In men, infertility is defined as the inability to fertilize the ovum. Sterility is defined as the lack of sperm production. Male fertility depends upon three things: adequate production of spermatozoa by the testes, unobstructed transit of sperm through the seminal tract, and satisfactory delivery to the ovum.
Laboratory analysis of sperm count, motility and morphology are the main parameters which gauge a man's ability to father a child.
WESTERN MEDICAL TREATMENT
Male infertility factors are easier to diagnose with Western methods than female infertility, but harder to treat. In cases of mechanical obstruction, the only potential remedy is surgery. Luckily, new microsurgical techniques have made it possible to repair obstructions or other problems within the narrow spaces of the vas deferens and the epididymis, the duct leading from testes and the location where sperm mature. In cases of varicocele, the affected vein or veins are either tied off surgically, or a balloon or other support is implanted in the vein to allow blood to flow freely through it again. Unfortunately, varicocele surgeries can worsen sperm counts because with every surgery, there is a risk or scarring and adhesion formation.
In cases of poor sperm production or quality, there are some dietary and lifestyle changes that can help. However, when it comes to hormonal abnormalities, Western medicine has little to offer as supplementation with testosterone, FSH, LH, or other hormones rarely improves sperm production significantly.
If a man has some healthy sperm present, the doctor may recommend that he and his partner try either an IUI or IVF procedure. In both cases, the man's sperm is retrieved, either from ejaculate or by extracting the sperm surgically from the epididymis, washed, and the healthy sperm separated out. This sperm sample is then placed in the woman's uterus through intrauterine insemination (IUI), or mixed with her retrieved eggs in an IVF procedure.
DISCUSSION AND ROOT CAUSES
Diagnosing male infertility issues usually begins with a doctor taking a thorough medical history to see if factors in the patient's past could be contributing to the problem. Significant factors would include a history of childhood cryptorchidism, which is failure of the testes to descend, mumps, or history of sexual problems, including sexually-transmitted infections.
The review of history is followed by a physical exam, including a prostate check. During the physical exam, the doctor looks for possible structural and/or congenital abnormalities that may cause obstruction of the seminal tract. The size and shape of the testicles are evaluated to see if they are within the normal range. Of particular interest is the presence of a varicocele-essentially, a varicose vein in the blood vessels serving the testicles, sometimes causing scrotal swelling. Occasionally, the swelling caused by a varicocele obstructs the vas deferens, the passage from the scrotum to the ejaculatory duct; more often, the abnormal backflow of blood into the scrotum causes the temperature in the testes to rise, which may interfere with testosterone levels and sperm production. Around 40 to 50 percent of men who report infertility are found to have a varicocele, although it's possible this condition can be found in upwards of 10 to 15 percent of all men, some of whom aren't diagnosed with infertility.
After examining the genital area, the doctor usually conducts a general evaluation of secondary sex characteristics such as breast size, amount and location of body hair, etc., as these may provide clues to an underlying endocrine disorder. As clues as to the cause of infertility are uncovered, results are often confirmed with further tests, including a semen analysis, measurements of hormone levels in the blood, and possibly x-rays or other tests to determine if there are any conditions that could prevent the sperm from being ejaculated. One such condition, retrograde ejaculation, is caused by a weakening of the muscles surrounding the bladder and the urethra. When these muscles are too weak to close the bladder's sphincter, the ejaculate can flow backwards into the bladder instead of through the ejaculate tube.
Most infertility evaluations for men include an analysis of their semen. One or more samples are sent to a laboratory and analyzed for:
- deficient sperm count (less than 20 million per milliliter; volume should be 1 to 5 milliliters of ejaculate),
- insufficient sperm motility (less than 50 percent motile and demonstrating purposeful forward movement), and/or
- poor sperm morphology (less than 30 percent normal form).
In 40 percent of male infertility cases, sperm abnormalities are either a factor or the factor in the condition. The average ejaculate sample contains almost 200 million sperm, but amazingly, only a few dozen sperm actually reach the egg for a chance at penetration. This makes for some pretty ominous statistics for sperm overall. Sperm numbers must be high just to have a modest hope of reaching the vicinity of the egg that is traveling down the fallopian tube.
Sperm counts have dropped 50 percent in the last 35 years. Sperm are just as susceptible as eggs to environmental influences. Deficient sperm production may be affected by factors such as radiation and other environmental toxins, an undescended testis, a varicocele, trauma-induced or infectious testicular atrophy, drug effects, prolonged fever or endocrine disorders affecting the hypothalamic-pituitary-gonadal axis. Low sperm counts can also be aggravated, if not caused by, factors such as tight-fitting underwear, which raises the scrotal temperature, environmental toxins, urogenital infections, poor diet and prescription drugs (e.g., anti-hypertensives and anti-inflammatories can drastically reduce sperm count). Even antihistamines can negatively affect sperm count by diminishing the quantity of seminal fluid. Stress, lack of sleep, and overuse of alcohol, nicotine, and marijuana decrease sperm production, as well.
If semen analysis shows results within normal parameters, and if physical examination has indicated no possible obstructions, hormone levels will be measured. To produce healthy sperm, men need many of the same hormones women do to produce healthy eggs, only these hormones are present in different amounts in men than in women. For instance, sperm production begins during puberty in response to the same hormones-LH and FSH-which trigger egg production in the female. In men, LH signals cells within the Leydig cells of the testes to produce testosterone, and FSH signals Sertoli cells to produce sperm. Hormonal tests will measure FSH and LH (normal levels of FSH in men are 4 to 10 mIU/mL), androgens (including testosterone; normal levels range between 300 and 1,111 nanograms per decaliter), and prolactin (the lactating hormone; amounts over 20 ng/mL can cause reduced fertility). In addition, hormone production by the thyroid and pituitary glands as well as the hypothalamus must be assessed to see if low hormonal levels are contributing to sperm abnormalities.
In certain couples antisperm antibodies also may be a factor in reduced fertility. Antisperm antibodies may be produced by either partner. In both cases, the antibodies will attack the sperm as if they were dangerous invaders, killing them off before they can reach the egg. Other tests of the sperm include measuring its ability to penetrate both the cervical mucus and the outer layer of the egg.
EASTERN MEDICINE DIAGNOSES
From the Chinese perspective, the main causes of male infertility fall into two broad categories: deficiency or vacuity of the Kidneys, usually Kidney Yang, sometimes Kidney Yin, or damp heat in the pelvic organs. Strengthening the source Qi, the basis of all life and cellular function, has been shown to promote testicular growth, testosterone levels and sperm formation.
A 1997 article in the Journal of Chinese Medicine stated the main causes of sperm abnormality are deficiency of Kidney Yang or Kidney Yin, or deficiency of the Kidneys that affects the Liver and Spleen and leads to stasis of Qi and Blood or downward flow of damp heat. Even when symptoms indicate patterns of excess damp heat and Qi and Blood stasis, they are usually superimposed upon or even caused by Kidney deficiency. Therefore, tonifying the Kidney almost always produces an improvement in sperm production and quality.
The presence of a varicocele translates to Blood stasis in Chinese medical diagnosis. The swollen veins obstruct transit, so treatment involves invigorating and moving the Blood so the sperm can develop normally.
Almost all aspects of male infertility can benefit from treatment using The Fertile Soul MethodTM. Certainly, sperm production and quality can be increased. Some mechanical blockages can be dissolved or reduced. Unlike treatment with Western medicine, even hormonal factors can be resolved by restoring balance to the entire body.
To nourish the sperm, the seminal vesicles secrete substances including fructose, which feeds the sperm, fibrinogen, which holds or coagulates the fluid together, and prostaglandins, which help the sperm penetrate the cervix. The prostate adds an alkaline fluid to the ejaculate. Seminal fluid in normal, fertile men contains antioxidant factors. In many sub-fertile men, the seminal fluid does not contain these protective elements, or the circulating free radicals may be so abundant that the seminal fluid is not capable of eliminating the damaged cells. Men with sub-optimum sperm counts should include dietary sources of antioxidants like wheat and barley grass, sprouts and dark green vegetables.
The plasma membrane of human sperm contains high levels of polyunsaturated fatty acids, making them extremely susceptible to damage by free radicals, which can lead to lower motility and morphology. Adding unsaturated fatty acids like those found in sesame, almond, flax seed, hazelnut, pecan, pumpkin seed, sunflower seed, pine nut, walnut, olive, avocado, soybean and quinoa, and omega-3 fatty acids found in fish oil to the diet can help sperm integrity.
Many environmental and dietary factors are hostile to the production of healthy sperm. For example, estrogen is important in sperm formation, but consuming too much synthetic estrogen in the diet can be harmful. Unfortunately, most meat, dairy products and even poultry and eggs contain substantial quantities of synthetic estrogens. Some reports have shown the presence of synthetic estrogen in sources of drinking water as well. Therefore, eating only hormone-free meat, poultry, eggs and dairy products, and drinking only purified drinking water is suggested. Many environmental toxins such as pesticides and other chemicals found in non-organically grown produce also can impair spermatogenesis, so you should consume only organic fruits and vegetables whenever possible. To support cardiovascular and reproductive health, avoid saturated fats, hydrogenated oils, coconut, palm and especially cottonseed oil, which contains gossypol, a chemical that inhibits sperm formation. Include polyunsaturated oils and essential fatty acids as both contribute to the health of the sperm and seminal fluid.
A wide variety of natural supplements can be used to promote fertility in men. For instance, soy products contain isoflavones or phytoestrogens that have a very weak estrogenic effect that actually inhibits the production of excess estrogen in the body. Soy, other legumes, nuts and seeds also contain phytosterols that promote testosterone production.
Oxidative damage is present in almost half of the diagnosed cases of insufficient sperm count. The seminal fluid contains high levels of antioxidants, but when the development of healthy sperm becomes impaired because of environmental toxins, stress or pharmaceutical agents, the seminal fluid will be found to have elevated levels of oxidants. To halt this process and prevent further free radical damage to developing sperm, it is recommended that the following nutritional supplementation be used by most, if not all men:
- A good multi-vitamin and multi-mineral
- Vitamin C: 2,000 mg/day (in divided doses)
- Beta-carotene: 100,000 IU/day
- Selenium: 200 mcg/day
Other important nutritional supplements include:
- Zinc: 60 mg/day, which is necessary for sperm production and testosterone metabolism
- Vitamin B12: 1,000 mg/day, involved in the replication of cells
- L-arginine: 4 g/day, an amino acid involved in cellular replication
- L-carnitine: 600 mg three times per day, this amino acid, found in very high levels in sperm, transports fatty acids into the mitochondria and assists sperm motility
To improve poor morphology and decrease high levels of oxidants in the seminal fluid, take antioxidants and superantioxidants like pycnogenol. One of the most potent bioactive antioxidant sources, pycnogenol, comes from the extracts of pine bark extract, red wine extract, grape seed extract, and bilberry extract. Pycnogenol also enhances the effects of other antioxidants.
CHINESE HERBAL THERAPY
Prescription herbal treatments can be used to achieve a number of objectives with respect to male factor issues. Most cases of male infertility involve some element of Kidney vacuity, which can be treated effectively with Kidney tonifying herbs. Other energetic patterns and conditions that improve with TCM herbal treatment include strengthening Source Qi, an important component in a man's reproductive health, as it is considered the basis of all life and cellular function. Ginseng (Chinese, Korean, or Siberian) supplements the source Qi, and has been shown to promote testicular growth, testosterone levels, and sperm formation.
Other specific objectives for herbal treatment include:
- To invigorate the Blood.
- To increase sperm counts: Take Blood and Qi tonics and seeds like Lycium and Cuscuta.
- To improve testosterone levels: Take Qi tonics like Ginseng.
- To improve sperm motility: Tonify Qi and Yang using Cornus.
- To improve liquefication: Supplement Kidney Yin with Asparagi, Ophiopogon or the formula Liu Wei di Huang Wan
- To resolve varicoceles: Apply a cold pack to the scrotum twice per day and take the herbal formula Gui Zhi Fu Ling Wan, which consists of Ramulus Cinnamomi Cassiae, Sclerotium Poriae Cocos, Radis Paeoniae, Cortex Moutan Radicis and Semen Persicae. This formula, which is traditionally used for gynecologic disorders of Blood stasis in the Uterus, has proven very promising in treating morphologic sperm abnormalities resulting from varicocele. Men also derive great improvement with the formula Cinnamon and Poria decoction.
ACUPUNCTURE AND ACUPRESSURE
Acupuncture treatments for male factor conditions are determined by the specific pattern being presented. Western medicine provides little in the way of assistance for male fertility problems caused by hormonal factors. However, acupuncture has been shown to help balance the hormonal system and restore higher levels of virility in men. Acupressure should be applied to the front and inner thighs at any areas of deep soreness. Massage deeply until tenderness resolves. The Infertility Cure offers detailed guidance on acupressure techniques.
If the seminal fluid is too viscous, the sperm cannot travel freely through the cervix. Men with overly-viscous seminal fluid should consider taking herbs which supplement the Yin like Ophiopogon or the herbal formula Liu Wei di Huang Wan. Guaifenesin, an expectorant found in some cough syrups, reduces the surface tension and therefore the viscocity of mucous secretions. We recommend that pure Guaifenesin, without other ingredients, be taken before the partner's ovulation.
Another potential problem with sperm viability is incompatibility with a woman's cervical mucus. It is extremely important to keep the sperm in a more alkaline environment because the vaginal pH is relatively acidic. If a woman's cervical and vaginal environment is too acidic, the sperm will not be able to survive. If she douches with vinegar, the acidity may become even more problematic. This scenario may be alleviated if she switches to douching with a baking soda and water solution. Sperm antibodies are addressed in TCM using pattern discrimination for each partner and treated accordingly. See Chapter 12 of The Infertility Cure for a discussion of treating female antisperm antibodies.
In addition, most vaginal lubricants are hostile to sperm. Newer lubricants like Pre-seed are sperm-friendly. The only vaginal lubricants which have been found to support sperm longevity are egg whites (yes, really) and canola oil. Using egg whites (room temperature, applied with a syringe or turkey baster) as vaginal lubrication around the time of ovulation will help sperm to reach the egg more easily.
Finally, since elevated temperatures in the testes can lower testosterone and compromise sperm production, keep scrotal temperatures between 94 and 96 degrees Fahrenheit.
Assisted reproductive technologies make it possible to father a child with poor-quality-even dead sperm. However, making changes to increase the health of your sperm will help ensure that the child you conceive is the healthiest he or she can be.
CASE STUDIES CLINICAL STUDIES
A 1997 Israeli study analyzed semen samples of 16 sub-fertile men treated with acupuncture. Analysis was done before and one month after the treatments, which were given twice a week for five weeks. Semen samples from 16 untreated sub-fertile men also were analyzed as a control group. In the subjects treated with acupuncture, improvements were measured in 1) percentage of viability, 2) total motile sperm per sample and 3) integrity of the flagella. The fertility index of the sperm was deemed to have increased "significantly" following acupuncture treatment.
A study conducted by the College of Acupuncture and Moxabustion at the Shanghai University of TCM in China reported on 35 cases of infertility due to sperm abnormalities that were treated only with low-frequency electro-acupuncture. Points Sp 6, Ren 12 and Ren 4 were stimulated along with moxibustion, which is heating the acupoints in conjunction with needle insertion. Study results showed improvement in symptoms of lumbosacral aching, frequent urination, emission and overall sperm parameters. Activity and quantity of sperm, semen quality and spermatogenic environment in terms of significant decrease of mucosity and liquefaction time also improved. Equally important, sex hormones were normalized as follows:
- 33.5 percent improvement in FSH
- 35.3 percent in LH
- 57.1 percent in estrogen
- 65.1 percent in testosterone
A study at the Institute of Acupuncture and Meridians, Anhui College of TCM, Hefei, China, reported that 87 cases of male infertility with semen abnormalities were treated with the herbal formula Ji Sheng Shen Qi Wan. Semen analysis after treatment showed that sperm parameters improved in 83 of the 87 cases, or over 95 percent of the time. By the end of the study, 49 of the men's wives (56.32 percent) were pregnant. Different studies have shown that another herb, Cornus Officinalis Fructus, which is used to stabilize Kidney essence and tonify the Liver and Kidneys, has been found to improve sperm motility. Kidney Yang tonics like Eucommia, Epimedii, Radix Morindae Officinalis and Cornu Cervi Parvum have been found to decrease impotence, fatigue, low back pain, urinary frequency and spermatorrhea.
A study from the American Journal of Chinese Medicine reported that 37 infertile patients with varicocele were treated with 7.5 grams per day of Gui Zhi Fu Ling Wan for three months, after which semen qualities such as sperm concentration and motility were graded. A varicocele disappearance rate of 80 percent was obtained with 40 out of 50 varicoceles. In addition, sperm count improved in 71.4 percent of patients, while sperm motility increased in 62.1 percent. This formula invigorates the Blood, inhibiting the pooling mechanism that causes the poor sperm quality.