Average male sperm count in 1940 was 113 million per ml, whilst in 1990 it had dropped to 66 million per ml. Furthermore, the volume of semen dropped, making the reduction in total numbers of sperm per ejaculation 50%. Today 40% of all cases of infertility is thought to be due to male subfertility.
Factors contributing to Male Infertility
One of the reasons for the decrease in male fertility appears to be increased exposure to environmental pollutants (pesticides, fungicides, plastics, detergents, lacquers, etc) and the amount of man-made oestrogens in the water supply, but nutrition, alcohol, smoking, caffeine, stress and immune system abnormalities can all be a contributory factor, as can tight clothing, excessive cycling and hot baths, which increase scrotal temperature, thus effecting the sperm. A history of urinary infections, sexually transmitted diseases, such as chlamydia or gonorrhea (which can effect sperm morphology), prostatitis (which can lower sperm count and motility) or trauma to the testicles can all be a factor, and systemic disorders such as diabetes or hypertension can lead to erectile dysfunctions. (see Common Causes for Infertility »)
Abnormalities of Sperm/Ejaculation
Male infertility can be due to:
- Low volume of sperm
- Low sperm count (oligospermia)
- Poor motility
- Poor morphology (ie deformities) (teratozoospermia)
- Liquefaction problems eg. the semen remains too coagulated so that sperm is not release sufficiently after ejaculation. Such problems can indicate male accessory gland disorders (prostate glands and seminal vesicles) or a history of infection.
- Blockage of sperm pathways, as in varicocele, which results from abnormal dilation of the veins within the testes. This causes insufficient drainage of blood from the testes, resulting in excessive pooling of blood and therefore higher intrascrotal temperatures. Varicoceles can give rise to poor sperm count and/or poor morphology. A urologist can usually repair a varicocele surgically, but improvement in sperm morphology is seen in only about half of the cases, and it may take up to 18 months to see an improvement. Varicocele is found in 15% of men, but in up to 40% of men being evaluated for infertility. Although they may be a factor in male infertility, some studies question whether surgery to correct varicoceles has any beneficial effect.
- Problems with the head of the sperm that can prevent it from penetrating the egg (this cannot be identified by a sperm test).
- Anti-sperm antibodies: sperm autoimmunity is a condition that accounts for 9-36% of male infertility. The immune system produces antibodies as part of the normal defense mechanism against foreign substances and organisms. Sperm are normally protected from exposure to the immune system. However, some men produce sperm antibodies following surgery or trauma to the testicles. In other men, there is no apparent cause for their development. The antibodies attach to the surface of the sperm and reduce their life span, impair sperm motility and ability to penetrate the partner’s cervical mucus. Antibodies located in the sperm head may prevent the sperm from fertilising the egg.
- Agglutination (which indicates immunological infertility)
- Presence of other cells and identification of leukocytes (which indicates inflammation/infection)
- DNA sperm fragmentation (this is not tested for in standard sperm tests)
- Retrograde ejaculation, where semen doesn’t come out of the penis during ejaculation, but, instead, enters the bladder. This can be caused by diabetes, certain medications, and surgery to bladder, prostate or urethra.
- The World Health Organization guidelines for assessing male fertility are:
- Volume: more than 1.5 ml
- Count: more than 15 million sperm per ml
- Motility: more than 50%
- Morphology: more than 4% normal forms
Treatment of male infertility with Western medicine
Western medicine can do very little to improve sperm quality and quantity, and management of male infertility is often unsatisfactory. Clomifene citrate is sometimes prescribed for 3-4 months. This can improve sperm count to some extent, though it does not improve sperm motility or morphology, and no studies suggest increased fertility.
However, the introduction of ICSI (Introcyoplasmic Sperm Injection) has, more or less, resolved the problem of poor sperm quality in IVF procedures, although it is suggested that there is a higher incidence of birth defects when ICSI is used.
Diagnosis and treatment of male infertility with acupuncture and Chinese herbal medicine
Chinese medicine, however, can offer a significant improvement in sperm count, morphology, motility and liquefaction, and it can also sucessfully treat varicoceles, retrograde ejaculation and anti-sperm antibodies. Research studies show that both acupuncture and Chinese herbal medicine effect hormone levels and testicular blood flow, thus promoting the production of healthy sperm. Certain herbs improve liquefaction time by stimulating the secretion of important enzymes into the prostatic fluid.
In Chinese medical terms, both male and female fertility is dependent on strong Kidney energy. Most cases of male infertility can be diagnosed as Kidney Yin or Yang Deficiency. Many cases appear to be genetic, indicating that a Deficiency of Kidney Jing or Essence is involved. In some cases, there may also be Damp Heat in the genitals or a blockage of the sperm pathways would indicate stagnation of Qi and Blood.
Sperm can take 3 months to form, so treatment should be continued for several months. As in the case of female infertility, the practitioner will devise a natural healthcare programme of acupuncture, herbal medicine and nutrition, in order to improve the patient’s overall health, and the quality of the sperm. Herbal treatment is especially important, as it is very effective in replenishing the Kidney energy. However, acupuncture treatment is also beneficial, and it is particularly important to give the patient an acupuncture treatment just before their partner is due to ovulate, as there has been a study that suggests that acupuncture treatment at this time greatly enhances the sperm’s activity.
See research into the treatment of sperm abnormalities using acupuncture.