Sperm count in western men has dropped a startling 50% since 1973. This drop could be an indication that male fertility issues may be more common than most realize. Read on to find out what are holistic ways to improve male fertility.
What portion of fertility issues are attributable to men?
It is generally agreed that approximately 50% of all infertility cases are due to male factor infertility. 30% of that is due to solely male factors, while 20% is due to combined male and female factors.
Despite the even split in contribution, women tend to bear the burden of seeking and getting fertility care. Often their partners express little interest to be evaluated by a healthcare practitioner.
Male fertility is frequently overlooked
According to the CDC’s 2010 report of men’s reproductive health in the United States, “An evaluation of the male is frequently overlooked or completed only after failure of assisted reproductive technologies in the female.” Evaluation of male fertility should take place at the same time as evaluation for female fertility, but, unfortunately, this is only done 18% of the time.
Furthermore, there is less awareness, support, and treatment regarding male fertility, especially using holistic approaches.
How is male fertility problem diagnosed?
So let’s take a deeper look at how male fertility problems are diagnosed,what factors can contribute to male fertility struggles, and holistic ways to optimize male fertility.
Typically, a semen analysis is used to assess male fertility. The following are common parameters assessed and their normal value per most recent World Health Organization (WHO) guidelines:
- Sperm concentration: > 15 million sperm per ml
- Volume: >1.5ml
- Sperm progressive motility: 32%
- Total sperm motility: ≥ 40%
- Sperm morphology: >4% normal forms
Some caveats to consider regarding WHO’s normal values
What many people do not realize is that the lower limit of normal as noted above is defined at the 5th percentile of the population. The median, or 50th percentile, for sperm concentration is actually 73 million sperm per ml. Thus, one can say that 73 million per ml is closer to normal than 15 million per ml.
A 2021 paper, asked the question “What thresholds for total sperm count, sperm concentration, progressive motility, and total progressive motile sperm count (TPMC) are associated with earlier time to conception in couples undergoing fertility evaluation?”
TPMC is calculated by multiplying semen volume (ml) by sperm concentration (million per ml), and the % of progressively motile sperm (%).
Thus, a man who has the WHO cut off values of semen volume of 1.5ml, sperm concentration of 15 million per ml, and 32% progressive motility, has a TPMC of 1.5 x 15 x 32% = 7.2 million.
In this 2021 paper that analyzed over 6000 subfertile men between 2002 to 2017, their answer to their research question was “Values well above the WHO references for total sperm count, concentration, and progressive motility, and values up to 100 million for TPMC were consistently with earlier time-to-conception and higher conception rates.”
Thus in my wholistic fertility clinic, for the purpose of natural conception, I encourage my patients to work on getting much higher numbers than what the WHO indicates as normal.
Impact of sperm DNA fragmentation on fertility
Very few people also realize that the semen analysis is just the tip of the iceberg. It is possible that male factors are still involved EVEN WHEN the semen analysis is normal. This is because routine semen analysis does not measure the fertilizing potential of sperm. One test that is more predictive of male fertility than routine semen analysis is sperm DNA fragmentation.
Sperm DNA integrity is crucial for the birth of healthy offspring. And there is increasing evidence that shows while embryos formed from sperms that has high amount of DNA damage may able to fertilize, they are more likely to cease further development, fail implantation, and result in miscarriages. And this impact is seen in embryos that are created from IUI (intrauterine insemination), IVF (in vitro fertilization), and ICSI (intracytoplasmic sperm injection).
There is evidence supporting the association between recurrent pregnancy loss and SDF, and a 2020 European Urology guideline recommended SDF testing in couples with recurrent pregnancy test following natural conception, IUI, and IVF, and men with unexplained infertility.
But as SDF testing is relatively new, there is still debate on what level of DNA fragmentation is considered high. Also, given the common opinion that SDF is untreatable, and the expense of this test, SDF testing is not commonly ordered.
However, given much of the sperm’s DNA damage is related to oxidative stress, I do think there are many things that can improve sperm DNA fragmentation, using a holistic approach. I discuss some of this approach further below.
Conventional Approach to male fertility issues
The commonly recommended approach to male subfertility is IVF and intracytoplasmic sperm injection (ICSI). ICSI is a procedure where an individual sperm is directly injected into an egg cell, and can easily cost $2,000 in California.
However, by failing to address the root causes of fertility struggles, assisted reproductive technology such as ICSI can lead to adverse pregnancy outcomes and poor offspring health.
For instance, possibly because ICSI bypasses the process of natural selection, this procedure can increase the possibility of transmission of genetic defects from one generation to the next. Research shows that pregnancies resulting from the use of ICSI have been associated with 1.5 to 4 times increased incidences of autism, intellectual disabilities, and birth defects compared with pregnancies resulting from conventional IVF.
Additionally, while ICSI increases the likelihood of fertilization in cases of male factor issues, implantation rates were lower when ICSI was used leading to lower rates of live births.
Yet, over the past 2 decades, the use of ICSI for patients with borderline or even normal semen characteristics has increased, even though the Society for Assisted Reproductive Technology concluded that there is insufficient evidence to support the routine use of ICSI in patients without male factor infertility.
Male fertility problems & poor overall health
Not only should the root cause of fertility struggles be addressed for optimizing chance of healthy pregnancy and healthy offspring, it is important that male fertility problems are not overlooked as there is significant research showing that male fertility challenges are associated with
- Poorer overall health
- Increased cancer risk
- Decreased life expectancy
Improving male fertility is important for the overall health of the man. Identifying and treating male fertility problems can improve overall health and improve male longevity, so that future fathers have more quality time to spend with their future children.
Factors that can contribute to male fertility problems
Male fertility can be caused by a series of biological factors including inability to produce sperm cells, production of low or poor quality sperm, genetic diseases, conditions such as diabetes and autoimmune disorders, exposure to chemotherapy or radiation. However, here are additional risk factors that contribute to male fertility challenges:
- Overweight or obesity
- Insulin resistance
- Age 40 or older
- Exposure to toxins such as bisphenol A (BPA), lead, mercury, and pesticides
- Exposure to radiation
- Exposure to drugs such as anabolic steroids and testosterone
- Tobacco, marijuana or alcohol use
- Heat exposure that raises the temperature of your testes.
Holistic ways to improve male fertility
The typical initial recommendation for treating male subfertility is intrauterine insemination. But this comes with only a 1-12% success rate per cycle and a hefty cost of $600-$700 per cycle. And if that fails, IVF, which cost around $21,000 per cycle, is frequently the recommended next step.
On the other hand, my holistic approach searches for and addresses the root cause(s) of male fertility problems, and in the process I can significantly improve his health and help him avoid future chronic diseases like diabetes and dementia.
Now keep in mind that a sperm's life cycle is about three months. Therefore, I recommend men to adhere to a sperm optimizing protocol for at least this duration. So here are 6 holistic ways to improve male fertility:
- Lose weight if overweight, especially for men who carries excess weight around their belly. Eating lower carbohydrate diet with focus on eliminating processed sugar like high fructose corn syrup will help.
- Avoid reproductive toxins such as BPA, mercury and pesticides. This means avoiding plastics that contain BPA, avoid eating big fish that frequently contain heavy metals like mercury, and eat organic.
- Avoid drugs that can impair male fertility such as testosterone, certain gout, anti-fungal, & blood pressure medications. However, this must be done under the guidance of your doctor.
- Avoid heat to testicles, such as use of jacuzzi hot tubs and saunas.
- Avoid smoking, recreational drugs, and alcohol
- Supplements: sperm quality boosting supplements such as a good quality multivitamin that has better absorbed and higher quality antioxidants such as vitamin E in the form of delta and gamma tocotrienols, and zinc in the form of zinc bisglycinate chelate.
When holistic only approach for male fertility is not appropriate
If the semen analysis shows extremely low or zero sperm count, it is best to refer to a urologist for further evaluation. Commonly, a urologist would assess for varicocele, where there is enlargement of veins within the scrotum, the loose bag of skin that holds the testicles. A urologist would also assess for obstruction to the male reproductive tract.
However, even in these cases, it does not hurt to follow the holistic approach at the same time, since the holistic approach can help improve the man's overall health.
I know firsthand how “unexplained infertility” or recurrent miscarriages for couples can be extremely frustrating. It is important that male factors are also examined carefully as part of a comprehensive wholistic fertility approach to unexplained infertility.
How wholistic fertility can further improve male fertility
In my wholistic fertility telemedicine clinic where I serve couples who live in California, I help men and women with personalized plan for
- Losing stubborn weight
- Reducing existing load of toxins in their body
- Reducing insulin resistance and inflammation
- Optimizing their hormones (FSH, LH, prolactin, androgens, cortisol,...etc)
The reality is that assisted reproductive technologies such as IUI or IVF, do nothing to improve sperm quality. For couples experiencing recurrent miscarriages that is due to poor sperm quality, the conventional approach may not be so helpful.
The advantages of my unique wholistic fertility approach is that I can help improve egg and sperm quality, while helping my couples get better sleep, have better energy, and increase their odds of having healthier children.
Important takeaways about male fertility
- Poor sperm count and sperm quality are more common than most people realize, as male factors are present in 50% of couples who are experiencing fertility challenges.
- Male fertility issues is a canary in the coal mine for other health problems for the man
- Semen analysis is a good starting point to evaluate male fertility, but does not fully capture the fertilization potential of the sperm
- Male factors can contribute to recurrent miscarriages, failed IUI & failed IVF
- Assisted reproductive technologies do not improve sperm quality
- Holistic approach to improve male fertility is an excellent alternative to IUI and IVF
How to work with Dr. Yao
If you are interested in working with me, first schedule a 30-minute Fertility Insight Session, where I give you my undivided attention and provide you with a better understanding of your fertility.
Was this article helpful for you? If so, please share this article with your friends and community! Together, we can build more awareness about the importance of male fertility, the holistic ways to improve male fertility, and that there are alternatives to IUI & IVF for fertility!
- Hagai Levine, et al. Temporal trends in sperm count: a systematic review and meta-regression analysis, Human Reproduction Update, 2017.
- Kumar N, Singh AK. Trends of male factor infertility, an important cause of infertility: A review of literature. J Hum Reprod Sci. 2015.
- Keihani S et a. Semen parameters thresholds and time-to-conception in subfertile couples. Hum Reprod. 2021.
- Esteves SC et al. Sperm DNA fragmentation testing: Summary evidence and clinical practice recommendations. Andrologia. 2021.
- Boulet SL et al. Trends in use of and reproductive outcomes associated with intracytoplasmic sperm injection. JAMA. 2015.
- “Male Infertility: Causes & Treatment.” Cleveland Clinic.
- Male Reproductive Health - Centers for Disease Control 13 Sept. 2010.
- Mora-Esteves C et al. Nutrient supplementation: improving male fertility fourfold. Semin Reprod Med. 2013.