What To Consider When Thinking About Male Fertility
Time and time again, infertility problems are often primarily thought of as a female issue. Male infertility is talked about significantly less, and in my own clinical and personal experience, more commonly overlooked. Men considering their own fertility may feel isolated, and even undervalued in their own contribution to the process. So, let’s talk about it.
In men, infertility is essentially defined as the inability to fertilize the ovum (egg). A male’s inherent fertility potential relies on a few things:
Adequate production of sperm by the testes.
Unobstructed transit and movement of sperm through the seminal tract.
Proper delivery to the ovum (egg).
Medical history is important. For example, this could include a previous mumps infection, failure of the testes to descend as a child or any potential STIs.
A physical exam should be done in order to evaluate the size and shape of the testicles. This also allows the healthcare provider to assess for the potential presence or lack of varicocele. A varicocele causes scrotal swelling and this can potentially obstruct the vas deferens (which is an important factor when it comes to proper sperm transportation). A varicocele can also interfere with testosterone levels and sperm production.
A semen analysis may be run, and is important to determine if there is:
Sufficient sperm counts (i.e. enough sperm).
Sufficient sperm motility (i.e. the sperm should be moving appropriately and with effective, purposeful movements).
Sufficient sperm morphology (i.e. normal sperm shape/size, without defects in the sperm itself).
So, that being said, sperm is important for determining male fertility.
Here are a few ways that sperm production and quality may be affected:
Radiation and potentially some environmental toxins.
Trauma to the testes.
Infectious trauma to the testes.
Urogenital infections.
Sexually transmitted infections.
Prolonged fever.
Endocrine disorders - for example, hypothyroidism.
Some lifestyle factors affecting sperm production and quality include:
Elevated scrotal temperatures:
Type of underwear worn.
Long periods of sitting or inactivity.
Chronic use of hot baths, seat warmers, hot tubs, etc.
Electronics in chronic, close proximity to the genitals. (1, 2, 3)
Poor diet and issues with weight management. (4)
Overuse of alcohol, nicotine and marijuana. (5, 6, 7, 8)
Stress. (9, 10)
Lack of proper sleep. (11, 12)
Now, whether it’s a problem with a mechanical/anatomical issue or sperm, there are a number of conventional methods to address male fertility:
Surgical options to repair mechanical concerns with the vas deferens or to address a varicocele.
Supplementation with hormones and/or medications to address potential underlying causes of infertility.
In vitro fertilization (IVF) or intrauterine insemination (IUI).
Further referral to a fertility specialist, reproductive endocrinologist or urologist.
In addition to working with a number of incredibly beneficial botanicals and natural health products (NHPs), Naturopathic Doctors (NDs) will work to:
Optimize nutrition & exercise and work to identify any nutritional deficiencies. Clinically, some of the following nutrients may be investigated and supported:
Zinc (13)
CoQ10 (14, 15)
Essential fatty acids (16, 17)
Selenium (18)
Address any lifestyle factors that might be a contributing factor:
Environmental and occupational toxins: pesticides (DES), PCBs, ethylene glycol ethers, bisphenol-A, phthalates, lead, arsenic, cadmium and mercury. (19, 20)
Monitoring and manipulating scrotal temperatures that encourage testosterone and sperm production.
Frequency and timing of intercourse.
Types of lubricants used and their role in sperm motility.
Issues with weight and insulin resistance are often correlated to low testosterone, so weight management and support of cardiovascular health is also important in the management of male fertility.
Stress management – psychological stress can inherently lower testosterone due to the role of cortisol. High cortisol can increase estrogen in the male body.
Providing support for patients who require limitation or complete cessation of alcohol, nicotine and marijuana.
Working with the emotional side of fertility – supporting patients through their fertility journey, both individually, and with their partner.
Supporting sleep. Sleep deprivation is known to disrupt a number of hormones and is associated with weight gain and insulin resistance.
Acupuncture: working to support the whole constitution (physically, emotionally) of the patient but also encouraging circulation into the reproductive organs.
Reference(s):
(1) Sheynkin Y, Jung M, Yoo P, Schulsinger D, Komaroff E. Increase in scrotal temperature in laptop computer users. Hum Reprod. 2005 Feb;20(2):452-5.
(2) Adams JA, Galloway TS, Mondal D, Esteves SC, Mathews F. Effect of mobile telephones on sperm quality: a systematic review and meta-analysis. Environ Int. 2014 Sep;70:106-12.
(3) Avendaño C, Mata A, Sanchez Sarmiento CA, Doncel GF. Use of laptop computers connected to internet through Wi-Fi decreases human sperm motility and increases sperm DNA fragmentation. Fertil Steril. 2012 Jan;97(1):39-45.
(4) Ahmad O. et al. Obesity and Male Infertility. Semin Reprod Med. 2012;30(6):486-495.
(5) Pasqualotto FF, Umezu FM, Salvador M, Borges E, Sobreiro BP, Pasqualotto EB. Effect of cigarette smoking on antioxidant levels and pres- ence of leukocytespermia in infertile men: a prospective study. Fertil Steril 2008;90:278–83.
(6) Stillman RJ, ed. Seminars in reproductive endocrinology: smoking and reproductive health. New York: Thieme Medical Publishers; 1989.
(7) Said TM, Ranga G, Agarwal A. Relationship between semen quality and tobacco chewing in men undergoing infertility evaluation. Fertil Steril 2005;84:649–53.
(8) Klonoff-Cohen HS, Natarajan L, Chen RV.A prospective study of the effects of female and male marijuana use on in vitro fertilization (IVF) and gamete intrafallopian transfer (GIFT) outcomes. Am J Obstet Gynecol. 2006 Feb;194(2):369-76.
(9) Whirledge S, Cidlowski JA. Glucocorticoids, stress, and fertility. Minerva Endocrinol. 2010 Jun;35(2):109-25.
(10) Li Y1, Lin H, Li Y, Cao J. Association between socio-psycho-behavioral factors and male semen quality: systematic review and meta-analyses. Fertil Steril. 2011 Jan;95(1):116-23.
(11) Jensen TK et al. Association of sleep disturbances with reduced semen quality: a cross-sectional study among 953 healthy young Danish men. Am J Epidemiol. 2013 May 15;177(10):1027-37.
(12) Rocha CS et al. Melatonin and male reproductive health: relevance of darkness and antioxidant properties. Curr Mol Med. 2015;15(4):299-311.
(13) Wu J et al. Zinc protects sperm from being damaged by reactive oxygen species in assisted reproduction techniques. Reprod Biomed Online. 2015 Apr;30(4):334-9.
(14) Mancini A., De Marinis L., Oradei A., et al: Coenzyme Q10 concentrations in normal and pathological human seminal fluid. J Androl 15. 591-594.1994
(15) Safarinejad M.R.: Efficacy of coenzyme Q10 on semen parameters, sperm function and reproductive hormones in infertile men. J Urol 182. 237-248.2009
(16) Safarinejad M.R.: Effect of omega-3 polyunsaturated fatty acid supplementation on semen profile and enzymatic anti-oxidant capacity of seminal plasma in infertile men with idiopathic oligoasthenoteratospermia: a double-blind, placebo-controlled, randomised study. Andrologia 43. 38-47.2011;
(17) Attaman J.A., et al. Dietary fat and semen quality among men attending a fertility clinic. Hum Reprod 27. 1466-1474.2012;
(18) Safarinejad M.R., Safarinejad S.: Efficacy of selenium and/or N-acetyl-cysteine for improving semen parameters in infertile men: a double-blind, placebo controlled, randomized study. J Urol 181. 741-751.2009.
(19) Sheiner EK, heiner E, Hammel RD, Potashnik G, Carel R. Effect of occupational exposures on male fertility: literature review. Ind Health. 2003 Apr;41(2):55-62.
(20) Jurewicz J, Hanke W, Radwan M, Bonde JP. Environmental factors and semen quality. Int J Occup Med Environ Health. 2009;22(4):305-29.