Male Infertility

male infertility fertility sperm
Male Infertility

Male fertility requires these main elements to be at least adequate, but for the best chance at conception and the healthiest baby, we prefer to aim for optimal:

  1. Semen volume – the amount of semen per ejaculate
  2. Sperm count – this one is pretty basic, if there is a very low sperm count, the numbers just aren’t high enough to achieve conception
  3. Sperm motility – this is how well do they swim and do they swim in a determinedly in a straightforward direction
  4. Sperm morphology – this is the appearance of the sperm, the shape of the head, length of the tail etc.
  5. The DNA of the sperm – the genetic material contained in the sperm determines half of the DNA that will contribute to the future baby, the health of the DNA is determined through testing for DNA fragmentation.  High DNA fragmentation is closely correlated to increased rates of miscarriage in IUI and IVF.

Normal Ranges for Semen Parameters (Source: World Health Organization, normal and more ideally [25-95th percentile values])

  1. Semen volume = >=1.5 ml [2.7-6.8 ml] per ejaculate
  2. Sperm count = >=15 million/ml of semen [41-213 million]
  3. Sperm motility = >=40% [53-78%], progressive motility – >=32% [47-72%]
  4. Normal forms (morphology) = >= 4% [9-48%]
  5. DNA fragmentation = ≤ 15% DFI = excellent to good sperm DNA integrity, > 15 to < 25% DFI = good to fair sperm DNA integrity, > 25 to < 50% DFI = fair to poor sperm DNA integrity, ≥ 50% DFI = very poor sperm DNA integrity

Factors that Impact Semen Parameters and Sperm Quality

  1. Semen volume – dehydration, retrograde ejaculation (ejaculate flows back into the bladder instead of out the urethra), lack of orgasm (SSRI’s, psychological, nerve injury), duct obstruction, absence of the vas deferens, hypogonadism (low testosterone or DHT).
  2. Sperm count – the causes of low sperm count include: varicocele, infection, retrograde ejaculation, anti-sperm antibodies, tumors, undescended testicles, hormone imbalance, sperm duct defects, celiac disease, testosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), certain anti-fungal and antibiotic medications, some ulcer medications, chemical exposure (like octinoxate, oxybenzone, BPA and PFC), overheating the testicles (sauna, hot tub, tight underwear, laptop use), prolonged cycling, x-rays, heavy metals, smoking, alcohol or drug abuse, soy intake, stress and obesity.
  3. Sperm motility – poor sperm motility can be caused by heat, smoking, alcohol, age, oxidative stress, vitamin and mineral deficiency
  4. Sperm morphology – low sperm morphology may be caused by heat, oxidative stress, age, alcohol intake, vitamin and mineral deficiency
  5. DNA fragmentation – high DNA fragmentation may be the result of heat, coffee consumption, obesity, hormone imbalance, infection, febrile illness, diet, drug use, cigarette smoking, exposure to environmental and occupational pollutants, advanced age, varicocoele.

Addressing physical causes of low sperm count, low sperm motility, poor morphology and high DNA fragmentation such as varicocele, along with addressing lifestyle and nutritional factors can improve sperm count and quality and enhance male fertility.

References:

WHO laboratory manual for the examination and processing of human semen, FIFTH EDITION, World Health Organization, Switzerland, 2010.

Matthew Roberts, MD, FRCSC and Keith Jarvi, MD, FRCSC. (2009 ) Steps in the investigation and management of low semen volume in the infertile man. Can Urol Assoc J. Dec; 3(6): 479–485.

Barazani Y1, Katz BF, Nagler HM, Stember DS. Lifestyle, environment, and male reproductive health. Urol Clin North Am. 2014 Feb;41(1):55-66. doi: 10.1016/j.ucl.2013.08.017. Epub 2013 Sep 26.

Cyrus A, Kabir A, Goodarzi D, Moghimi M. The effect of adjuvant vitamin C after varicocele surgery on sperm quality and quantity in infertile men: a double blind placebo controlled clinical trial. Int Braz J Urol. 2015 Mar-Apr;41(2):230-8. doi: 10.1590/S1677-5538.IBJU.2015.02.07.

Chavarro JE, Toth TL, Sadio SM, Hauser R.Soy food and isoflavone intake in relation to semen quality parameters among men from an infertility clinic. Hum Reprod. 2008 Nov;23(11):2584-90. doi: 10.1093/humrep/den243. Epub 2008 Jul 23.

Sobreiro BP, Lucon AM, Pasqualotto FF, Hallak J, Athayde KS, Arap S. Semen analysis in fertile patients undergoing vasectomy: reference values and variations according to age, length of sexual abstinence, seasonality, smoking habits and caffeine intake. Sao Paulo Med J. 2005 Jul 7;123(4):161-6.

Hamad MF, Shelko N, Kartarius S, Montenarh M, Hammadeh ME. Impact of cigarette smoking on histone (H2B) to protamine ratio in human spermatozoa and its relation to sperm parameters. Andrology. 2014 Sep;2(5):666-77. doi: 10.1111/j.2047-2927.2014.00245.x. Epub 2014 Jul 14.

Eroglu M, Sahin S, Durukan B, Ozakpinar OB, Erdinc N, Turkgeldi L, Sofuoglu K, Karateke A. Blood serum and seminal plasma selenium, total antioxidant capacity and coenzyme q10 levels in relation to semen parameters in men with idiopathic infertility. Biol Trace Elem Res. 2014 Jun;159(1-3):46-51. doi: 10.1007/s12011-014-9978-7. Epub 2014 Apr 23.

Jurewicz J, Radwan M, Sobala W, Radwan P, Jakubowski L, Hawuła W, Ulańska A, Hanke W. Lifestyle factors and sperm aneuploidy. Reprod Biol. 2014 Sep;14(3):190-9. doi: 10.1016/j.repbio.2014.02.002. Epub 2014 Mar 4.

Wdowiak A, Raczkiewicz D, Stasiak M, Bojar I. Levels of FSH, LH and testosterone, and sperm DNA fragmentation. Neuro Endocrinol Lett. 2014;35(1):73-9.

Osman A, Alsomait H, Seshadri S, El-Toukhy T, Khalaf Y (2014) The effect of sperm DNA fragmentation on live birth rate after IVF or ICSI: a systematic review and meta-analysis. Reprod Biomed Online. Nov 13. pii: S1472-6483(14)00603-8. doi: 10.1016/j.rbmo.2014.10.018. [Epub ahead of print] Review.

Zhao J, Zhang Q, Wang Y, Li Y (2014) Whether sperm deoxyribonucleic acid fragmentation has an effect on pregnancy and miscarriage after in vitro fertilization/intracytoplasmic sperm injection: a systematic review and meta-analysis. Fertil Steril 102(4):998-1005

Wright C, Milne S, Leeson H (2014) Sperm DNA damage caused by oxidative stress: modifiable clinical, lifestyle and nutritional factors in male infertility. Reprod Biomed Online 28:684-703

Zini A and Dohle G (2011) Are varicoceles associated with increased deoxyribonucleic acid fragmentation? Fertil Steril. 96 (6):1283-7

 

Nutrition and Male Infertility Research

Omega 3’s: Omega-3 fatty acids were found to have a positive effect on sperm development and motility, whereas high levels of other types of fats resulted in lower sperm counts.

Source: Human Reproduction, Volume 27, Issue 5, pages 1466-1474, March 2012.

Vitamin E: Supplementation with vitamin E may improve sperm concentration, motility, and rate of pregnancy.

Source: Zhonghua Nan Ke Xue, 2012 May; 18(5):428-31.

CoQ10 (Ubiquinone): Researchers found that men with idiopathic infertility supplemented with ubiquinone (coenzyme Q10) had improved fertility.

Source: J Urol, 2012 Jun 13.

Walnuts: Ingestion of walnuts was found to improve sperm vitality, motility, and morphology in men.

Source: Biol Reprod. 2012 Aug 15.

Folate, Vitamin E, Zinc, Vitamin C: Daily intake of folate was found to decrease sperm DNA damage in older men.

Source: Fertil Steril. 2012 Aug 23.

Zinc: Treatment with zinc, D-aspartate and coenzyme Q10 was found to be associated with total and progressive sperm motility maintenance in both normospermic and oligospermic samples.

Source: Reprod Biol Endocrinol, 2013 Aug 16; 11(1): 81; [Epub ahead of print].

CoQ10: Treatment with zinc, D-aspartate and coenzyme Q10 was found to be associated with an increase in DNA fragmentation and lipid peroxidation in the spermatozoa, preventing a decrease in motility.

Source: Reprod Biol Endocrinol, 2013 Aug 16; 11(1): 81; [Epub ahead of print].

Vitamin B12: In a study involving infertile couples, 39% of all men with an abnormal semen analysis were found to have vitamin B12 deficiency.

Source: Andrologia, 2009; 41(1): 46-50.

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