The Naturopathic View: Male Fertility (Spring 2010)
Printer-friendly versionMALE FERTILITY
by Judith Fiore, ND
It is estimated that male factor problems account for roughly 40% of all fertility cases, including situations where there is a combination of male and female infertility. Research, especially in the area of nutrition and acupuncture, is showing that various lifestyle changes and treatments may improve male fertility. In this article I will outline the basic recommendations that a naturopathic doctor might make in cases of male infertility. These are general guidelines, and it is important that individuals see a naturopathic doctor to get case-specific treatment in order to improve their health and fertility. One important note: any therapy you begin for male fertility must be used for at least three months before testing to see if there is improvement.
Possible causes of male infertility
The most important marker for male fertility is the number of sperm that are regularly found in the ejaculate. Men are most likely to be fertile with a sperm count over 48 million per milliliter of semen and least likely with counts below 13.5 million, although healthy fertile men are expected to have counts of 100 million or more.1 Unfortunately, we now know that for a number of possible reasons, most of them environmental, men’s sperm counts are declining worldwide.2
Men should be aware that eating non-organic foods, especially animal products like beef and chicken, could lower their sperm count, while workplace exposure to industrial chemicals and pesticides can cause male infertility. In both cases, men risk exposure to xeno-estrogens, the by-products of an increasingly polluted world.3
Xeno-estrogens introduce synthetic estrogen into a man’s body, and this can dramatically interfere with his ability to produce sperm. In Britain, environmentalists have found that freshwater male fish are becoming “feminized” (they develop smaller testes, begin to produce substances normally found in the female reproductive system, and become unable to reproduce).4,5 Here in Canada, David Suzuki has also talked about the impact of xeno-estrogens on the ecosystem and human health. Other concerns involve the effect on fertility of exposure to pesticides, heavy metals, and radiation.6,7 Male reproductive health is clearly vulnerable to the environmental toxins of the industrialized world.
There are other possible causes for male infertility, such as trauma brought about by contact sports or injury, infections that affect the reproductive tract, and lifestyle habits such as smoking and alcohol consumption.8 Too much heat generated around the testicles can reduce sperm count and motility. Male cyclists are at risk for this, as are men who wear briefs instead of boxers, who sit for long periods of time, and who regularly have a computer sitting on their laps. Obesity can also have a devastating effect on male fertility, with most obese men showing lower levels in all sperm parameters of count, motility, and morphology.9
Nutrition
The best and simplest lifestyle change I recommend to patients is to increase their fruit and vegetable consumption. The simplest way to do this is to make sure that at each meal half of what is consumed is fruits and/or vegetables. I call it the 50/50 rule, and based on my clinical experience it is a simple yet very effective way to make a big difference in overall health and fertility.
Besides the effects of improving the diet, there have been many nutritional studies showing the effect of nutrient supplementation on fertility. Male fertility has been especially studied, mostly because it is much easier to measure sperm count, motility, and morphology, and thus easer to monitor the effect of supplementation. I have outlined here the most commonly prescribed nutrients, but as always, you are encouraged to consult with a naturopathic doctor or nutritionist to determine which supplements you should use, as well as the correct dosage.
Vitamin C and selenium. As antioxidants, vitamin C and selenium are known for their ability to “quench” free radicals, molecules that damage the body’s cells. We know that sperm are sensitive to free radicals because they are so dependent on the integrity of the sperm’s cell membrane. And it is through the cell membrane that a free radical will inflict its damage. With vitamin C and selenium supplementation, the sperm has some protection against this free radical damage. Vitamin C also helps to prevent sperm agglutination, where the sperm “stick” or clump together.10,11
Zinc. Zinc is probably the most critical trace mineral for male fertility. It is involved in almost every aspect of male reproduction including the hormone metabolism, sperm formation, and sperm motility. A deficiency in zinc can result in decreased testosterone levels and sperm count.12,13
Arginine. Arginine is an amino acid needed in the replication of cells, and is considered important for male fertility. Studies have shown L-arginine improves sperm count and motility without side effects. It is also used for erectile dysfunction due to its positive effect on blood circulation.14,15
Carnitine. Another amino acid that has been talked about a lot is carnitine. Carnitine is essential in the transport of fatty acids into the cell mitochondria. Mitochondria are sometimes described as "cellular power plants," because their primary function is to convert organic materials into energy. So think of carnitine as a substance that enables a cell to make its energy. This may help to make sense of the fact that the higher the carnitine content in the sperm, the better their motility. Carnitine also helps to increase sperm count, and should be a primary supplement to promote male fertility.16
Omega 3 fatty acids. There has been a great deal of research lately into omega 3 fatty acids, in particular for fish oil and flaxseed oil. Fish oil has an anti-inflammatory effect on the body, which helps to improve circulation. While there is not yet specific evidence as to the effect of fish oil on male fertility, a recent Iranian study showed that infertile men were deficient in DHA, the fatty acid that is found in fish oil, as compared to fertile males.17
Co-Enzyme Q10. Co-enzyme Q10 (CoQ10) is most concentrated in the mitochondria of sperm, and is important for sperm motility. CoQ10 is also an antioxidant and therefore, like vitamin C and selenium, protects the sperm’s cell membranes from the effects of free radicals. CoQ10 is known to increase sperm counts and motility.(18)
Botanical medicine
Ginseng. Ginseng is probably the botanical extract most widely used to improve male fertility. It has been shown to promote the growth of the testes, increase sperm count and increase testosterone levels.19,20 Of the two types of ginseng that are recommended as most likely to be effective,, Panax ginseng (Chinese or Korean ginseng) and Eleutherococcus senticosus (Siberian ginseng), Siberian ginseng is regarded as milder in its effect.
Pygeum. Another botanical, pygeum africanum, is also effective in improving fertility where there is reduced seminal volume. It also helps to improve the composition of the seminal fluid, especially when the fluid is less alkaline than it should be. This is an important consideration in male fertility, since it is estimated that only a small number of sperm will ever reach the egg due to the natural “barriers” in the female reproductive tract. The more alkaline the seminal fluid, the more sperm are able to survive for longer periods of time.21
Maca. Maca has several interesting applications for promoting male sexual health. It has been traditionally used to increase energy, stamina, and athletic performance. Research has shown that it can increase seminal volume, sperm counts, motile sperm numbers, and sperm motility. Especially encouraging, in the studies performed, no changes were found in hormone levels (LH, FSH, prolactin, testosterone and estrogen).22,23
Acupuncture
The use of acupuncture dates back approximately 4000 years, and is part of Traditional Chinese Medicine, a system of medicine which aims to balance energy and blood in the body in order to keep it functional and healthy. In simple terms, acupuncture aims to improve circulation and stimulate the body’s natural healing abilities. The results are reduced inflammation in the body and increased physical and emotional well-being. Acupuncture has also been seen to help improve sperm parameters.24 A study published in Andrologia in 2000 showed that weekly acupuncture sessions on azoospermic and severely oligozoospermic males resulted in 67% of the cases of azoospermia being able to produce sperm while the rest saw an increase in sperm count.25
Lifestyle
The bottom line with lifestyle is to try to make the changes that will see you feeling better and ultimately lead to better fertility. Research has shown that smoking and alcohol consumption can have a negative effect on sperm. If you smoke, stop. If you have more than three alcoholic drinks per week, you must cut down. In some cases I ask male patients to stop alcohol completely, especially if the couple is preparing for IVF. Don’t use recreational drugs like marijuana, and avoid saunas and hot tubs. Wear boxers, not briefs.
Modify your exercise routine: exercise less if you are doing more than an hour of intense activity on a daily basis, and exercise more if you are sedentary or only manage short sessions of exercise once or twice per week. It’s good to sweat, but within reason. If you’re not sure what is reasonable for you, it is best to consult a personal trainer.
The final word
I encourage every man who is experiencing reduced fertility to see a naturopathic doctor, or an acupuncturist, nutritionist or herbalist. Most employee benefit plans have coverage for naturopathic care and acupuncture, and many naturopathic doctors and acupuncturists offer evening and weekend appointments. There should be few reasons not to take the steps that have been shown to improve fertility. The situation is not always hopeless, and one guaranteed benefit to seeking out naturopathic care is that overall health will improve. That alone is worth every bit of your time, money, and effort.
References
1. Andersen AG, Jensen TK, Carlsen E, Jorgensen N, et al. High frequency of sub-optimal semen quality in an unselected population of young men. Human Reproduction 2000; 15(2): 366-372.
2. Carlsen E, Giwercman A, Keiding N, Skakkebæk NE. Evidence for decreasing quality of semen during the past 50 years. Br Med J 1992; 305:609-613.
3. Rozati R, Reddy PP, Reddanna P, et al. Role of environmental estrogens in the deterioration of male factor fertility. Fertil Steril 2002; 78: 1187-94.
4. Gross-Sorokin MY, Roast SD, Brighty GC. Assessment of feminization of male fish in English rivers by the Environment Agency of England and Wales. Environ Health Perspect 2006 April; 114(S-1): 147-151.
5. Gimeno S, Komen H, Jobling S, Sumpter J, Bowmer T. Demasculinisation of sexually mature male common carp, Cyrinus carpio, exposed to 4-tertpentylphenol during spermatogenesis. Aquatic Toxicology 1998; 43: 93-109.
6. Figa-Talamanca I, Traina ME, Urbani E. Occupational exposures to metals, solvents and pesticides: recent evidence on male reproductive effects and biological markers. Occup Med (Lond) 2001; 51: 174-188.
7. Tielemans E, Burdorf A, te Velde ER, et al. Occupationally related exposures and reduced semen quality: a case-control study. Fertil Steril 1999; 71: 690-696.
8. Goverde HJM, Dekker HS, Janssen HJG, et al. Semen quality and frequency of smoking and alcohol consumption - an explorative study. Int J Fertil 1995;40:135–8.
9. Du Plessiss SS, Cabler S, McAlister DA, Sabanegh E, Agarwal A. The effect of obesity on sperm disorders and male infertility. Nature Reviews Urology 2010; 7: 153-161.
10. Fraga CG, Motchnik PA, Shigenaga MK, et al. Ascorbic acid protects against endogenous oxidative DNA damage in human sperm. Proc Natl Acad Sci 1991; 88: 11003-6.
11. Scott R, MacPherson A, Yates RWS, et al. The effect of oral selenium supplementation on human sperm motility. Br J Urol 1998; 82: 76-80.
12. Kynaston HG, Lewis-Jones DI, Lynch RV, Desmond AD. Changes in seminal quality following oral zinc therapy. Andrologia 1988; 20:21-2.
13. Tikkiwal M, Ajmera RL, Mathur NK. Effect of zinc administration on seminal zinc and fertility of oligospermic males. Indian J Physiol Pharmacol 1987; 31:30-4.
14. De Aloysio D, Mantuano R, Mauloni M, Nicoletti G. The clinical use of arginine aspartate in male infertility. Acta Eur Fertil 1982; 13:133-67.
15. Scibona M, Meschini P, Capparelli S, et al. L-arginine and male infertility. Minerva Urol Nefrol 1994; 46:251-3.
16. Lenzi A, Lombardo F, Sgro P, Salacone P, et al. Use of carnitine therapy in selected cases of male factor infertility: a double-blind crossover trial. Fertil Steril 2003; 79(2):292-300.
17. Safarinejad MR, Hosseini SY, Dadkhah F, Asgari MA. Relationship of omega-3 and omega-6 fatty acids with semen characteristics, and anti-oxidant status of seminal plasma: A comparison between fertile and infertile men. Clinical Nurtition 2009. Published online ahead of print.
18. Lewin A, Lavon H. The effect of coenzyme Q-10 on sperm motility and function. Mol Aspects Med 1997; 18(suppl.):S213-S219.
19. Hong CY, Ku J, Wu P. Astragalus Membranaceus stimulates human sperm motility in vivo. Am J Chin Med. 1992; 20:289-294.
20. Salvalti G, Genovesi G, Marcellini L, et al. Effect of Panax ginseng, CA Meyer saponins on male fertility. Panminerva Med 1996; 38:249-254.
21. Carnini C, Salvioli V, Scuteri A, et al. Urological and sexual evaluation of treatment of benign prostatic disease using Pygeum africanum at high doses. J Arch Ital Urol Nefrol Androl 1991; 63:341-345.
22. Gonzales GF, Cordova A, Vega K, et al. Effect of Lepidium meyenii (Maca) on sexual desire and its absent relationship with serum testosterone levels in adult healthy men. Andrologia 2002; 34:367-372.
23. Gonzales GF, Cordova A, Gonzales C, Chung A, Vega K, Villena A. Lepidium meyenii (Maca) improved semen parameters in adult men. Asian J Androl 2001; 3:301-303.
24. Gerhard I, Jung I, Postneek F. Effects of acupuncture on semen parameters/hormone profile in infertile men. Mol Androl. 1992; 4:9-24.
25. Siterman S, Eltes F, Wolfson V, Lederman H, Bartov B. Does acupuncture treatment affect sperm density in males with very low sperm count? A pilot study. Andrologia 2000 Jan; 32(1): 31-9.
Dr. Judith Fiore, ND, a registered naturopathic doctor, owns and operates the Naturopathic Fertility Centre, located in close proximity to several downtown Toronto fertility clinics. Her practice is devoted entirely to providing naturopathic care and acupuncture for individuals and couples with fertility concerns. She can be reached at 416-231-4477, or www.naturalfertility.ca.