A lot of men, especially in the Western world, do not see their lifestyle and nutrition as a key element to having children or improving the odds of fertilisation.
This is partly because 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 is a lot of conflicting nutritional advice, which often doesn’t fit the conventional diet.
However, it is now considered that up to 60% of infertility is actually due to the man.1
This article provides a strategy for 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 seeks help for fertility, it is important to get the 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 in millions of sperm per millilitre. Over 15 million sperm per ml is considered normal (WHO in 2010), while older definitions stated 20 million. The average sperm count today is around 60 million per ml in the Western world, having decreased by 1-2% per year from a substantially higher number decades ago. 2.
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 okay by conventional doctors, ideally, a male should aim at a sperm count of 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 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 as well. Good sperm should be slightly alkaline, 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 ml) 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 told 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 suggest supplements for at least four months, which is the time sperm takes to be made. The usual dosage is 15 mg of zinc supplementation and 100mg fish oil, with 1,000 mg vegetable oil.
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 a highly-refined diet, then B-complex or multi-vitamins may be required to assist absorption of the zinc and good quality fat.
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 his health.
Good nutrition should include a significant amount of vegetables and fruit, ideally organic, and plenty of fatty fish, seeds and unrefined vegetable oil, the best being flaxseed, sesame, sunflower and pumpkin. Good sources of zinc are oysters, wholemeal and rye bread, green peppers, potatoes, eggs, chicken and apples.
More important, is to also ensure that the patient reduces his intake of “nutrients’ robbers”, that would prevent the body from absorbing good fat, zinc or other key nutrients. These include highly refined foods, 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. 3.
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 ideally be an unprocessed organic foods with no use of plastic packaging, and little or no sugar, coffee and alcohol. For this reason, providing supplementations while the patient slowly moves to a better diet, may be a more successful approach.
Importance of Medical History for Male Patients
A male patient should have 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 and 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 patient works in close proximity to these chemicals, they will have to be considered a factor.
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 they 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 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 they are a major part of the presenting picture of the patient.
Addressing aetiological causes
When investigation points to some possible causes, then homeopathy should be used alongside the present nutritional advice.