I see mostly women in my practice, and when a woman comes to me for help supporting her fertility, I always remind her that “it takes two”, and partners also need to be involved in the preconception self-care process. When a male-female couple is trying without luck to get pregnant, it is important to involve the male partner in looking for ways to support their fertility status, as well.
Infertility is defined as a lack of conception after 12 months of regular intercourse without contraception. Male infertility factors are present in about 20% of infertile couples and contributory in about 30 to 40%. Male infertility factors are usually defined by an abnormal semen analysis. When a semen analysis is normal, other male factors may play a role.
Male infertility can result from a variety of conditions. Of those conditions that are identifiable, some are reversible and some are not. A thorough physical exam, laboratory testing and evaluation help to identify conditions contributing to difficulty conceiving.
Lifestyle and diet play an important role in supporting a man’s fertility. Further, several specific nutrients and herbs have been demonstrated to be beneficial in improving sperm quality and promoting male factor fertility.
- Obesity or high Body Mass Index (BMI). Obesity is associated with lower testosterone, higher abnormal sperm counts, decreased ejaculate volume, sperm concentration and total sperm count. Optimal hormone functioning in men depends upon appropriate caloric and nutritional intake. Inadequate of excessive caloric intake disrupts normal GnRH pulses (the brain hormone that stimulates testosterone production). Excess body fat also increases the rate of testosterone converting to estradiol. Additionally, excess scrotal fat has been hypothesized to elevate scrotal temperatures, resulting in impaired sperm quality.
- Tobacco. Smoking and chewing tobacco have been associated with lower sperm concentration, impaired sperm motility and morphology, and increased incidence of abnormal chromosomal numbers.
- Marijuana. Several studies consistently conclude that marijuana has a negative impact on male fertility.
- Alcohol. Some studies have demonstrated a dose-dependant effect of alcohol on sperm quality. While adverse effects on sperm parameters were not detectable in men with limited alcohol use, progressive deterioration in semen quality was demonstrated in several studies; the authors conclude that the evidence is sufficient to recommend minimizing alcohol consumption in men.
- Caffeine. To date, there have been no randomized controlled trials evaluating the effect of caffeine on male fertility and existing studies on caffeine are inconsistent; moderate consumption of caffeine (1-2 cups a day) appears to be safe for male reproductive health.
- Avoid hot tubs and steam rooms, and wear boxers rather than briefs. Warmer scrotal temperatures are associated with suboptimal fertility.
- Infrequent ejaculation.
- Exposure to pollutants and plastics. The Environmental Working Group reports that environmental exposures such as lead, chemicals in personal products (including BPA in plastics), and pesticides is linked to infertility in men.
- Poor diet or inadequate nutrient intake. Healthy sperm requires a variety of vitamins and minerals to be produced. Evidence suggests that ingesting antioxidant supplements can improve sperm quality; therefore, enhancing dietary intake of antioxidant-rich foods is an important component of a well-rounded approach to supporting semen quality.
- Coenzyme Q10 (CoQ10) has been shown to improve sperm concentration, motility, and morphology.
- Glutathione is one of the most potent antioxidants in the body; it has been shown to improve sperm motility and morphology in men with varicocele or genital tract inflammation.
- L-Carnitine is an antioxidant and functions in fatty acid metabolism; it improves sperm concentration and motility.
- Omega 3. Improves sperm concentration, motility and morphology.
- Selenium and N-Acetyl-Cysteine (NAC). Improves sperm concentration, motility and morphology, and improved serum testosterone levels.
- Zinc and folate. Zinc depletion results in reduced semen volume and decreased serum testosterone; supplementing the two together increased sperm concentration.
Herbs and Herbal Extracts
- Nigella sativa (black cumin). Improves sperm count, motility, morphology and semen volume.
- Panax ginseng. Improves sperm concentration, motility, morphology and viability in subfertile men with varicocele.
- Aescin. Aescin is an extract from horse-chestnut, which has been studied as a fertility support for men who are subfertile due to a varicocele. There was a >30% improvement in sperm concentration in more than half of the men who took this supplement. It also decreased the diameter of the varicocele.
Dr Mahannah works with couples to support preconception and fertility, as well as providing adjunctive care for patients undergoing Assisted Reproductive Techniques (such as IVF) for conception.
Ahamdi et al. (2016) Antioxidant supplements and semen parameters: An evidence-based review. Int K Reprod BioMed, 14(12): 729-36.
Stefan S, Agarwal A, Syriac A (2015) Marijuana, phytocannabinoids, the endocannabinoid system, and male infertility. J Assist Reprod Genet, 32: 1575-88.
Yao D, Mills J (2016) Male Infertility: lifestyle factors and holistic, complementary and alternative therapies. Asian J of Andrology, 18, 410-18.
Environmental Working Group. EWG’s issue guide to men’s health. Obtained online from http://www.ewg.org/release/ewg-issues-guide-men-s-environmental-health