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CPP Seminar Series

Male Infertility

Peter Conway
April 2005
Male Infertility
 Infertility/subfertility
= inability of a couple
to conceive after 1 year of unprotected
intercourse
 30 - 40% of couples have a major
identifiable male factor involved
 Roughly – ⅓ have male factors
predominating, ⅓ female factors
predominating and ⅓ no cause is found in
either partner
Declining Sperm Counts?
Carlsen, E.; Givercman, A.; Shakkeback, N.E. Evidence
for decreasing quality of semen during past 50 years
British Medical Journal 1992 305:609-13
 analysed sperm count data from many studies
 concluded there had been a dramatic decline in
sperm counts over 50 yrs
 suggested a link with oestrogen-like compounds
such as the pesticides
dichlorodiphenyltrichloroethane (DDT) and 1,2-
dibromo-3-chloropropane (DBCP),
endosulphane
 and other pollutants like polychlorinated
biphenyls (PCBs) and dioxins
Safe SH. Endocrine disruptors and human health - is there a
problem? An update.
Environ Health Perspect. 2000 Jun;108(6):487-93.
 Results of recent studies show that there are large
demographic variations in sperm counts within countries
or regions, and analyses of North American data show
that sperm counts have not decreased over the last 60
years.
 In Scandinavia, the difference between high (Denmark)
and low (Finland) incidence areas are not well
understood and are unlikely to be correlated with
differences in exposure to synthetic industrial chemicals.
 Results from studies on organochlorine contaminants
(DDE/PCB) show that levels were not significantly
different in breast cancer patients versus controls. Thus,
many of the male and female reproductive tract
problems linked to the endocrine-disruptor hypothesis
have not increased and are not correlated with synthetic
industrial contaminants.
Wong, W.Y.; Zielhuis, G.A.; Thomas, C.M.; Merkus, H.M.;
Steegers-Theunissen, R.P.
New evidence of the influence of exogenous and endogenous
factors on sperm count in man
Eur J Obstet Gynecol Reprod Biol. 2003 Sep 10;110(1):49-54
Case-control study among 92 fertile and 73 sub
fertile Caucasian males

RESULTS: At risk for oligozoospermia are men


exposed to –
 pesticides, welding, antibiotic use
 a history of mumps, gastrointestinal complaints
 decreased intake of fruits, vegetables
 or with female fertility disorders in their families.

Unlike other studies, no associations were observed


between oligozoospermia and exposure to paint or heat.
De Rosa M, et al.
Traffic pollutants affect fertility in men.
Human Reproduction 2003 May;18(5):1055-61.

 METHODS: Semen quality was investigated in 85 men


employed at motorway tollgates and in 85 age-matched
men living in the same area. Semen, circulating sex
hormones, methaemoglobin, sulphaemoglobin,
carboxyhaemoglobin, lead (Pb) and zinc (Zn)
protoporphyrin were assayed.
 RESULTS: Sperm count, and serum levels of FSH, LH
and testosterone were within normal range in both
groups. Total motility, forward progression, functional
tests and sperm kinetics were significantly lower in
tollgate workers versus controls.
 CONCLUSIONS: The finding that blood methaemoglobin
and Pb were inversely correlated with sperm parameters
indicates that nitrogen oxide and Pb adversely affect
semen quality
Rozati, R.; Reddy, P.P.; Reddanna, P.; Mujtaba, R.
Xenoesterogens and male infertility: myth or reality?
Asian Journal of Andrology 2000 Dec;2(4):263-9.

 Seminal PCB concentrations were compared between i)


fertile and infertile men and ii) men from different areas
and diets. The relationship between PCB concentrations
and measures of sperm quality such as the total motile
sperm count, was assessed.
 RESULTS: PCBs were detected in seminal plasma of
infertile men but absent from controls. Sperm quantity
and quality were significantly lower in infertile men
compared to controls. The highest average PCB
concentrations were found in fish-eating urban dwellers,
and followed in succession by fish-eating rural dwellers,
non fish-eating urban dwellers and non fish-eating rural
dwellers.
 CONCLUSION: PCBs may be instrumental in the
deterioration of sperm quantity and quality, a
contaminated fish diet being the main source of
exposure
Clinical Assessment
 Fertilityhistory
 Previous testicular
damage (orchitis, etc)
 Sexual history
 STIs
 Mood – depression
 Energy
 Stress
 Lifestyle – work/home
 Feelings about
conception
Clinical Assessment
 Drug intake
 Alcohol: > 3 units alcohol per day can impair
fertility
Anderson, RA, Jr.; et al. Male reproductive tract sensitivity to ethanol: a
critical overview Pharmacol Biochem Behav 1983; 18:S305
 Smoking: evidence of DNA damage to sperm
Smoking increases dna damage in sperms of male infertile patients in egypt
Abdel Rahman M Zahran, Mohamed Elsamra, Yehia Elgarem, Mohamed M
Elsawy, Alexandria, Egypt AUA Male Infertility Conference 2004
 Weight: being overweight is associated with low
testosterone and low sperm counts
 Dietary history
Investigation

Serological tests:
 LH & FSH
 Testosterone
 Testicular biopsy
 Antisperm antibody
test
Semen analysis
Semen Analysis
 Volume – 0.7-6.5ml
 Sperm count – 20-150 million/ml
 Morphology – at least 40% of
spermatozoa should be normal
 Motility – at least 20% of spermatozoa
should show progressive motility within 4
hours of collection
Varicocele

Present in up to 40%
of male fertility
“Varicose vein of the
spermatic cord”
Examine scrotum for
obvious vascular
congestion
•Mobile phones –
precautionary principle
Laptop – not on the lap!
Don’t wrap food in it!
Eat organic
Mineral / filtered water
Non-toxic cleaning/ grooming
Exercise & weight loss
Meditation / relaxation
Lifestyle precautions

• Avoid mobile phones near testes


• Laptop – not on the lap!
• Don’t wrap food in cling film!
• Eat organic
• Drink mineral / filtered water
• Use non-toxic cleaning/ grooming
• Exercise & weight loss
• Meditation / relaxation
Nutrition
 Good general organic diet
– low in carbohydrates
and saturated fat and
processed foods
 Optimal fruit and
vegetable intake
 High quality protein –
amino acid deficiency is
associated with low
sperm counts and quality
 Whole grains
Nutrition
 VitC – 500mg bid may improve sperm motility
and reduce abnormal clumping of sperm Dawson,
E.B. et al. Effect of ascorbic acid on male fertility Ann NY Acad Sci 1987;
498:312
 Zinc– 25-60mg/day – essential for testosterone
and sperm production and may improve sperm
counts
Piesse, J. Zinc and human male infertility Internat Clinic Nutr Review
1983;3:4
 Multimineral – with selenium and chromium –
deficiencies of selenium and chromium can
reduce sperm counts
Scott, R.; et al. The effect of oral selenium supplementation on human
sperm motility. Br J Urol. 1998 Jul;82(1):76-80.
Antioxidants – including Vitamin E 250mg bid,
carotenoids
Nutrition

Omega 3 EFAs (flax oil;


fish oils) improve
sperm motility

Comhaire, F.H.; Mahmoud, A. The


role of food supplements in the
treatment of the infertile man.
Reprod Biomed Online. 2003 Oct-
Nov;7(4):385-91.
Adaptogens
 Withania somnifera
 Panax ginseng
 Panax quinquefolius
 Astragalus
membranaceus
 Eleutherococcus
senticosus
 Schisandra chinensis

Korean ginseng
Adrenal Support

 Borago officinalis
 Glycyrrhiza glabra
 Astragalus
membranaceus
 Rehmannia glutinosa

Milk vetch
Nervous Trophorestoratives

 Avena sativa
 Hypericum
perforatum
 Scutellaria lateriflora
 Valeriana officinalis
Reproductive Tonics
 Serenoa serrulata
 Turnera diffusa
 Ptychopetalum
olacoides
Detox/ Liver Herbs
 Taraxacum officinale
 Silybum marianum
 Arctium lappa
 Apium graveolens
 Galium aparine
 Viola odorata
 Schisandra chinensis
Immune modulators/ enhancers

 Echinacea spp.
 Tabebuia spp.
 Uncaria tomentosa

E
Pelvic Decongestants
 Phytolacca decandra
 Calendula officinalis
 Zanthoxylum clava-
herculis
 Anemone pulsatilla
Varicocele Treatment
 Aesculus hippocastanum
 Calendula officinalis
 Zingiber officinalis
 Achillea millefolium
 Ginkgo biloba
 Crataegus spp.
 Solidago virgaurea
 Zanthoxylum clava-
herculis
Contraindicated herbs?
 oral Andrographis leaf powder
caused cessation of
spermatogenesis in male rats
 very high oral doses of
andrographolide caused lack of
fertility
 but oral Andrographis dried herb
5:1 ethanol extract showed no
adverse effects on male fertility
indices
Mills, S.; Bone, K. 2005 The Essential
Guide to Herbal Safety Elsevier:
Churchill Livingstone