Maximizing Male Fertility
Roughly one couple in five will have difficulty conceiving. In the United States, this means that more than 6 million couples are currently experiencing infertility. Of couples who fail to achieve a pregnancy, the issue is due exclusively to female infertility about 40% of the time and to male factor infertility about 40% of the time. The remaining 20% of the time, there may be issues with both partners that contribute to the infertility.
Strictly speaking, infertility is defined as the failure to conceive after a full year of unprotected intercourse. At that point, couples should seek professional assistance. And while the support of a fertility doctor may be crucial, there are also steps you can take on your own to help improve the chances of conception.
What are the Causes of Male Infertility?
When the semen analyses are abnormal, the urologist’s evaluation may reveal the source of the problem. The possible causes include:
A varicocele is a condition in which the veins surrounding the testicle become swollen and dilated. It is fairly common, affecting about one in every seven men. Men with a varicocele have about a 50% chance of having an abnormal sperm count. Treating the varicocele, which is usually done with a minor surgical procedure, will often correct the problem.
Infections of the prosate or epididymis (a duct behind the testicle) can have a major impact on a man’s fertility. Such an infection would usually be diagnosed by the finding of numerous white blood cells in the semen. If infection is suspected, the urologist may request a semen culture and may recommend treatment with an antibiotic.
Sperm production is under the control of special hormones that come both from the pituitary gland (FSH, LH) and from the testicle (testosterone). If the blood levels of these hormones are abnormal, sperm production may be very low or even completely absent. This type of problem is diagnoses with simple blood and saliva tests and, if present, may be correctable with medication.
We now realize that many cases of male infertility are caused by genetic abnormalities. These include cases in which whole chromosomes are broken or misshapen, where either a whole chromosome is missing or an extra one is present, or where individual genes on the Y chromosome are damaged.
Another type of genetic problem is known as sperm DNA fragmentation. IN this condition, the DNA strands, which contain the genetic information in the sperm head, are filled with many breaks and nicks. This is believed to be due, in many instances, to oxidative stress.
Recent scientific evidence has revealed that a condition known as oxidative stress may in fact be a common factor in some of the causes of male and female infertility. Oxidative stress is caused by the presence of certain molecules known as reactive oxygen in the semen. These molecules, also known as oxidants, can damage the sperm cell membrane and DNA. Oxidants are normally kept under control by the presence of antioxidants in the semen.
When the amount of oxidants in the semen exceeds the amount of antioxidants, we say that oxidative stress is present. Oxidative stress has been clearly shown to reduce fertility. Some studies have shown that oxidative stress may be present even when a standard semen analysis appears normal.
Blockage of Sperm Flow
Sperm are produced in the testicles and then move into the epididymis, a small duct behind the testicle, where they become fully mature. After several days in the epididymis, the sperm swim up a tube called the vas deferens toward the ejaculatory duct. There are several conditions that can lead to a blockage of the path from testicle to ejaculatory duct. Such a blockage could cause the sperm count to be extremely low or even crate a condition known as azoospermia, in which no sperm are present in the ejaculate. Sometimes a blockage can be repaired. And if repair of the blockage is not possible, a pregnancy should be achievable through IVF.
Medications and Treatment Side Effects
Certain medications or medical treatments can interfere with sperm production. Radiation treatment for cancer can impair testicular function. Many chemotherapy drugs will have a permanent effect on production. Some drugs, such as testosterone replacement therapy, can have a temporary effect that should reverse when the medication is stopped.
When taking a medical history, the urologist will ask about any medications or illnesses that have occurred in the past.
IMPROVING MALE FERTILITY THROUGH DIET AND LIFESTYLE CHANGES
Whether your semen analyses are normal or not, there is a good evidence that diet and lifestyle can have a major impact on a man’s fertility.
Several studies have linked cigarette smoking to lower sperm count, motility, and morphology. Smoking also increases levels of oxidative stress in the semen and can lead to sperm DNA damage and genetically abnormal sperm. If you’ve tried to quit without success, seek help from your family doctor.
Alcohol and Drug Use
Excessive alcohol consumption has been shown to impair normal sperm. The evidence regarding moderate alcohol intake is less clear, but most experts agree it is best to avoid more than one drink per day.
The likelihood of a woman becoming pregnant is much higher when you have intercourse in the three days immediately leading up to and including ovulation. Some experts call these three days the fertile window. You can determine when the woman ovulates either by using basal temperature charts or with an over-the-counter ovulation predictor kit.
The frequency of intercourse during the fertile window generally doesn’t matter. Although earlier studies seemed to show that several days of abstinence might increase sperm counts, more recent findings indicate that more frequent intercourse may in fact be better.
Avoid the use of any artificial lubricants, which can be toxic to sperm.
Avoid Excessive Heat
It is well-known that the testicles should be cooler than the rest of the body for sperm production to be at its best. The harmful effect of a varicocele on sperm production is believed to result from the extra warming of the area caused by the dilated veins. While there is no scientific evidence to support the claim that boxer-style shorts are better than Jockey type, it is important to avoid other sources of heat exposure to the testicles such as hot tubs, laptop computers, high-temperature work area, or prolonged baths.
Eating a healthful diet rich in fruits, vegetables, and whole grains can be beneficial for sperm function and male fertility. Drinking enough water to stay well-hydrated is also important.
Moderate exercise may be beneficial. Aim for at least 30 minutes of moderate physical activity on most days of the week.
Try to limit coffee or other caffeine-containing beverages to one serving per day.
If your work or hobby brings you in contact with environmental dangers such as pesticides, solvents, organic fumes, or radiation exposure, you may be unknowingly affecting your fertility by impairing sperm production.
Harmful Nutritional Supplements
Nutritional supplements that provide hormone-like substances such as DHEA or “andro” can actually impair fertility by stopping sperm production. If you are taking any of these types of supplements, or other products intended to build muscle mass, it’s probably best to stop immediately.
BENEFICIAL NUTRITIONAL SUPPLEMENTS
There is substantial scientific evidence to suggest that certain nutritional supplements may help improve male fertility. A recent Cochrane Review found that antioxidants increased pregnancy and birth rates, and improved sperm motility in sub-fertile males.
Vitamin C and Vitamin E
Vitamins C and E are essential antioxidants that protect the body’s cells from damage from oxidative stress and free radicals. Vitamin C is one of the most abundant antioxidants in the semen of fertile men, and it contributes to the maintenance of healthy sperm by protecting the sperm’s DNA from free radical damage.
Vitamin E is a fat-soluble vitamin that helps protect the sperm’s cell membrane from damage. Studies have shows that vitamin E improves sperm motility (movement). Vitamin C functions to regenerate vitamin E; thus, these vitamins may work together to improve sperm function. Vitamin C has been shown to increase sperm count, motility, and morphology. Men with low fertilization rates who took vitamin E supplements for three months showed a significant improvement in fertilization rate. Vitamin E supplementation in infertility men resulted in increased pregnancy rates.
Vitamin D has several important roles in the body, including regulating the immune system, improving muscular function, and potentially offering protection from a variety of health conditions. Vitamin D is important for male reproduction and androgen (testosterone) status. In a recent study, men with normal vitamin D levels had better sperm motility than men who were vitamin D deficient.
Selenium is a trace mineral that functions as an antioxidant. Selenium supplements have been shown to increase sperm motility, ad a combination of selenium and vitamin E has been shown to decrease damage from free radicals and improve sperm motility in infertile men.
Lycopene is a potent antioxidant and carotenoid (plant pigment) that is abundant in tomatoes. This phytonutrient is found in high levels in the testes, and research has shown that lycopene supplementation improved sperm parameters in infertile men.
L-Carnitine is an amino acid derivative produced y the body that functions to transport fat so it can be broken down for energy. L-carnitine is though to also have antioxidant properties. L-carnitine’s primary benefit is to provide energy for sperm, and therby increase sperm motility.
Zinc is an essential trade mineral that plays a role in sperm formation, testosterone metabolism, and cell motility. Zinc supplementation has been shown to increase testosterone levels, sperm count, and sperm motility.
Folic Acid is a B-vitamin that is necessary for DNA synthesis. Low levels of folic acid have been associated with a decreased sperm count and decreased sperm motility. In a recent study, the combination of zinc and folic acid results in a 75% increase in total normal sperm count in sub-fertile men.
CHOOSING A NUTRITIONAL SUPPLEMENT
A number of combination-type products are currently for sale on the internet and elsewhere that claim to promote male fertility. However, the lack of government oversight of the dietary supplement industry create significant concerns about the purity and content accuracy of these products. It’s best to choose a supplement that has been independently certified for content accuracy and purity (by NSF or USP). In particular, since it is extremely difficult to standardize the content and purity of plant extracts, supplements with any herbal content should be considered with care, and probably avoided completely if they have not been independently certified.
EVALUATING MALE FERTILITY:
The Semen Analysis
Couples having trouble conceiving often seek the advice of their family physician or the woman’s gynecologist. Usually, as part of the initial evaluation, that physician will suggest that the man undergo a semen analysis.
How many specimens are needed?
Considerable variation in semen quality can occur from day to day or week to week. For this reason, it’s usually best to do two separate specimens at least two weeks apart.
How should the specimens be collected?
Semen specimens should be obtained by masturbation, and collecting the specimen properly is very important. First, you should abstain from ejaculation for at least three days before each specimen. Second, be sure to use a sterile collection container. Your doctor’s office or the lab should provide this. Finally, it’s best to product the specimen at the lab so it can be tested immediately. If you must produce the specimen at home, be sure to et it to the lab within 30 minutes, and protect it form extreme heat or cold.
What do they test for?
The three most important measurements taken are the sperm count, motility, and morphology. The count simply means the number of sperm present. The motility means determining the percentage of sperm seen that are actively moving. The morphology is reported as the percentage of sperm that are shaped normally. Individual labs have slightly different standards of what is normal for each of these measurements.
What if the results are abnormal?
If the semen analyses are abnormal, the man should be evaluated by a physician, usually a urologist, who specializes in male infertility. This evaluation should start with a comprehensive history and physical examination and then may go on to include blood work, ultrasound testing, genetic testing, or specialized test on the semen.
What if the results are normal?
A normal result on two semen analyses usually means that the man has normal fertility potential. However, there are certain situations (see “Oxidative Stress” section) in which a man’s fertility may be low despite a normal semen analysis.