Male factor infertility

Male infertility is involved in a couple’s inability to conceive in 40% to 50% of cases today, whereas it is estimated that in the 1950s only 10% of infertile couples had problems with male infertility. This dramatic decline in semen quality may be due to environmental factors, nutritional status, or stressful lifestyles. The inability to fertilize an ovum defines male infertility, while total lack of sperm production is labeled male sterility.

Chinese medical treatment of male infertility

Chinese medicine is an effective treatment option for the majority of cases of male infertility, whether used on its own or in combination with Western drug protocols or assisted reproduction to improve their outcomes:

Acupuncture has been shown in research studies to improve all three sperm parameters: motility, morphology and count. It can also be used in conjunction with IUI (Intra Uterine Insemination) or IVF (In Vitro Fertilization) cycle to improve the reproductive response of both male and female partners.

Chinese herbs contain bioactive substances that reduce inflammation, enhance the functioning of the immune system, and increase blood flow to the reproductive organs. They may also be used to address hormonal imbalances that are contributing to male infertility.

Nutritional supplements and dietary therapy are often used to protect developing sperm from oxidative damage. Many research articles prove that specific antioxidant supplements are beneficial for sperm parameters.

Lifestyle and stress management are important for most cases of male infertility; avoiding smoking, alcohol, excessive testicular temperatures and high levels of stress can create a dramatic improvement over time.

Causes of male infertility

Multiple factors influence male fertility; the most common are:

  • Abnormal sperm count, motility or morphology
  • Low testosterone levels or other hormonal imbalance
  • Antisperm antibodies/ immunologic infertility
  • Hypogonadism due to various causes
  • Lifestyle factors such as drugs, alcohol, smoking
  • Prescription drug use: antihypertensives and anti-inflammatories reduce sperm count. Antihistamines decrease the amount of seminal fluid
  • Strenuous bicycle or horseback riding
  • Teratospermia (abnormally shaped sperm)
  • Oligospermia (low semen volume)
  • Azoospermia (complete lack of sperm in semen; can be due to scar tissue in testicle)
  • Y chromosome microdeletions
  • Klinefelter syndrome (abnormal set of chromosomes)
  • Neoplasm, e.g. seminoma (a type of testicular cancer)
  • Cryptorchidism (undescended testicle)
  • Varicocele
  • Testicular trauma
  • Hydrocele
  • Mumps
  • Malaria
  • Testicular dysgenesis syndrome
  • Obstruction of the vas deferens
  • Lack of vas deferens, often related to genetic markers for cystic fibrosis
  • Infection, e.g. prostatitis
  • Retrograde ejaculation
  • Hypospadias
  • Impotence
  • Acrosomal defect/egg penetration defect

Diagnosis of male infertility

A semen analysis is typically the first and most useful test done to evaluate male fertility, and may include any of the following tests to evaluate the quality and quantity of the semen:

Volume. Measures the amount of semen in one ejaculation. A volume greater than 2 ml is considered normal.

Liquefaction time. Measures the amount of time required for semen to liquefy. Normal semen should be transformed from a thick gel into a liquid within 20 minutes of ejaculation.

Sperm count. Count of the number of sperm present per milliliter (ml) of semen. A sperm sample with less than 20 million sperm per ml is considered low.

Sperm morphology. Measures the percentage of sperm that have a normal shape. According to WHO (World Health Organization) criteria, a sample is normal if 30% or more of observed sperm have normal morphology; when evaluated by the Kruger criteria, a sample is normal if 14% or more have normal morphology.

Sperm motility. Measures the percentage of sperm that are moving forward normally. According to the WHO, 50% or more of sperm must be moving forward to have normal motility. Motility is graded on a scale of 1-4 with 1 being no movement and 4 being purposeful forward progression.

pH. This is a measure of the acidity (low pH) or alkalinity (high pH) of the semen, WHO criteria specify 7.2–7.8 as the normal range.

White blood cell count. Tests for the presence of infection.

Fructose level. Measures the amount of fructose in the semen. Fructose provides energy for the sperm, and may indicate a problem with the seminal vesicles if low.

Sperm chromatin structural assay (SCSA) measures the level of DNA fragmentation in the sperm, which may serve as a predictor of reduced male fertility.

Western treatment of male infertility

Treatment options for male infertility most commonly involve techniques of assisted reproduction, including IUI (intrauterine insemination) or IVF (in vitro fertilization). If the sperm count is very low, ICSI (intracytoplasmic sperm injection), wherein a single sperm is injected into each egg, may be used with IVF. In certain cases, sperm aspiration techniques may be required to allow for extraction of sperm directly from the epididymis or testicle, namely MESA (microsurgical epididymal sperm aspiration), TESE (testicular sperm extraction), and PESA (percutaneous epididymal sperm aspiration). When large varicoceles are present, surgical intervention to remove the varicocele may result in improved fertility. Fertility drugs such as Clomid, FSH or hCG may be applicable in certain cases.