Understanding Male Infertility

Infertility is becoming much too familiar in today’s society. Unfortunately, it is not uncommon to hear stories from close friends or family members that are undergoing the barrage of tests and alternative pregnancy methods such as In Vitro Fertilization (IVF) and Intrauterine Insemination (IUI). In many cases, these costly procedures end up being the last resort for couples. But that doesn’t mean that there is nothing to be done before (or even during!) this process.
In cases where male infertility is suspected or it has been confirmed that the male partner is contributing to unsuccessful pregnancy outcomes, there may be hope. If physical and anatomical obstructions are ruled out as causes, sperm disorders are the most common problem. Sperm disorders refer to one of the following:

Low sperm count: not enough sperm are being produced or matured
Impaired motility: the sperm are not moving properly
Improper morphology: the sperm are abnormally shaped

If we know we are dealing with one of these problems, or any combination of the 3, there are many interventions to consider. A plethora of research has found that lifestyle and dietary factors contribute to sperm disorders and male infertility. For example, higher levels of heavy metals such as lead, mercury and cadmium have been correlated with lower sperm motility and sperm counts. Here is a more comprehensive list of factors that have been linked to male infertility through impaired sperm quality and quantity:

– smoking
– alcohol
– psychological stress
– heavy metal toxicity
– pesticide exposure and environmental pollutants
– obesity or being underweight
– nutrient-poor diets (ie. high in sugary drinks and processed foods)

What is the common thread among all of these factors? For starters, they all contribute to increased reactive oxygen species (ROS) and diminish the mitochondrial function of sperm. By quitting smoking, reducing alcohol, removing processed foods and by exercising, we improve mitochondrial function, prevent damage to sperm and ultimately increase the sperm parameters. Lifestyle and dietary changes are clearly paramount for optimal outcomes and timely results. However, research has found that additional nutrients may be helpful for male infertility. Here are some of the most promising:

Vitamin E: Vitamin E is a fat-soluble antioxidant that has been shown to protect the sperm cell membrane from damage. Studies have found that vitamin E helps to improve sperm motility and lead to better fertilization in those with a reduced number of sperm cells. A full blend of tocopherols and, ideally, tocotrienols should be supplemented as opposed to the sole synthetic form dl-alpha-tocopherol. Moreover, vitamin E in combination with other nutrients such as selenium, zinc, copper and vitamin C has been found beneficial in cases of oxidative stress (ie. smoking or environmental pollutants).

Omega-3 Fatty Acids: Compared with infertile men, fertile men tend to have higher blood levels and sperm levels of omega-3 fatty acids. The ratio of omega-6 fats (such as those found in corn) to omega-3 fats (such as those found in fish) also tends to be much lower in fertile males, indicating a healthier balance of fatty acids in the body – a ratio that has been correlated to much more than fertility measures. For men with the worst sperm parameters, one study found that supplementation with omega-3s significantly increased sperm count and sperm concentration. Considering the widespread health benefits associated with optimal omega-3 status, in addition to fertility implications, supplementation should be considered.

L-Carnitine: L-Carnitine is perhaps the best-recognized nutrient therapy for male infertility. In fact, a 2010 study found that L-carnitine should be considered a first step treatment in cases of male infertility with no known cause, either in combination with, or instead of, the pharmaceutical drug most often used to treat male infertility, clomiphene citrate. Within the body, carnitine is known for transporting fatty acids into the mitochondria, thereby helping to create cellular energy. L-Carnitine directly supports the mitochondrial function of sperm, leading to better motility and quality sperm. However, one study found L-carnitine had less of a benefit on sperm parameters in smokers when compared to non-smokers, confirming the necessity of smoking cessation in infertility cases.

Ashwagandha: Also known as Withania somnifera, this adaptogenic herb is best known for its ability to treat stress and reduce anxiety. But it has also been described in ancient Indian Ayurvedic medicine as an aphrodisiac capable of treating male sexual dysfunction and infertility. A 2013 placebo-controlled study confirmed this ancient wisdom by showing significant improvements in sperm parameters after 3 months of treatment intervention. Specifically, a 167% increase in sperm count was noted, with a 53% increase in sperm volume and a 57% increase in sperm motility!

Other treatment considerations should include astaxanthin, zinc, folate, B12, coenzyme Q10 and arginine, all of which have been studied and proven beneficial for various sperm measures. Depending on individual factors, positive treatment outcomes and improvements in sperm parameters with any of these natural health ingredients should be expected within 3-6 months. Keeping this timeline in mind is important for building realistic expectations, minimizing stress and maintaining compliance. Of course, with something as important as infertility, and in all cases of taking natural health supplements, professional consultation and guidance is recommended.

Selected References:

Ambiye VR, Langade D, Dongre S, Aptikar P, Kulkarni M, Dongre A. Clinical Evaluation of the Spermatogenic Activity of the Root Extract of Ashwagandha (Withania somnifera) in Oligospermic Males: A Pilot Study. Evid Based Complement Alternat Med. 2013; 571420.

Barazani Y, Katz BF, Nagler HM, Stember DS. Lifestyle, environment, and male reproductive health. Urol Clin North Am. 2014;41(1):55-66.

Khademi A, Alleyassin A, Safdarian L, Hamed EA, Rabiee E, Haghaninezhad H. The effects of L-carnitine on sperm parameters in smoker and non-smoker patients with idiopathicsperm abnormalities. J Assist Reprod Genet. 2005;22(11-12):395-9.

Mahdi AA, Shukla KK, Ahmad MK, Rajender S, Shankhwar SN, Singh V, Dalela D. Withania somnifera Improves Semen Quality in Stress-Related Male Fertility. Evid Based Complement Alternat Med. 2009

Moradi M, Moradi A, Alemi M, Ahmadnia H, Abdi H, Ahmadi A, Bazargan-Hejazi S.
Safety and efficacy of clomiphene citrate and L-carnitine in idiopathic male infertility: a comparative study. Urol J. 2010;7(3):188-93.

Sarafinejad MR. Effect of omega-3 polyunsaturated fatty acid supplementation on semen profile and enzymatic antioxidant capacity of seminal plasma in infertile men with idiopathic oligoasthenoteratospermia: a double-blind, placebo-controlled, randomized study. Andrologia. 2011;43(1):38-47.

Safarinejad MR, Hosseini SY, Fafkhah F, et al. Relationship of omega-3 and omega-6 fatty acids with semen characteristics, and anti-oxidant status of seminal plasma: a comparison between fertile and infertile men. Clin Nutr. 2010;29(1):100-105.

Walczak-Jedrzejowska R, Wolski JK, Slowikowska-Hilczer J. The role of oxidative stress and antioxidants in male fertility. Cent European J Urol. 2013;66(1):60-7.