“Male factor” infertility is seen as a reduction in sperm concentration, motility and/or a change morphology (shape) in at least one of two sperm samples, collected 1 - 4 weeks apart. Male infertility accounts for 40-50% of infertility and affects approximately 7% of all men. There are well-known medical causes of male infertility that include:
· Varicocele
· Testicular Failure
· Hormone imbalance
· Infection
· Ejaculation Dysfunction
· Sexual Dysfunction
· Immune Factors
· Genetic Factors
· Drug-Induced
· Previous Cancer Treatment or Radiation Therapy
· Idiopathic – Meaning “Unknown Causes”
Idiopathic or unknown causes of male infertility represent a significant portion of infertility cases and are often discovered on sperm analysis when sperm quality is low without a clear medical reason. A number of lifestyle factors have been linked to poor sperm quality including:
· Prolonged exposure to heat
· Obesity
· Older age
· Smoking
· Alcohol
· Heavy metal exposure
· Pesticide exposure
· Oxidative stress
· Genetic factors
· Environmental factors
· Nutritional factors
If you think that sperm quality is affecting your ability to conceive – it is important to mention this to your medical doctor or fertility specialist as it is still surprisingly overlooked in fertility treatments that remain mostly female-centric. Although, one sperm analysis is generally used to assess male factor infertility, it is highly recommended that your fertility assessment include:
· A Physical Exam including a testicular exam by a MD with appropriate training or expertise.
· At least 1 sperm analysis. However, as sperm is variable, the World Health Organization recommends two analyses. Such a test should include a test for DNA fragmentation.
· A full evaluation by a urologist or reproductive specialist should be scheduled if the results of the above tests are abnormal. Or in cases where there is a treated, female infertility factor yet infertility persists.
If you are like many couples, looking for ways to optimize sperm count, motility and shape - there is a lot you can do naturally!
Scrotal Temperature:
There is mixed evidence on the impact of scrotal temperature on sperm quality but it makes sense to be mindful. Reduce tight clothing that impairs circulation or causes heat. Exercise mindfulness when working long days around hot equipment. Examples include manual laborers who are required to wear thick clothing around hot equipment or workers who leave a laptop on their legs all day. In addition, exercise such as cycling also has a heating effect.
Obesity:
Numerous studies have shown that sperm quality decreases with increasing body weight (Calculated as Body Mass Index or BMI). Men with high body fat percentages are more likely to convert testosterone to estrogen, an undesirable hormone for male fertility. In addition, obese men show altered sperm quality as well as DNA damage/fragmentation of sperm. Weight loss and lowering of BMI have helped improve sperm quality in some, but not all men.
Age:
Similar to ovarian function in women, sperm quality decreases with age in men. There is debate and variability on when this begins but most sources cite 40-50 years of age with a consistent decline over the rest of a man’s lifetime. Maintaining a anti-inflammatory lifestyle can help reduce the impact of ageing on sperm quality. Read more below!
Smoking:
Cigarette smokers have lower semen volumes, sperm counts, and percentage of motile sperm compared to men who did not smoke. The relationship between smoking and sperm concentration seems to be dose-dependent (meaning that the more you smoke, the larger the problem). Men who smoked > 20 cigarettes per day experienced a 19% reduction in sperm concentration compared with non-smokers. Research has also demonstrated that cigarette smoking impacts the genetic quality of sperm and may have a genetic impact on future children. Work with your naturopathic doctor on a plan to cut smoking out entirely at least 3 months prior to conception.
Alcohol:
Chronic Alcohol Consumption is shown to reduce testosterone, increase estrogen and decrease sperm. The reduction in sperm is dose dependent with progressive deterioration of sperm count, concentration and morphology; this result is more evident in patients with a weekly alcohol intake higher than 25 ‘units’. The impact is exacerbated by smoking. Reducing alcohol consumption to the recommended limits or cutting it out completely is advised.
Marijuana and Other Substance Use:
The impact of substance use on male fertility is well known in general, however it is worth mentioning that all recreational drugs should be stopped prior to attempting to conceive. This is also true for marijuana which many couples assume will be harmless. Research supports a role for cannabis in reducing sperm count and concentration, inducing abnormalities in sperm morphology, reducing sperm motility and viability, and inhibiting capacitation and fertilizing capacity. Animal models demonstrate a role for cannabis in testicular atrophy and reduced libido and sexual function, but these results have not yet been replicated in human studies. Discontinue marijuana use a minimum of 3 months prior to conception.
Ask your Doctor about the safety of your medication:
Some prescription medications affect male fertility including some medications for depression, high blood pressure, ulcers, gastric reflux/ heart burn, aromatase inhibitors, anabolic steroids, gout, fungal infections and some antibiotics.
Environmental:
Environmental elements that affect fertility include pollution (PCB’s, dioxins, phthalates, DDT among others), heavy metals, solvents, pesticides as well as exposure to Electromagnetic Frequencies (EMF). The environment you live in, the foods you eat, the water you drink, the skin care or cosmetic products you use and the cleaning products you use all contribute to environmental exposure. There has been an alarming rise in male infertility in certain countries and areas of the world including Africa and Central/Eastern Europe, North America and Australia that can only be explained by environmental factors. In addition, it appears that some environmental factors influence the genetics of future generations and that certain genetic features make certain individuals more susceptible to environmental toxins.
Therefore, it is important to become aware and educated around environmental influences on fertility, to take these issues seriously. If unexplained fertility is an issue, it makes sense to reconsider your environment, your food, water supply and the chemicals you apply to your hair or skin or the ones you clean with. Bringing awareness to your surroundings will not just help with fertility but with your health and longevity in general. Genetic testing can be helpful to see if you clear toxins well. Heavy metals and solvent burden can be tested.
Finally, electromagnetic toxicity (EMFs) are another important potential source of infertility. Small studies indicate that EMFs have a negative impact on sperm DNA. It is important that men keep their cellphones out of their pockets and laptops off their laps.
Stress:
Yes! Stress has a profound impact on fertility. The main stress hormone, cortisol, has been shown to suppress testosterone and other factors that influence spermatogenesis. Lifestyle changes, reflection, meditation and counselling are all great ways to address stress.
Nutrition:
Last, but certainly not least, nutrition has a huge impact on the overall health of the body and, in particular, oxidative stress. Oxidative stress causes and is triggered by inflammation in the body. A highly inflammatory diet and lifestyle have been linked to infertility in men and women. In the supplement list that follows, you will find that many of the supplements support antioxidant (anti-inflammation) mechanisms in the body). The recipe for healthy nutrition is more simple then the media makes it seem:
· Reduce Saturated Fat to less than 10% total caloric intake
· Increase Fruit & Vegetable Intake to 8-10 servings per day
· Maintain a healthy balance of whole grains while avoiding refined carbohydrates 2-3 servings per day
· Increase dietary fibre to 50 g per day
· Reduce exposure to synthetic estrogens through cooking practices (such as using plastic mugs, cups or heating food in plastic Tupperware).
· Drink Water
· Minimize caffeine to less than 200mg per day (1-2cups)
Supplements:
Many of the supplements listed below play an important role as anti-oxidants. Most of the studies on these supplements are small but they all have that one feature in common. Using supplements to increase fertility is supplementary to adopting lifestyle and diet changes that reduce stress, reduce or eliminate environmental toxins, improve diet and reduce overall inflammation.
Horse Chestnut Seed Extract is a herbal mixture of saponins with antioxidants, anti-edematous, and anti-inflammatory properties that has been shown to be beneficial in men with varicocele-associated infertility. The benefit was more notable in mild cases of varicocele.
Coenzyme Q10 (CoQ10) is an antioxidant commonly recommended in female and male fertility treatment. In men, it appears to help with sperm production, concentration, motility and morphology. Interestingly, some studies have shown that FSH and LH can decrease while testosterone seems unaffected.
Glutathione is an intracellular antioxidant found in every cell of the human body. Glutathione supplementation has been found to improve sperm motility and morphology.
Korean red ginseng is a well-known and long-used herb in Traditional Chinese Medicine that has been found to improve sperm concentration, motility, morphology, and viability. It can also help to increase sex drive and reduce sexual dysfunction.
L-carnitine is derived naturally from the amino acids found in protein. It is required for fatty acid and energy metabolism but also plays a role as an antioxidant. It is readily made inside the body and individuals are rarely deficient however, some studies have shown that a 2-month supplementation with L-carnitine improved sperm motility and concentration.
Black Cumin is a medicinal plant with antioxidant properties that has shown improved sperm count, motility, morphology and semen volume.
Omega-3 fatty acids (DHA, EPA and ALA) are essential to human health and also play anti-inflammatory and antioxidant roles. Men with poor sperm parameters have shown lower levels of DHA compared to fertile men. EPA and DHA in the seminal plasma are correlated with antioxidant activity. In a study of 211 infertile men with abnormal semen parameters, omega-3 supplementation for 28 weeks improved sperm concentration, motility and morphology
Selenium is a mineral that has shown beneficial effects to sperm in terms of motility. When dosed at higher levels, it has been shown to increase sperm concentration, motility and volume. Adding N-acetyl-cysteine (NAC) enhances this effect. This combination also seems to increase testosterone levels and decrease LH and FSH.
Zinc is another mineral that may also promote sperm quality through its antioxidant and anti-apoptotic properties. Zinc acts as a cofactor in DNA transcription and protein synthesis in spermatogenesis. Zinc depletion can cause reduced semen volume and decreased serum testosterone.
Resources/References
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