I have treated women through their fertility journey for many years, with both natural and assisted fertility and during this time continued extensive training to support them. What has become apparent over the last few years is that for some female patients, after numerous tests and procedures, there appears to be no good reason for them not to conceive.
I then started to look more into the male investigations and realised that for most men, a semen analysis is all that is offered, and providing the results meet the basic criteria, there are no other tests, advice or support offered to them.
Currently around 1 in 7 couples in the UK seek assistance for fertility and it may surprise you to hear that the quality and quantity of sperm account for around half of the cases. Even when the results are on the lower side, the clinics keep the focus on the females and use ICSI as the treatment of choice (the best sperm are chosen and injected into the egg). There seems to be little or no thought for what men are going through.
As there seems to be a gap in how to help couples where male factor is involved, I decided to take further training to look specifically at what can be done for men. I was already aware from the World Health Organisation that the quantity and quality of sperm had declined over the last 30 years . The table below illustrates the minimum results that are expected in the average sperm sample.
World Health Organisation (WHO) | WHO 1992 | WHO 2021 |
Volume (amount of semen produced) | >2ml | >1.4ml |
Concentration millions/ml | >20 | >16 |
Total number of sperm millions | >40 | >39 |
Progressive motility (if they swim the right way) | >50% | >30% |
Morphology (shape and if they are formed correctly) | >32% | >4% |
From this we can see that there is a decline in the amount of ejaculate, concentration and number of sperm, but the biggest decline is the movement and morphology which can have an impact on fertilisation.
Progressive motility refers to the percentage of sperm that are able to move efficiently. This is important in fertility because sperm need to move through the woman's reproductive tract to reach and fertilize her egg.
Morphology relates to the shape of each sperm and sperm needs to be a certain shape to be able to penetrate the outer layers of the egg. So, if there are a smaller number of good shaped sperm, it is likely to take longer to conceive, or assistance from a fertility clinic may be needed.
It will also let you know whether there is an immune response, known as anti-sperm antibodies, which are antibodies that attack sperm.
The good news is that it takes only around 3 months for sperm to mature. This means that as most men are constantly producing new sperm, the right lifestyle changes can help improve both quality and quantity.
But before we start looking at any lifestyle changes, it is important to understand how oxidative stress can affect sperm health.
Did you know that sperm cells are the smallest cells in the body? They are also affected by the amount of oxidative stress within the body. Oxidative stress occurs when there is a disturbance in the balance between the production of free radicals and antioxidant defences. Excess oxidative stress has been linked to poor sperm health which in turn is potentially contributing to lower pregnancy rates and higher risk of miscarriage. It is estimated that 25 – 40% of infertile men have high levels of oxidative stress and a reduced antioxidant capacity compared with fertile men.
The most common causes of oxidative stress are
Infection and pus cells
Prostatitis, Varicocele, undescended testes, surgery
Poor diet – especially processed foods high in poor fats, sugars and additives
Excessive exercise
Alcohol
Caffeine
Tobacco
Heat Exposure
Recreational drugs
Environmental pollution and exposure to harmful substances
Diet
From the list above, you will see that there may be things that you can either cut out or reduce yourself to lower the levels which in turn will reduce oxidative stress. But it is not just about removing things from your diet, what you put in is just as important. You need to include good quality fruit, vegetables, and unprocessed meat (organic if possible) because of the vitamins and minerals in them, and because they contain antioxidants. Below are some ideas that can help to improve sperm health.
Lean meat - saturated fats in red and processed meat are not good for sperm health so should be limited.
Increase fish high in Omega 3’s such as Salmon, Mackerel and Trout. Care needs to be taken in relation to Tuna intake due to its high mercury levels.
Nuts such as Walnuts, Almonds and Pumpkin seeds are a healthy snack and helpful for sperm health.
Tomato puree is a powerful antioxidant as it contains a substance called Lycopene. It can be taken as a spoonful every day or bought as a supplement.
Whilst there is no evidence to suggest that protein shakes are bad for sperm health, it is important to check for additives and level of sugar in them. You should also check that there are no anabolic steroids in them at all!
Taking a good quality men’s prenatal supplement for at least 3 months is recommended. It should include Omega 3, vitamins ACEDB, Selenium, Zinc, Magnesium, Folate, COQ10, Ubiquinol, Resveratrol, L Argenine, Caritine and Taurine.
Alcohol
High alcohol intake can reduce testosterone levels which can lead to low libido and affect the quality of the erection. When trying to conceive it is important not to binge drink and reduce your intake where possible. However, research has shown that the odd beer or glass of wine doesn’t have a significant impact on fertility. In fact, where stress is concerned, the odd glass may help.
Caffeine
Caffeine contains strong antioxidants so will have some health benefits; however, it is about moderation so 1-2 cups a day should not be too detrimental.
Tobacco and Recreational Drugs
There are only negative effects where sperm is concerned for those who smoke or take recreational drugs. Stopping both as soon as possible when trying to conceive is important.
Men who smoke have decreased sperm concentration, decreased motility, fewer normally shaped sperm, and increased sperm DNA damage.
Recreation drugs also have a negative effect on all aspects of sperm health, and long-term use of cannabis can cause erectile disfunction and the testes to diminish in size.
Stress
For many of us stress seems to play a part in everyday life, whether it is someone putting pressure on us, or we put it on ourselves. The hormones produced when we are under stress can affect non-essential bodily functions and this includes fertility. Therefore, it is important to find things to do that help reduce your own stress levels. This will vary for everyone and could include going for a walk, yoga, going for a run or simply listening to your favourite music.
Exercise
This is a great way to combat stress and maintain a healthy weight. Again, it is important to do what you enjoy whether it be high intensity or gentle and remember to do it in moderation. Over exercising to the point of feeling exhausted is not good for us, and if you have chosen cycling or high intensity it can influence sperm health.
Temperature
The other thing to consider is that the testicles are outside of the body for a reason and that is to keep them 2-3 degrees cooler than the core body temperature. An increase in temperature can cause damage to sperm production. Factors that can cause an increase in temperature include
Obese men tend to have higher scrotal temperatures – the ideal BMI for sperm health is between 20-25
Using a laptop on your lap for extended periods of time
Long periods of sitting/driving
Hot baths and saunas
Tight fitting underwear/shorts
Excessive cycling
Mobile phones in front pocket. There is no conclusive evidence that the radiation emitted from them is detrimental to sperm health, but just in case it might be better to avoid!
How to stay motivated…
I have provided a lot of information in this blog which may feel overwhelming. What I want you to remember is that it is all about balance and understanding what has a detrimental effect on sperm. A few small changes often have a huge impact on not only sperm health, but your health in general. Start by choosing what you think you can implement and take it from there.
So how can acupuncture help?
Traditional Chinese Medicine has been practised for over 2000 years with the philosophy that our health is dependent on the body’s energy moving in a smooth and balanced way through a series of channels beneath the skin. This energy is known as qi (chee) and ill health occurs when it becomes depleted, disturbed, or blocked. The flow of qi can be disrupted by a range of factors including emotional states such as anxiety, worry, anger, or grief, as well as poor nutrition, hereditary factors, infections, and trauma. Acupuncture treatment aims to allow the body to rebalance by stimulating its natural healing abilities to promote physical and emotional wellbeing. In relation to male infertility, research shown on the British Acupuncture website currently suggests that acupuncture may help
lower scrotal temperature (Siterman 2009)
enhance local microcirculation, by increasing the diameter and blood flow velocity of peripheral arterioles (Komori 2009)
reduce inflammation, by promoting release of vascular and immunomodulatory factors (Zijlstra 2003)
by improving sperm maturation in the epididymis, increasing testosterone levels, and reducing liquid peroxidation of sperm (Crimmel 2001)
A comprehensive consultation will be completed to assess your overall health and to find out if there are any simple lifestyle changes that might support you. If you have already had a sperm analysis done, this information can be included to help choose the best acupuncture points for you. Most points chosen will be on either the forearm, abdomen back or lower leg so loose clothing is advised.
To find out if acupuncture might help you, please call 07941 567053 to arrange a free
30-minute consultation.
All the best
Sharon
Resources
World Health Organisation (2022) https://www.who.int/publications/i/item/9789240030787
Ian Stones (2021) Hove Fertility and Wellness
Jill Glover (2020) Diploma in Fertility, Obstetrics and Gynaecology
Andrology Solutions (2022) https://www.andrologysolutions.co.uk/services/fertility-testing/comprehensive-semen-analysis/
British Acupuncture Council (2022) https://acupuncture.org.uk/about-acupuncture/_fact-sheets/male-infertility/
The Effects of Cigarette Smoking on Male Fertility (2015) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4639396/
Urology Associates (2022) https://denverurology.com/urology-blog/how-does-marijuana-effect-male-fertility/
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