Male Infertility

Male Infertility Overview:

Roughly 50% of couples fertility problems, including miscarriage, can be traced back to the male. The majority of these cases come down to poor sperm quality [1].

Sperm quality is becoming an increasing issue in the general public in recent years. A recent review investigating this trend reported that between the years 1938 and 1990, sperm counts have dropped more than 50%. Even more significant is sperm quality, which a European sperm bank reported a 900% increase in the incidence of reduced fertility parameters of tested sperm and a 600% increase in total infertility (9%) from 1980 to 1990 [1].

A normal sperm count per ejaculate should be 100 million to 400 million.

 

Aetiology:

Their are many different causes for male infertility, including:

+ Hypothalmic Pituitary Disease

  • 1-2% of cases 1*

Causes:

  • Congenital or genetic disorders
  • Pituitary tumors
  • Surgery
  • Chronic illness
  • Severe nutritional deficiencies
  • Obesity

+ Testicular Disease

30-40% of cases 1

Causes:

  • Congenital disorders
  • Varicocele
  • Orchitis (Mumps, Chlamydia)
  • Drugs
  • Radiation
  • Environmental toxin exposure (Cd, Pb, Hg, Xenoestrogens, Dibromochloropropane, Carbon disulphide)
  • Hyperthermia
  • Immunologic disorders
  • Trauma
  • Systemic illness (hepatic cirrhosis, CKD, haematochromatosis, sickle cell anemia)

+ Post-Testicular Disease

  • 10-20% of cases 1*
  • Disorder of sperm transport
  • Epididymal dysfunction (drugs, infection)
  • Congenital defects
  • Ejaculatory dysfunction

Causes:

  • Epididymal dysfunction (drugs, infection)
  • Congenital defects
  • Ejaculatory dysfunction

+ Idiopathic Causes

  • 40 to 50% of cases*

Causes

  • System imbalance
  • Nutritional deficiencies
  • Medications
  • Social drugs (including caffeine and alcohol)
  • Chronic stress
  • Undetected infections
  • Increased temperature (jocks, baths, spas)
  • History of injury
  • History of testicular torsion
  • Childhood surgery

+ Autoimmune Infertility

  • Common after vasectomy reversal or following genitourinary infection
  • Detection needs to be from semen test not blood test
  • Antibodies:
    • IgM - Worst prognosis, intractyoplasmic spermi injection required
    • IgG - Local immunoglobulin production within the urethra. Sperm can be washed and used for intrauterine insemination.
    • IgA + IgG - Most common. Indicates poor capacity for sperm to penetrate mucus. Sperm can be washed and used for intrauterine insemination.

+ Drugs That Can Impair Spermatogenesis

  • Alkylating drugs (Cyclophosphamide, chloramucil)
  • Antiandrogens (flutamide, cyproterone, spirolactone)
  • Antifungals (ketoconazole)
  • Antibiotics (nitrofurantoin)
  • Antiepleptics (phenytoin)
  • Antipsychotics (methyldopa)
  • Adrenergic neuroneblockers (guanethidine)
  • Calcium channel blockers (nifedipine, verapamil)
  • Colchicine
  • Glucocorticoids(prednisone)

add the list from this study and cite https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5354694/

Other Chemicals Known To Affect Semen Quality:

  • Organochlorines
  • Dioxins
  • Phthalates
  • Phytoestrogens

+ Other Factors That Can Impair Spermatogenesis

  • Tobacco
  • Marijuana
  • Alcohol
  • Caffeine
  • Aflotoxin
  • Radiation
  • Heat stress
  • Hydrogenated oils (especially cottonseed oil)
  • Pesticides (dioxins, DDT, PCBs, dibromochloropropane, carbon disulphide)
  • Heavy metals (Cd, Pb, Hg, Cu)
  • Xenoestrogens
  • Industrial chemicals (solvents, ethylene bromide, boric acid, aromatic and hydrogenated hydrocarbons, carbon monoxide, formaldehyde, vinyl chloride, anaesthetic gases)
  • H2 receptor antagonists (Cimetidine)
  • Inflammatory Bowel disease drugs (sulfasalazine)
  • Statin drugs

Sources: 1

 

Spermatogenesis:

Sperm takes an average of 117 days to mature, during which time they are subject to the same damage potential of other cells in the body. This can include high stress, illness and infection, toxic exposure, nutritional deficiencies. [1]. 

spermatogenesis and male hormones
IMG_8627.jpg
 

HPO Axis:

Screenshot 2018-07-11 13.13.46.png

Hormones in the Male Reproductive System

  • Testosterone
  • Luteinising hormone
  • Follicle stimulating hormone
  • Prolactin
  • Sex hormone binding globulin
 

Diagnostic Considerations:

Interpretation Of Semen Analysis

Parameter Reference Range Pathological Range
Volume 2-5 mL < 1.5 mL
pH 7.2-8.0 < 7.2 or > 8.5
Sperm Density 40 - 250 Million/mL < 20 million/mL or > 250 million/mL
Total Sperm Count > 80 Million/ejaculate < 40 Million/ejaculate
Sperm Motility > 50% < 35%
Progressive Motlity > 40% < 25%
Sperm Morphology > 30% Normal < 20% Normal
TZI < 1.6 > 1.8
Vitality > 75% Alive < 50% Alive
Viscocity Normal Increased
Clumping None > 15%
Round Cells None Numerous
Leukocytes None > 1 Million/mL

Second opinion (no reference)

Screenshot 2018-07-11 13.16.12.png
 

Diagnostic Considerations For Male Infertility

Finding Considerations
Oligospermia Genetic or endocrine disorder
Varicocele or anatomic disorder
Stress
Toxic substance exposure
Systemic ill health
Nutrient deficiencies
Polyspermia Metabolic or endocrine disorder
Low Sperm Volume Dehydration
Prostate or other glandular dysfunction
Obstruction of ejaculatory ducts or partial retrograde ejaculation
High Sperm Volume Prostate infection or irritation
Unknown. Use split ejaculation
High Viscocity Excessive mucus producing conditions (asthma, mucus forming foods, dairy, etc.)
Prostate infection or irritation.
Asthenozoospermia Sperm antibodies
Infection, fever
Drug use
Varicocele
Poor nutrition (especially low zinc)
Semen sample damaged during testing
Teratozoospermia Varicocele
Drugs
Toxic substance exposure
Fever, infection
Chronically ill health
Nutritional deficiencies
Triple Factor Defect Congenital disorders
Endocrinopathies
Sperm Antibodies Vasectomy reversal
Chronic Chlamydia, Candida, other infectious disease
Low pH Chronic illness
Chronic stress
Leukocytes Present Infection or irritation of the genitourinary tract
 

Therapeutic Aims:

1. Remove Exposure To Environmental Causes

  • Antioxidants (Myriciaria dubia, Ilex paraguariensis)

2. Optimise Nutritional Intake

  • Clean, nutrient dense foods
  • Adequate water intake

3. Improve Digestive Assimilation

  • Antinflammatories(Curcuma longa, Boswellia serrata, Calendula officinalis)
  • Bitters (Achillea millefolium, Taraxicum officinale, Cynara scolymus)
  • Choleretics (Cynara scolymus)
  • Cholagogues (Cynara scolymus)
  • Carminatives (Mentha piperita, Foeniculum vulgare)

4. Normalise The Balance Between The Sympathetic And Parasympathetic Nervous Systems

  • Nervine relaxants (Passiflora incarnata, Turnera diffusa)
  • Adaptogens (Rehmannia glutinosa, Rhodiola rosea)

5. Improve Circulation And Treat Varicocele If Applicable

  • Circulatory stimulants (Panax ginseng, Zingiber officinale)
  • Vascular tonics (Aesculus hippocastanum)

6. Improve Elimination Pathways

  • Alteratives (Smilax spp.)
  • Hepatics (Cynara scolymus, Silybum marianum)
  • Immunomodulators (Ganoderma lucidum)
 

Differential Diagnosis:

  • Female partner infertility
 

Cautions:

Consider herb-drug interactions.

 

Herbs For Male Infertility:

  • Albizzia lebbeck
  • Andrographis panniculata
  • Muira puama
  • Turnera diffusa
  • Ginkgo biloba
  • Serenoa repens
  • Withania somnifera
  • Mucuna pruriens
  • Astragalus membranaceus
 

Herbs For Varicocele:

  • Ginkgo biloba
  • Aesculus hippocastanum
  • Ruscus aculeatus
  • crataegus monogyna
  • Rosmarinus officinalis
  • vitis vinifera
  • vaccinum myrtallis
  • achillea millefolium
  • curcuma longa
  • berberis vulgaris
  • rumex crispus
  • taraxicum officinalis
  • cynara scolymus
 

Author:

Justin Cooke

The Sunlight Experiment

Updated: June 2018


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References:

  1. Koeman, M. (2001). Male infertility and subfertility: aetiology and treatment considerations. Australian Journal of Medical Herbalism, 13(3), 85.
  2. Murray, M. T., & Pizzorno, J. (2012). The Encyclopedia of Natural Medicine Third Edition. Simon and Schuster.