Improving Conception Is a Team Effort
How does the team in a team sport succeed if:
- Only one player has all the assessments, all the one-on-one coaching, all the skills improvement training, and shoulders the burden for all the losses?
- The other player is minimally assessed, only has to come to the first and last games, never has to learn details about the game, and gets all the credit for the winning game?
It doesn’t — at least not easily. You can imagine the struggles this team will have to accomplish a win.
Sadly, this is what it looks like with many couples struggling with infertility. Almost as soon as a couple starts having trouble conceiving, they are guided through the process with one active player (female) and one benched player (male). For centuries, we have been taught that evaluating the female is all that needs to be done for a successful win of conception. Research is proving this wrong: the male factor is just as important for conception and maintaining early pregnancy as the female factor. Conception success starts by getting both “players” fully involved in the assessment and treatment of their fertility health.
The Male Factor
Male factor infertility accounts for 35% of all infertility cases—this is equal to the female factor—with an additional 20% having both female and male factor involvement. Therefore, if you are struggling to conceive, having both factors investigated will reduce your time to conception and increase your live birth rate. Additionally, when couples go through Advanced Reproductive Technologies (ART), 80% of male factor investigation involves a sperm count only; a medical history isn’t performed in order to uncover any underlying contributing health concerns. This is simply poor medicine. Wasting valuable time and money with repeat procedures concerning the female factor, an average of six in vitro fertilization (IVF cycles needed to take home a baby, and never investigating a just-as-likely cause for infertility, the male factor, is poor medicine.
Let us improve the outcome of taking home a baby through involving the male factor on this journey to parenthood. There are two main areas he can work on to help improve the chances of conception.
- Know his numbers: Semen analyses can tell a lot about the overall health of the male factor. One study found men with a low sperm count were more likely to have a higher percentage of body fat (bigger waistline and higher BMI) and higher blood pressure than men with higher sperm counts. They also experienced a higher frequency of metabolic syndrome, or higher chance of developing diabetes, heart disease, and stroke.
Male patients are often told their semen analysis is “fine” when the couple is shuffled through intracytoplasmic sperm injection (ICSI). ICSI is a more advanced IVF procedure in which a single sperm is injected directly into the egg. If ICSI is suggested, it is most likely that the semen analysis isn’t really “fine” at all—it is only fine enough for the most extreme manipulation to conception.
It is important to understand the numbers to know if your semen analysis may result in natural conception. Following are the World Health Organization (WHO) reference ranges, Functional Medicine reference ranges, causes of abnormal readings, and general treatment. Due to the drastic decrease in WHO parameters over the past 80 years, both WHO and Functional Medicine reference ranges are listed here; research showing higher success of IVF when male factor numbers are nearer functional medicine reference ranges/values.
- Semen volume:
WHO: > 1.5 mL
Functional: > 3 mL
Low causes: Dehydration, spillage of sample, not abstaining long enough, congenital health issues, low testosterone, alcohol use
Treatment: Hydration, correcting low testosterone, abstain 3–5 days for testing
- Sperm concentration: In 1940, the average sperm concentration was 113 million/mL; here are today’s numbers:
WHO: > 15 million/mL (most men today would have been considered infertile in 1940)
Functional: > 48 million/mL
Low causes: Low testosterone, testicular failure, ductal obstructions, genetic factor, varicocele, retrograde ejaculation
- Semen volume:
Treatment: Eating organic, maca, multivitamin, glutathione, fish oil, CoQ10, inositol, L-arginine + pycnogenol
A study published in the scientific journal Lancet showed 43% more sperm with organic eating.
- Sperm motility: Ability to move toward the egg.
WHO: Progressive > 32%; nonprogressive + progressive > 40%
Functional: Nonprogressive + progressive > 50%
Abnormal causes: Infection, Inflammation (prostatitis), sperm antibodies, stress, toxin exposure, poor diet
Treatment: Carnitine + L-acetyl-carnitine, CoQ10, arginine, reduced glutathione, zinc
A recent study showed a 491% increase in motility when male did not use hot tubs and saunas; get out of wet heat if you have motility issues. Motility issues are seen in 25% of semen analyses.
- Sperm morphology: Size and shape
WHO: >/= 4–10% are considered to be shaped normally
Functional: > 15% (shown to have much higher positive results for IVF)
Causes: Inflammation, stress, toxins, poor diet, daily alcohol use
Treatment: Vitamin C, antioxidants, decrease toxin exposure (especially alcohol), curcumin, EGCG (epigallocatechin gallate), glutathione, CoQ10
White blood cells: A sign of infection or inflammation
WHO: < 1 million leukocytes/mL ejaculate
Causes: Infection, inflammation like prostatitis
Treatment: EPA (eicosapentaenoic acid), vitamin C, astragalus, dong quai, beta-glucan, vitamin E
DNA fragmentation: Damage to sperm DNA and epigenetic changes made to sperm DNA during assembly and development, simply put-environmental influences that turn DNA on or off in the sperm itself.
Functional: <20%, subfertility seen at fragmentation rates > 25%
Risk factors: Infection, high fever,
advanced age, disrupted sleep, poor diet, toxin exposure, and stress
- Sperm motility: Ability to move toward the egg.
Treatment: Remove negative environmental influences, DHA (docosahexaenoic acid), omega-3s, resveratrol, quercetin, hyperbaric oxygen
Embryos from sperm with DNA fragmentation have a poor prognosis and higher miscarriage rates. According to Dr. Pojer, an Austrian reproductive endocrinologist specializing in male fertility, DNA fragmentation investigation and correction is first-line therapy in Europe, before IVF/ICSI.
An abnormal semen analysis should merit evaluating testosterone (T), sex hormone binding globulin, luteinizing hormone (LH), and follicular stimulating hormone (FSH), minimally.
- All low: Stress is major driving factor
- High LH, and FSH; low testosterone: need to evaluate testicular function, toxin exposure
- Normal testosterone with high or normal LH and FSH: Y chromosome deletion, varicocele, and autoimmunity are potential causes. Testosterone is normal between 300–800 ng/dL; measure fasting between 8–10 am. Testosterone readings < 250 ng/dL merit an MRI of the brain.
- Being the best dad you can be starts NOW, during preconception time.
Mayo Clinic emphasizes that male infertility isn’t always preventable; however, you can try avoiding the following known causes of male infertility to improve conception outcomes.
- Smoking: Nicotine affects fertilization
- Alcohol and/or drug use: Alcohol is toxic to testosterone-making cells in the testicles, marijuana inhibits pituitary function, and certain prescription medications decrease fertility
- Being an unhealthy weight: Overweight men are 20% less fertile, obese men are 30–40% less fertile, and 15.6% of men with a BMI > 30 had oligospermia (low sperm count)
- Having a vasectomy
- Prolonged heat on the testicles: Decrease sperms’ ability to move, increase in DNA damage
- Stress: Negative impact on sperm quality and motility
- Exposure to pesticides, heavy metals, and other toxins like degreasers, paints, solvents:
- Bisphenol A (BPA) in plastics: Lower quality sperm
- Phthalates in personal care products, polyvinyl chloride (PVC) plastics: Decrease sperm concentration, motility, FSH and LH in men
- Parabens in personal care products, preservative in foods: Failed implantation
Additional support for male factor fertility include:
- Multivitamins, which can make up for nutrient deficiencies, help correct underlying sperm assembly issues, and overall improve the health of the male factor.
- Moderate exercise, which has been shown to boost sperm count.
- Quality sleep, which is necessary for proper testosterone production.
- Removing cell phones from pants pockets; avoid working with computers on laps.
A Case Study
A 34-year-old male with a congenital abnormality had a sperm count of just five total sperm, all of which were nonmotile. After three months out of the hot tub, losing 20 pounds of extra weight, taking Coq10, vitamin B complex, and carnitine, the sperm count improved to 50,000 with progressively moving sperm: a 10,000% improvement in count after three months. When hope for this couple had been shaken by mainstream medicine suggesting that donor sperm would be needed, taking these simple steps allowed the couple to instead pursue IVF with ICSI. After one round of IVF, they gave birth to a baby girl.
Remember, conception is a team sport—not a solitary game. Getting in the game is the best way to win. Supporting each other is vital when struggles start to occur surrounding fertility. Knowing your numbers is half the battle; the other half is living a healthy, wholesome, and clean lifestyle.
Dr. Nicole Kerr, ND, LAc, operates an all-natural fertility clinic in Wallingford CT, Fertility Oasis. At Fertility Oasis, Dr. Kerr teaches her patients the importance of preconception care and about all treatment options available to couples struggling to conceive. Male and female infertility factors are addressed by Dr. Kerr to offer comprehensive fertility care for her patients.
Fertility Oasis, 857 N Main St., Ext Suite 1, Wallingford, CT, 203.265.0459.