity can be a problem because it causes the scrotal temperature to be too high. Both high and low BMI (body mass index) can cause sperm quality problems. Optimally BMI should be between 20 and 25. Issues can also be caused be electromagnetic radiation from phones in the pocket or laptops on the lap. Prolonged sitting or standing, particularly on vinyl seats or chairs, can cause problems with sperm quality. Bicycling can cause circulatory deficiencies to the testicles, damaging sperm. These are delicate little organisms, good thing we make a bunch of them!!

There are five major factors that influence male fertility. They are:

  • Sperm
  • Semen
  • Testosterone
  • Erectile function
  • Temperature

Let’s look at each individually.

Sperm: Obviously, sperm fertilize the egg. It only does take one. But the journey from penis to egg is a long and arduous one for these single cell organisms, so there needs to be a lot of them. Millions and millions die along the way. Low sperm count is a big problem. Here’s an alarming fact: in 1992, the World Health Organization said that the average sperm count for men was more than 40 million. in 2010, that had fallen to less than 39 million. During that time, average morphology for men fell from greater than 30% normal forms to about 4% normal forms, a drastic decrease in the normal morphology of sperm. No one really knows why, but environmental factors are probably responsible for this drastic decrease. The average healthy male produces 100 to 300 million sperm per day.

Semen: Seminal fluid is made of fluid from the prostate and the seminal vesicles. Average ejaculate should be 3-5 ml of semen. The job of semen is to keep the sperm alive for as long as possible by protecting the sperm (average pH 7.9) from the vaginal environment (average pH 4.0 to 4.5.) Enzymes in the semen ensure liquefaction after ejaculation. Semen should ejaculate with force, not dribble. (Chinese herbs can help this problem.)

Testosterone: We all know that testosterone turns men into brutish, aggressive thugs. (not really, just kidding!!) It does help the sperm to mature and increases sexual desire. It is highest in the morning, and testing of testosterone levels should be done then. Levels of testosterone are reduced by diabetes, alcohol, obesity, varicoceles, adult mumps, anabolic steroids, stress and depression. Testosterone levels fall approximately 1% per year starting at age 30.

Erection: Not sure I need to explain this one, but basically, erectile dysfunction prevents conception. Erectile health is usually a clear indication of not only sexual health, but of health in general. Circulatory impairment, as in smokers and diabetics, may be a primary cause of erectile dysfunction, as can testosterone deficiency.

Temperature: The temperature of the scrotum is critically important in sperm health. Scrotal temperature should be 1 to 8 degrees lower than the body temperature. Hot baths, saunas, phones in pockets cause scrotal temperature to increase to a point of affecting sperm motility, morphology, and count.

A few other factors to consider:

Anti Sperm Antibodies (ASAB): This is a condition wherein the immune system has decided that the sperm are a foreign protein, and develops antibodies against them. There are pharmaceutical treatments for this, and there are Chinese medicine treatments for it. Either of these are viable, I (for obvious reasons) prefer the latter. Sports injury, prostatitis, testicular surgery and vasectomy reversal are frequent causes of anti-sperm antibodies.

Varicocele: This is a varicosity of the testicular veins, and by far the best treatment for it is Chinese herbs. Works fast and well.

Time: Depending on who you ask, it takes between 70 and 100 days to make a sperm. Any changes you make today, however perfect they may be, will not show up for a while. This is why men who undertake treatment with Chinese herbs and acupuncture will not see much result for three months. I recommend semen analysis once per month while being treated to make certain we are heading in the right direction.

One other really important thing to consider is that not all male factor fertility issues show up on routine semen analysis. DNA issues in the sperm, which will not show up on SA, can cause inability to conceive, recurrent pregnancy loss, birth defects, and slow early embryonic development.

Most of my patients have heard me say that there is no such thing as a sperm that is too good, too strong, or too well shaped. I believe most of our patients would benefit by including their male partner in their acupuncture and Asian herbal medicine treatments. We do offer a discount for couples who come together.

Please let us know if you, and/or your male partner, would like to take advantage of male factor fertility protocols.

My thanks to Jill Glover, L.Ac. for her expert help with this article.

Sincerely, Dr. Cherry