Male Infertility

Also indexed as: Low Sperm Counts, Sperm Motility

Infertility is defined by doctors as the failure of a couple to achieve pregnancy after a year of unprotected intercourse. In men, infertility is usually associated with a decrease in the number, quality, or motility (power of movement) of sperm. There are multiple possible underlying causes for male infertility, some of which readily respond to natural medicine, while others do not. The specific cause of infertility should always be diagnosed by a physician before considering possible solutions.

Checklist for Male Infertility

Rating Nutritional Supplements Herbs
3Stars Vitamin C (for sperm agglutination only)
Zinc (for deficiency)		  
2Stars Arginine
L-carnitine
Selenium
Vitamin B12		 Asian ginseng
1Star Acetylcarnitine
Coenzyme Q10
SAMe
Vitamin E		  
3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

What are the symptoms of infertility? The inability of a couple to become pregnant after one year of regular, unprotected sex may indicate infertility of one or both sexual partners. Low sperm count in the semen, decreased sperm motility, or abnormal shape of the sperm are responsible for infertility in about 40% of these couples.

How is it treated? Initial treatments may include timing sexual activity for ovulation (usually during the second week of the menstrual cycle), avoiding drugs that may reduce sperm count, and limiting intercourse to no more than every three days, except during ovulation. Artificial insemination can also be used to place sperm directly in the cervix or uterus. Another more advanced procedure is called “in vitro fertilization” (IVF), wherein the man’s sperm and the woman’s egg (collected from the ovary in a surgical procedure) are combined under controlled conditions in a laboratory. The fertilized embryo is then implanted into the woman’s uterus.

Dietary changes that may be helpful: In a study of men with poor sperm quality, excessive alcohol consumption was associated with a decrease in the percentage of normal sperm.1 In a study of Danish greenhouse workers, an unexpectedly high sperm count was found among organic farmers, who grew their products without the use pesticides or chemical fertilizers. The sperm count was more than twice as high in these men as in a control group of blue-collar workers.2 Although these findings are not definitive, they suggest that consuming organically grown foods may enhance fertility.

Lifestyle changes that may be helpful: Some conventional medications can interfere with fertility. If in doubt, men taking prescription drugs should consult their physician.

The optimal temperature of the testes for sperm production is slightly lower than body temperature, which is why the testes hang away from the body in the scrotum. Men with low sperm counts are frequently advised to minimize lifestyle factors that may overheat the testes, such as wearing tight (e.g., “bikini-style”) underwear or frequently using spas and hot baths.

Environmental exposures (e.g., formaldehyde), smoking, and use of recreational drugs (e.g., marijuana, cocaine, hashish) may reduce sperm count or cause abnormal sperm morphology (shape).3 4 Smoking adversely affects the semen quality of infertile men.5

Nutritional supplements that may be helpful: Vitamin C protects sperm from oxidative damage.6 Supplementing vitamin C improves the quality of sperm in smokers.7 When sperm stick together (a condition called agglutination), fertility is reduced. Vitamin C reduces sperm agglutination,8 and supplementation with 200–1,000 mg per day increased the fertility of men with this condition in a controlled study.9 10 Many doctors recommend 1 gram of vitamin C per day for infertile men, particularly those diagnosed with sperm agglutination. However, a double-blind trial studying the effects of combined vitamin C and vitamin E supplementation found no improvements in semen quality among men with low sperm motility.11

Zinc deficiency leads to reduced numbers of sperm and impotence in men.12 The correlation between blood levels of zinc and sperm quality remains controversial. Infertile men have been reported to have lower levels of zinc in their semen, than do men with normal fertility.13 Similarly, men with normal sperm density tend to have higher amounts of zinc in their semen, than do men with low sperm counts.14 However, other studies have found that a high concentration of zinc in the semen is related to decreased sperm motility in infertile men.15 16 A few studies have shown that oral zinc supplementation improves both sperm count17 18 motility,19 20 and the physical characteristics of sperm in some groups of infertile men.21 For infertile men with low semen zinc levels, a preliminary trial found that zinc supplements (240 mg per day) increased sperm counts and possibly contributed to successful impregnation by 3 of the 11 men.22 However, these studies all included small numbers of volunteers, and thus the impact of their conclusions is limited. In a controlled trial, 100 men with low sperm motility received either 57 mg of zinc twice daily or a placebo.23 After three months, there was significant improvement in sperm quality, sperm count, sperm motility, and fertilizing capacity of the sperm. The ideal amount of supplemental zinc remains unknown, but some doctors recommend 30 mg two times per day. Long-term zinc supplementation requires 1–2 mg of copper per day to prevent copper deficiency.

Arginine, an amino acid found in many foods, is needed to produce sperm. Research, most of which is preliminary shows that several months of L-arginine supplementation increases sperm count, quality,24 25 26 and fertility.27 28 However, when the initial sperm count was extremely low (such as less than 10 million per ml), L-arginine supplementation produced little or no benefit.29 30 While some pregnancies have been attributed to arginine supplementation in preliminary reports,31 no controlled research has confirmed these claims. For infertile men with sperm counts greater than 10 million per milliliter, many doctors recommend up to 4 grams of L-arginine per day for several months.

In a double-blind study of infertile men with reduced sperm motility, supplementation with selenium (100 mcg per day for three months) significantly increased sperm motility, but had no effect on sperm count. Eleven percent of 46 men receiving selenium achieved paternity, compared with none of 18 men receiving a placebo.32

Vitamin B12 is needed to maintain fertility. Vitamin B12 injections have increased sperm counts for men with low numbers of sperm.33 These results have been duplicated in double-blind research.34 In one study, a group of infertile men were given oral vitamin B12 supplements (1,500 mcg per day of methylcobalamin) for 2 to 13 months. Approximately 60% of those taking the supplement experienced improved sperm counts.35 However, controlled trials are needed to confirm these preliminary results. Men seeking vitamin B12 injections should consult a physician.

L-carnitine is a substance made in the body and also found in supplements and some foods (such as meat). It appears to be necessary for normal functioning of sperm cells. In preliminary studies, supplementing with 3–4 grams per day for four months helped to normalize sperm motility in men with low sperm quality.36 37 While the majority of clinical trials have used L-carnitine, one preliminary trial found that acetylcarnitine (4 grams per day) may also prove useful for treatment of male infertility caused by low quantities of immobile sperm.38

Coenzyme Q10 (CoQ10) is a nutrient used by the body in the production of energy. While its exact role in the formation of sperm is unknown, there is evidence that as little as 10 mg per day (over a two-week period) will increase sperm count and motility.39 In one study, men with low sperm counts were given CoQ10 (60 mg per day for about three months). No significant change was noted in most sperm parameters, but a significant improvement was noted in in-vitro fertilization rates.40

Vitamin E deficiency in animals leads to infertility.41 In a preliminary human trial, 100–200 IU of vitamin E given daily to both partners of infertile couples led to a significant increase in fertility.42 Vitamin E supplementation may enhance fertility by decreasing free-radical damage to sperm cells. In another preliminary study, men with low fertilization rates in previous attempts at in vitro fertilization were given 200 IU of vitamin E per day for three months.43 After one month of supplementation, fertilization rates increased significantly, and the amount of oxidative stress on sperm cells decreased. However, the evidence in favor of vitamin E remains preliminary. A review of research on vitamin E for male infertility concluded that there is no justification for its use in treating this condition.44 Controlled trials are needed to validate these promising preliminary findings.

Preliminary research suggests that oral SAMe (S-adenosyl-L-methionine), in amounts of 800 mg per day, may also increase sperm activity in infertile men.45

Calcium is a key regulator of human sperm function.46 The concentration of calcium in semen determines sperm motility (i.e., the ability of sperm to move spontaneously).47 48 However, calcium deficiency has not been confirmed as a cause of male infertility nor is there any evidence that calcium supplementation improves male infertility.

Are there any side effects or interactions? Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful: Asian ginseng may prove useful for male infertility. One preliminary study found that 4 grams of Asian ginseng per day for three months led to an improvement in sperm count and sperm motility.49

Are there any side effects or interactions? Refer to the individual herb for information about any side effects or interactions.

Other integrative approaches that may be helpful: Acupuncture may be helpful in the treatment of some cases of male infertility due to impairment of sperm function. A controlled study of men with reduced sperm function found that one measure of sperm function significantly improved in the men treated with acupuncture (two times per week for five weeks) compared to controls.50 Similar results have been reported in other studies.51 52 Nevertheless, double-blind trials are needed to determine conclusively whether acupuncture is a useful treatment for male infertility.

References:

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2. Abell A, Ernst E, Bonde JP. High sperm density among members of organic farmers’ association. Lancet 1994;343:1498.

3. Hruska KS, Furth PA, Seifer DB, et al. Environmental factors in infertility. Clin Obstet Gynecol 2000;43:821–9.

4. Wang SL, Wang XR, Chia SE, et al. A study on occupational exposure to petrochemicals and smoking on seminal quality. J Androl 2001;22:73–8.

5. Zhang JP, Meng QY, Wang Q, et al. Effect of smoking on semen quality of infertile men in Shandong, China. Asian J Androl 2000;2:143–6.

6. Fraga CG, Motchnik PA, Shigenaga MK, et al. Ascorbic acid protects against endogenous oxidative DNA damage in human sperm. Proc Natl Acad Sci 1991;88:11003–6.

7. Dawson EB, Harris WA, Teter MC, Powell LC. Effect of ascorbic acid supplementation on the sperm quality of smokers. Fertil Steril 1992;58:1034–9.

8. Dawson EB, Harris WA, McGanity WJ. Effect of ascorbic acid on sperm fertility. Fed Proc 1983;42:531 [abstr 31403].

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10. Dawson EB, Harris WA, Rankin WE, et al. Effect of ascorbic acid on male fertility. Ann N Y Acad Sci 1987;498:312–23.

11. Rolf C, Cooper TG, Yeung CH, Nieschlag E. Antioxidant treatment of patients with asthenozoospermia or moderate oligoasthenozoospermia with high-dose vitamin C and vitamin E: a randomized, placebo-controlled, double-blind study. Hum Reprod 1999;14:1028–33.

12. Prasad AS, Cossack ZT. Zinc supplementation and growth in sickle cell disease. Ann Intern Med 1984;100:367–71.

13. Kvist U, Kjellberg S, Bjorndahl L, et al. Seminal fluid from men with agenesis of the Wolffian ducts: zinc-binding properties and effects on sperm chromatin stability. Int J Androl 1990;13:245–52.

14. Saaranen M, Suistomaa U, Kantola M, et al. Lead, magnesium, selenium and zinc in human seminal fluid: comparison with semen parameters and fertility. Hum Reprod 1987;2:475–9.

15. Danscher G, Hammen R, Fjerdingstad E, Rebbe H. Zinc content of human ejaculate and motility of sperm cells. Int J Androl 1978;1:576–81.

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18. Hartoma TR, Nahoul K, Netter A. Zinc, plasma androgens and male sterility. Lancet 1977;2:1125–6.

19. Stankovic H, Mikac-Devic D. Zinc and copper in human semen. Clin Chim Acta 1976;70:123–6.

20. Kynaston HG, Lewis-Jones DI, Lynch RV, Desmond AD. Changes in seminal quality following oral zinc therapy. Andrologia 1988;20:21–2.

21. Tikkiwal M, Ajmera RL, Mathur NK. Effect of zinc administration on seminal zinc and fertility of oligospermic males. Indian J Physiol Pharmacol 1987;31:30–4.

22. Marmar JL, Katz S, Praiss DE, DeBenedictis TJ. Semen zinc levels in infertile and postvasectomy patients and patients with prostatitis. Fertil Steril 1975:26:1057–63.

23. Omu AE, Dashti H, Al-Othman S. Treatment of asthenozoospermia with zinc sulphate: andrological, immunological and obstetric outcome. Eur J Obstet Gynecol Reprod Biol 1998;79:179–84.

24. De Aloysio D, Mantuano R, Mauloni M, Nicoletti G. The clinical use of arginine aspartate in male infertility. Acta Eur Fertil 1982;13:133–67.

25. Tanimura J. Studies on arginine in human semen. Part II. The effects of medication with L-arginine-HCl on male infertility. Bull Osaka Med School 1967;13:84–9.

26. Scibona M, Meschini P, Capparelli S, et al. L-arginine and male infertility. Minerva Urol Nefrol 1994;46:251–3.

27. Schacter A, Goldman JA, Zukerman Z. Treatment of oligospermia with the amino acid arginine. J Urol 1973;110:311–3.

28. Schacter A, Friedman S, Goldman JA, Eckerling B. Treatment of oligospermia with the amino acid arginine. Int J Gynaecol Obstet 1973;11:206–9.

29. Mroueh A. Effect of arginine on oligospermia. Fertil Steril 1970:21:217–9.

30. Pryor JP, Blandy JP, Evans P, et al. Controlled clinical trial of arginine for infertile men with oligozoospermia. Br J Urol 1978;50:47–50.

31. Aydin S, Inci O, Alagol B. The role of arginine, indomethacin and kallikrein in the treatment of oligoasthenospermia. Int Urol Nephrol 1995;27:199–202.

32. Scott R, MacPherson A, Yates RWS, et al. The effect of oral selenium supplementation on human sperm motility. Br J Urol 1998;82:76–80.

33. Sandler B, Faragher B. Treatment of oligospermia with vitamin B12. Infertility 1984;7:133–8.

34. Kumamoto Y, Maruta H, Ishigami J, et al. Clinical efficacy of mecobalamin in treatment of oligozoospermia. Acta Urol Jpn 1988;34:1109–32.

35. Isoyama R, Baba Y, Harada H, et al. Clinical experience of methyl-cobalamin (CH3-B12)/clomiphene citrate combined treatment in male infertility. Hinyokika Kiyo 1986;32:1177–83 [in Japanese].

36. Costa M, Canale D, Filicori M, et al. L-carnitine in idiopathic asthenozoospermia: a multicenter study. Andrologia 1994;26:155–9.

37. Vitali G, Parente R, Melotti C. Carnitine supplementation in human idiopathic asthenospermia: clinical results. Drugs Exp Clin Res 1995;21:157–9.

38. Moncada ML, Vicari E, Cimino C, et al. Effect of acetylcarnitine treatment in oligoasthenospermic patients. Acta Europaea Fertilitatis 1992;23:221–4.

39. Tanimura J. Studies on arginine in human semen. Part III. The influences of several drugs on male infertility. Bull Osaka Med School 1967;13:90–100.

40. Lewin A, Lavon H. The effect of coenzyme Q10 on sperm motility and function. Mol Aspects Med 1997;18 Suppl:S213–9.

41. Thiessen DD, Ondrusek G, Coleman RV. Vitamin E and sex behavior in mice. Nutr Metab 1975;18:116–9.

42. Bayer R. Treatment of infertility with vitamin E. Int J Fertil 1960;5:70–8.

43. Geva E, Bartoov B, Zabludovsky N, et al. The effect of antioxidant treatment on human spermatozoa and fertilization rate in an in vitro fertilization program. Fertil Steril 1996;66:430–4.

44. Martin-Du Pan RC, Sakkas D. Is antioxidant therapy a promising strategy to improve human reproduction? Are anti-oxidants useful in the treatment of male infertility? Hum Reprod 1998;13:2984–5.

45. Piacentino R, Malara D, Zaccheo F, et al. Preliminary study of the use of s. adenosyl methionine in the management of male sterility. Minerva Ginecologica 1991;43:191–3 [in Italian].

46. Hong CY, Chiang BN, Turner P. Calcium ion is the key regulator of human sperm function. Lancet 1984;2:1449–51.

47. Kilic S, Sarica K, Yaman O, et al. Effect of total and ionized calcium levels of seminal fluid on sperm motility. Urol Int 1996;56:215–8.

48. Prien SD, Lox CD, Messer RH, DeLeon FD. Seminal concentrations of total and ionized calcium from men with normal and decreased motility. Fertil Steril 1990;54:171–2.

49. Salvati G, Genovesi G, Marcellini L, et al. Effects of Panax ginseng C.A. Meyer saponins on male fertility. Panmineva Med 1996;38:249–54.

50. Siterman S, Eltes F, Wolfson V, et al. Effect of acupuncture on sperm parameters of males suffering from subfertility related to low sperm quality. Arch Androl 1997;39:155–61.

51. Riegler R, Fischl F, Bunzel B, Neumark J. Correlation of psychological changes and spermiogram improvements following acupuncture. Urologe [A] 1984;23:329–33 [in German].

52. Fischl F, Riegler R, Bieglmayer C, et al. Modification of semen quality by acupuncture in subfertile males. Geburtshilfe Fraunheilkd 1984;44:510–2 [in German].