Men's Health in fertility treatment.
The importance of men's health in fertility treatment & strategies to overcome the main issues
A lot of men, especially in the Western world, do not see their lifestyle and nutrition as a key element to have children or improve the odds of fertilisation.
It is partly due to the fact that conventional medicine does not have a lot to offer when a sperm test shows minor or major problems. Usually, the response will be to put the female partner on hormone treatment to increase the odds. The other main reason is that there are a lot of conflicting nutritional advice, and that many do not fit conventional modern diet.
However, it is now considered that up to 60% of infertility is actually down to the man (M. Fox, "Oestrogen Mimics", Green Network News - March 1994.
This articles provides a strategy on how to help the male partner of a couple who want to have children. Of course, the female partner will also need treatment.
Semen Analysis briefly explained
When a couple comes and seek help for fertility, it is important to ask medical history, and a recent sperm and semen test for the male partner. This will help set metrics if required.
A semen analysis evaluates certain characteristics of a male's semen and the sperm contained in the semen.
Its key parameters are:
Sperm count measures the concentration of sperm in a man's ejaculate. It is measured un million sperm per millilitre. Over 15 million sperm per millilitre is considered normal (WHO in 2010), while older definitions stated 20 million. The average sperm count today is around 60 million per milliliter in the Western world, having decreased by 1-2% per year from a substantially higher number decades ago ("The sperm count has been decreasing steadily for many years in Western industrialized countries: Is there an endocrine basis for this decrease?" The Internet Journal of Urology TM. ISSN: 1528-839).
Successful pregnancy rate varies with the sperm count. With everything else equal. a reading of 20 million will increase a chance of successful pregnancy by 20%, while 30 million will increase the odds by 40%. Above 50 million, the successful pregnancy rate link is flatter.
This shows that even if the sperm count is considered OK by conventional doctors, ideally, a male should aim at a sperm count about 50-60 million.
Total sperm count
Total sperm count, or total sperm number, is the total number of spermatozoa in the entire ejaculate. It is the sperm count multiplied by the volume of semen, which should be at least 2 ml.
The motility of the sperm shows good forward movement, and is similar to the quality of the sperm. Not all sperm is good quality, and an average of 50-60% of observed sperm with good quality is considered good by conventional medicine (Cooper TG, Noonan E, von Eckardstein S, et al. (2010). "World Health Organization reference values for human semen characteristics).
A man can have a high total number of sperm, but still have bad quality because too few of them are motile. This will reduce the chance of a successful procreation.
The morphology of the sperm is also evaluated. The WHO criteria in 2010 was that a sample was normal if 4% or more of the observed sperm have normal morphology. Morphology is a predictor of success in fertilizing oocytes during in vitro fertilization.
The volume of the sample is measured. Conventionally, volumes between 1.5 ml and 6.5 ml are considered normal. Low volume may indicate partial or complete blockage of the seminal vesicles, or that the man was born without seminal vesicles.
The level of fructose in the semen is also usually measured. Absence of fructose may indicate a problem with the seminal vesicles.
The pH of the sample is measured. Good sperm should be slightly alkalyne, with a normal range of 7.2-7.8. A pH value outside of the normal range is harmful to sperm. Acidic ejaculate (lower pH value) may indicate one or both of the seminal vesicles are blocked. A basic ejaculate (higher pH value) may indicate an infection.
Other data are sometimes measured, such as:
- liquefaction: process when the gel formed by proteins from the seminal vesicles is broken up and the semen becomes more liquid.
- MOT: measures how many million sperm cells per ml are highly motile
- Total motile spermatozoa: combination of sperm count, motility and volume, measuring how many million sperm cells in an entire ejaculate are motile.
- White blood cells: a high level of white blood cells (over 1 million per milliliter) may indicate an infection
Important Sperm Test Metrics and Nutritional advice
In most cases, poor sperm quality is the primary reason for male infertility. A high sperm count (over 50-60 million) and a high motility rate (> 50%) should then be the first elements to address in order to help a male increase the chances of fertilisation. I ask all male patients to have a sperm test at the first consultation, and then to do another one after 4 months.
When people are explained the importance of these two metrics in procreation, and that they can be easily modified with lifestyle changes, they are usually open and eager to make the necessary changes in their life.
The two most important elements for good sperm are essential fats (making about 85% of the sperm mass) and zinc (about 15% of the sperm mass). I now rarely hesitate to suggest supplements for at least 4 months, which is the time sperm takes to be made. The usual dosage is 15 mg of zinc supplementation and 100 mg fish oil with 1,000 mg vegetable oil.
A good quality Vitamin C can also be added (1,000 mg) as it has been shown to improve sperm production.
This will however be fine-tuned when the diet and lifestyle are assessed. If the patient is a heavy smoker or drinker, or lives on highly-refined diet, then B-complex or multi-vitamins may be required to assist absorption of the zinc and good quality fat.
However, supplements should not be a substitution for a better diet and lifestyle, and the time of conception is a rare occasion when a man may decide to significantly take ownership of their health.
A good nutrition should include a significant amount of vegetables and fruit, ideally organic, and plenty of fatty fish, of seeds and vegetable unrefined oil, the best being flaxseed, sesame, sunflower, pumpkin. Good sources of zinc are oysters, wholemeal & rye bread, green peppers, potatoes, eggs, chicken, apple…
More important is also to ensure that the patient reduces his intake of "nutrients' robbers", that would prevent the body to absorb good fat, zinc or other key nutrients. These include highly refined food, man-made fats, sugar, coffee, alcohol and toxins (see below). For example, it is estimated that smoking reduces sperm concentration by 24% while alcohol is toxic to the male reproductive tract (DM de Kretser, "declining sperm counts", British Medical Journal, 1996, vol. 312).
Robbers also includes additives or artificial products that are now commonly used. Major hormonal disrupters include Thalates (plastics, alkylphenols (detergents), Bisphenol A (food coating), organochlorine pesticides (such as Lindane, DDT, etc...), vinclozolin (fungicide used on foods) and phytoestrogens (refined soya products).
Many patients in the UK find it hard to move quickly to a healthy normal diet, which would be ideally unprocessed organic diet with no use of plastic packaging, and little or no sugar, coffee and alcohol. For this reason, providing supplementations while the patient slowly move to a better diet may be a more successful approach.
Importance of Medical History for Male Patients
A male patient should have at least a consultation to assess any other issues that may impact his sperm quality.
Beside nutrition, the more common issues to keep in mind are:
- Use of medical drugs that have a detrimental effect on testes: the major hormonal disrupters are steroids, anti-depressants, pain killers. However, any long-term use of medications should be considered. Checking the list of side-effects may help to confirm if a medication can have an impact. For example, the drug susphasalazine, used in treatment of ulcerative colitis, is known to reduce sperm counts.
- Use of recreational drugs, especially marijuana and opioids
- Exposure to radiation
- Work hazards such as dyes, solvents, weed killers, mercury or lead. If the patients works in close proximity of these chemicals, then this may have to be considered.
As these are major hormonal disrupters, if they show in the medical history, even long ago, then this may need to be addressed.
- Mumps and sexually transmitted diseases, than can impact testes
Again, if such events appear in the medical history. then this may need to be addressed.
If the following issues are presently current, then them may need to be addressed as well:
- Long-term chronic stress and depression
- Impotence and premature ejaculation
If there are no other issues in the case, then constitutional prescribing can be used to help the patient alongside the nutritional advice.
Emotional Issues that may need to be addressed
If there are any present emotional issues related to the sexual act, these need to be addressed homoeopathically. Similarly, depression or long-term chronic stress can also be an obstacle, and it may be necessary to address them if there are a major part of the presenting picture of the patient.
Addressing aetiological causes
When investigation point to some possible causes, then homeopathy should be used alongside the present nutritional advice.
If there is one specific issue, then this should be taken into account in the repertorisation.
If there is a combination of issues (such as mumps in late teens and history of steroids abuse between age 25 and 28), then depending on the vitality of the patient, the practitioner may decide to prescribe classically by taking into account the presenting symptoms and the aetiological causes, or sequentially in reverse chronological order: for instance, in the example above, this could be a tautopathic prescription (steroids), followed by remedy fitting the mumps outbreak.
Addressing sources of toxicity
While trying to conceive, a male patient should try to reduce the amount of toxic disrupters for at least four months, the time, it takes sperm to be made.
If there has been long term exposure, however distant in the timeline, it can useful to check the effects of exposure to these toxins or drugs, and check if these are present in the case.
If the patient is now willing or if it is not possible to reduce this source of exposure at the present moment, then an isopathic / tautopathic prescription may be used during the fertilisation treatment.
If a patient is on chronic medication, such as steroids for skin issues for example, then there may be a window of opportunity to support the patient. This is usually better down gently and in cooperation with the allopathic practitioner, by introducing gently safe alternatives such as homeopathic remedies or herbal support.
P. Holford & S. Lawson "Optimum Nutrition before, during and after pregnancy"
E. Kramer "A practical guide to methods of homeopathic prescribing"
Information from the following websites were used: Wikipedia, Netdoctor, WebMD
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