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Infertility is defined as the failure to
become pregnant after one year of unprotected, well-timed sexual intercourse. In men, infertility is
usually associated with a decrease in the number, quality, or motility (movement) of sperm. There are
a number of possible underlying causes of male
infertility, some that respond readily to natural medicine, and some that don't.
A physician should always diagnose the specific cause of infertility before considering
potential solutions.
If pregnancy is not achieved after one year of regular, unprotected sex,
both sexual partners should be tested for possible infertility problems. Low sperm count, decreased
motility, or abnormal shape of the sperm are responsible for infertility in
about 40% of these couples. Female causes account for 40% of infertility cases,
and 20% are attributed to a combination of both.
The first test in the evaluation of an infertile male is the semen
analysis which will test a man's ejaculate for any problems with low sperm
count, motility (movement) or morphology (shape). The test is inexpensive, easy to perform and
provides valuable information. Because the test is so easy to perform, we
recommend starting with semen analysis to determine if this is a problem, or
rule out the male factor, before you begin any costly, intrusive procedures on
the female. Often, in the case
of male infertility, it is the semen analysis that is abnormal. The sperm count
can be low (oligospermia), sperm can be completely absent in the ejaculate (azoospermia) or sperm motility
can be seriously affected (asthenospermia) and sometimes the sperm is immobile or dead
(necrospermia). There are many anomalies that may be found in semen analysis,
but once a problem is found, the next step is to try and
find a cause for it so it may be treated.
Initial treatments may include timing sexual activity
to coincide with
ovulation, avoiding
drugs that may reduce sperm count, and limiting intercourse to no more than
every three days, except during ovulation. Other treatment methods include
artificial insemination, used to place sperm directly in the cervix or uterus,
and a more advanced
procedure called “in vitro fertilization” (IVF), where the man’s
sperm and the woman’s egg are collected and combined in a laboratory. The fertilized
egg
is then implanted into the uterus.
Studies have shown that some dietary changes
can be helpful for men with infertility issues. For instance, excessive alcohol consumption was associated with a decrease in the
percentage of normal sperm in a study of men with poor sperm quality. In another
study, an
unexpectedly high sperm count was found among organic farmers, who grew their
products without the use pesticides or chemical fertilizers. Their sperm count was
more than twice as high as workers who did use pesticides and fertilizers.
These findings, while not definitive, suggest that
consuming organically grown foods could enhance fertility.
Some conventional medications can
interfere with fertility, so men with fertility issues who take prescription
drugs should
consult their physician.
The testes hang away from the body in the
scrotum because the optimal temperature for sperm production is slightly lower
than body temperature. For this reason, men with low sperm counts are typically advised to minimize
any activities that may overheat the testes, such as wearing tight underwear or frequently using
hot tubs and taking hot baths.
Recreational drugs, anabolic steroids, cigarette smoking and
exposure to chemicals may reduce sperm count or
cause abnormal sperm morphology (shape). Changing any of the above behavior may improve a man’s fertility and should be considered
when a couple is trying to conceive.
Some nutritional supplements have been
shown to be helpful in enhancing male fertility. Vitamin C protects sperm from
oxidative damage and improves the quality of sperm in smokers. When sperm stick together,
a condition known as agglutination,
fertility is reduced. Vitamin C has been shown to reduce sperm agglutination in
a study of men with
this condition. Many doctors recommend one gram of
vitamin C per day for infertile men, particularly those diagnosed with sperm
agglutination.
Zinc deficiency can lead to reduced numbers of sperm and impotence in
men, although the
correlation between blood levels of zinc and sperm quality remains
controversial. Reportedly, infertile men have lower levels of zinc in
their semen, than men with normal fertility. Similarly, men with normal
sperm density tend to have higher amounts of zinc in their semen, than do men
with low sperm counts. Other studies, however, have found that a high
concentration of zinc in the semen is related to decreased sperm motility in
infertile men. A number of studies of infertile men taking oral zinc supplementation
have shown significant improvement in sperm
quality, sperm count, sperm motility, and fertilizing capacity of the sperm. The
ideal amount of supplemental zinc remains unknown, but some doctors recommend 30
mg two times per day. Long-term zinc supplementation requires 1–2 mg of copper
per day to prevent copper deficiency.
Arginine is an amino acid found in many
foods that is needed to produce sperm. Preliminary research shows that several months of
L-arginine
supplementation increases sperm count, quality, and fertility.
However, when the initial sperm count was extremely low (such as less than 10
million per ml), L-arginine supplementation produced
very little benefit, if any. Some pregnancies have been attributed to arginine supplementation in
preliminary reports, however these claims have not been confirmed through controlled research.
Many
doctors recommend up to 4 grams of L-arginine per day for several
months for
infertile men with sperm counts greater than 10 million per milliliter.
Supplementation with selenium (100 mcg per day for three months)
was shown to significantly increase sperm motility in a double-blind study of infertile men with reduced sperm motility,
however it had no effect on the sperm count.
Studies of both Vitamin B12 injections
and oral supplements given to infertile men have shown that taking the
supplements improved sperm counts. Men seeking vitamin B12 injections
should consult a physician.
L-carnitine is a substance that is necessary for normal functioning of
sperm cells which is made in the body and also found in supplements and
some foods such as meat. Supplementing with 3–4 grams per day for
four months helped to normalize sperm motility in men with low sperm quality,
according to a preliminary study.
Vitamin E deficiency in animals leads to
infertility. In a preliminary human trial, infertile couples given vitamin E
supplements (200 IU per day for the female and 100 IU per day for the male)
showed a significant increase in fertility. Vitamin E
enhances fertility in men by decreasing free-radical damage to sperm cells,
however, the evidence remains preliminary.
Calcium helps regulate sperm function as
the concentration of
calcium in semen determines sperm motility, the ability of sperm to move,
however, calcium deficiency has not been confirmed as a
cause of male infertility nor is there any evidence that calcium supplementation
will improve male infertility.
A specific cause of infertility, such as a
varicocele, can also be responsible for a low
sperm count. Varicoceles
are enlargements of veins inside the scrotum that drain the testicles. They're
found in 15 percent of all men, and in up to 40 percent of men in infertile
couples. These venous enlargements may lead to a rise in temperature and a
decrease in blood circulation through the testes and could negatively affect
sperm production. A surgical procedure known as a varicocelectomy can often correct this
problem and improve sperm count. Varicocele repair is controversial however, and should only be considered if
the varicocele is rather large.
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