Reversing Male Infertility
Forty years ago, couples did not wonder if they could have children. Infertility problems were almost non-existent. These days, the problem is so widespread that if fertility rates continue to decline, then births will fall below the population replenishment rate in the next 10 to 40 years.
Although a large proportion of infertility cases focus on women, the reality is that more than half of infertility cases are related to the male factor. A study in 2012 showed that only 1 in 4 men have optimal sperm quality. According to some estimates, the number of spermatozoa worldwide may have decreased by 50% compared to 1930.
No one knows for sure what is causing this alarming deterioration, but it is clear that some of the factors that plague the modern world are, at least in part, responsible. For example, toxic chemicals acting on the endocrine system, such as insecticides and phthalates from plastics, affect sperm-producing hormones and produce excessive oxidative stress which damages the DNA and the function of spermatozoa. Obesity is an additional factor.
Despite the alarming increase in male infertility, the good news is that in many cases it is completely reversible. Numerous studies show that certain nutrients can directly affect sperm quality and can lead to improved pregnancy rates.
The reduction of sperm quality
In order to understand what causes male infertility, we need to understand the concept of sperm quality. Sperm quality is essentially determined by four factors:
- The total number of spermatozoa (sperm count)
- Their physical characteristics (sperm morphology)
- Their ability to move properly after ejaculation (motility)
- The integrity of sperm DNA
Under ideal conditions, a healthy young man can produce 300 to 500 million spermatozoa per ejaculation, but usually only one of them will fertilize an ovum. In the 1940s, most young men typically produced an average of 100 million spermatozoa per ml of semen, well above the approximately 40 million per ml required to ensure a normal fertility capacity. But recent studies in young men show a worrying tendency: sperm concentration is declining, with many men producing less than 40 million spermatozoa per ml.
Unfortunately, other aspects of sperm quality are also at risk. Sperm motility (the ability to move forward to reach the ovum), sperm volume per ejaculation, and the number of normal spermatozoa are also decreased. Even the number of testicular cells that produce testosterone, has decreased.
Solving all these factors using the conventional medical approach would require multiple medicines, many of which are ineffective and with many side effects. Due to these factors, women are still undergoing fertility treatments even if the female factor is not the underlying cause of the problem, in order to enable men with poor sperm quality to have children.
Fortunately, many studies show that certain nutrients can have a direct impact on sperm quality, and possibly they can lead the patients to avoid the need for expensive medicines or invasive procedures.
Carnitine boosts fertility rates
Spermatozoa have to travel the longest distance than any other human cell in order to fertilize an egg, and they need a huge amount of energy to make that journey. This is exactly what makes carnitine a vital nutrient for men with poor sperm quality.
Carnitine is a key transporter molecule whose function is to transport lipids (high energy compounds) to the mitochondria, where they are "burned" in order to release energy. So, carnitine can provide sperm the boost it needs to have the opportunity to fertilize the ovum. This process is important because sperm with low motility (asthenozoospermia) is one of the most important causes of male infertility.
Taking L-carnitine and/or acetyl-L-carnitine supplements has proven benefits in sperm quality. Doses of 2.000 - 3.000 mg per day of L-carnitine and 500 - 1.000 mg per day of acetyl-L-carnitine have been shown in clinical trials to promote the increase of the number of spermatozoa, overall motility, rapid forward movement and increase in the rate of normal forms of sperm. When men were treated with carnitine, the pregnancy rates ranged from 22 to 31%. Pregnancy rates in the control group (participants who did not receive carnitine) ranged between 1.7 and 3.8%.
Antioxidants protect the developing spermatozoa
Given the fact that spermatozoa have an increased need for energy, they create oxidation that can eventually damage their cell membranes, DNA integrity, and even their mitochondria, the responsible intracellular organelle for supplying cells with energy.
There is a well-known correlation between oxidative stress, the antioxidant capacity of spermatozoa and semen, and ultimately sperm quality. In general, men with increased oxidation rates have a reduced sperm count and increased pathological sperm morphology. In contrast, men with good cellular antioxidant defenses have higher sperm counts and better motility. In other words, men with better sperm quality have a higher overall intake of antioxidant nutrients than men with poor sperm quality. This effect seems to be more pronounced in older men.
Various antioxidants have proven abilities to enhance sperm quality. These antioxidants include vitamins C and E, coenzyme Q10 (CoQ10), selenium, N-acetylcysteine (NAC), and zinc.
Effects of antioxidants on sperm quality
|Nutrient||Daily Dose||Improvement of Sperm Quality||Improvement of Pregnancy Rates|
|Vitamin C||1.000 mg||Concentration, motility, morphology||100% (in combination with Vitamin E)|
|Vitamin Ε||300-1000 mg*||Enhances sperm binding to the ovum, reduces sperm DNA damage||21%|
|Coenzyme Q10||60 mg||Concentration, motility||16%|
|Selenium||200–225 μg||Motility||10.8% (in combination with Vitamin E)|
|N-Acetyl Cysteine (NAC)||600 mg||Concentration, motility, morphology, volume||It has not been studied|
|Zinc||66 mg||Concentration||It has not been studied|
|* Equivalent to 447-1.490 IU d-α-tocopherol (natural form) or 666-2.220 IU dl-α-tocopherol (synthetic form)|
Zinc deficiency is associated with poor sperm quality, as a result of increased oxidative stress in seminal plasma (the liquid part of semen that is responsible for keeping sperm in a healthy state). Also, zinc deficiency reduces the volume of the produced sperm.
Studies in both animal models and humans (clinical trials) have shown significant improvements in sperm quality after the use of zinc supplements, especially in cases of known infertility. Taking zinc supplements increases sperm count, motility, and fertility, and reduces the level of DNA damage, structural abnormalities in sperm, and the level of sperm antibodies that can impair sperm quality. Studies have shown a 74% increase in total sperm count in infertile men taking 66 mg of zinc daily along with folic acid (5000 μg daily).
The benefits of zinc supplements are especially evident in smokers, whose overall level of oxidative stress is significantly higher than in non-smokers. In addition, smokers accumulate toxic levels of cadmium, which is another mineral element. It is accumulated in testicular tissue and further contributes to increased oxidative stress. These effects cause a significant decline in sperm quality and fertility in smokers. Studies show that zinc supplements reduce the effect of cadmium toxicity and enhance sperm quality in smokers.
Dietary Supplements provide significant support to male fertility
Scientists have observed a global decline in sperm quality, which is reflected in the reduction in sperm count, motility, morphology, and DNA integrity.
If left out of control, this epidemic could mean a huge drop in human fertility, especially in industrialized countries where the problem is most acute.
The reasons for the decline in sperm quality are not fully understood, but clearly include some important nutritional and environmental factors, as a result of the modern lifestyle.
No medicine has yet been found that can effectively and safely improve sperm quality.
A wide range of nutritional supplements offer real hope in improving sperm quality and most importantly, in improving the fertility rates and the birth rates of healthy children.
Antioxidant vitamins and minerals, along with natural molecules such as coenzyme Q10, N-acetylcysteine, lycopene, carnitine, omega-3 fatty acids, vitamin D, and Ashwaganda (Withania somnifera), improve the sperm quality and have almost zero side effects.
N-Acetyl- Cysteine (NAC)
N-acetyl- Cysteine (NAC) is a modified amino acid with strong direct antioxidant activity. It also boosts natural cellular antioxidant systems, such as glutathione. NAC was first used to reverse oxidative toxicity caused by an overdose of acetaminophen (paracetamol) and was later used to reduce the viscosity of mucus in patients with cystic fibrosis.
Both of these characteristics of acetyl-cysteine make it attractive as a means of enhancing the quality of spermatozoa and semen.
As an antioxidant, NAC has been shown to reduce the concentration of destructive reactive oxygen species in human semen, helping to improve motility. A dose of 600 mg of NAC per day, improves sperm motility and volume in men with diagnosed infertility. Also, like zinc, the antioxidant capacity of NAC makes it an effective antidote to toxic chemicals that negatively affect sperm quality: experiments in mice showed that the use of NAC supplements can reverse the effects of arsenic, a well-known environmental toxin.
NAC's ability to reduce the viscosity of body secretions provides an added advantage. The same dose of 600 mg/day, reduces the viscosity of the sperm, which makes it easier for the sperm to move forward and achieve its goal, the fertilization of the ovum.
NAC intake, both alone and in combination with selenium supplements, helps increase serum testosterone levels as well as improve sperm parameters.
Antioxidant supplements enhance sperm quality, especially in older men
The percentage of men, who decide to become fathers later in life, is rising according to recent studies. This trend raises important questions about the impact of a father's age on pregnancy outcome and infant health.
Most data indicate significant risk factors associated with paternal age, which can affect both fertility and genetic risk for the child.
For these reasons, older men need to be especially careful in order to maximize the chances of a successful conception and healthy fatherhood.
Two recent studies on dietary antioxidant combinations provide important information.
In the first study, researchers examined the micronutrient intake in a group of men aged 22 to 80 years. They determined the percentage of sperm with DNA damage as an indicator of the overall health of the sperm.
According to this study, men with a higher intake of vitamins C and E, folic acid, and zinc, had about 16% less damage to sperm DNA compared to men with a lower intake of these antioxidant nutrients. The benefit was greater in the older members of the group (ages 44 to 80). In fact, the level of sperm DNA damage among these members was similar to those of younger men.
In the second study, a group of infertile men participated (infertility due to low sperm count and abnormal morphology). The researchers gave the patients an antioxidant supplement containing L-carnitine, vitamin C, coenzyme Q10, vitamin E, zinc, folic acid, selenium, and vitamin B12 for a period of 3 months.
The results showed a significant improvement in sperm DNA integrity. At the same time, there was a significant increase in other components of sperm quality, such as sperm concentration, motility, vitality, and morphology.
These studies offer new hope for the growing number of men seeking to start (or raise) their families later in life. The use of supplements with multiple antioxidant nutrients seems to increase a man's overall chances of a successful start to a healthy pregnancy.
Lycopene helps reverse Male Infertility
Lycopene is a natural, plant-based carotenoid pigment that produces the red color of tomatoes, watermelon, and other fruits. It has strong antioxidant properties and is involved in many other cellular activities.
Low dietary lycopene intake is associated with poor sperm quality and male infertility. However, lycopene supplementation has been shown to reverse some or all of the damage.
Men with reduced fertility participated in a study, receiving 2 mg of lycopene twice a day. The results were impressive: 66% presented improved sperm count, 53% had improved motility and 46% had an increase in the number of normal sperm forms. 23% of the men who participated in this study managed to have children.
Lycopene, also, improves sperm quality by reducing the impact of advanced glycation end products (AGEs), i.e., the dangerous sugar/protein structures formed during life by exposure to blood glucose. In one study, supplementation with 20 mg of lycopene per day resulted in a reduced presence of sRAGE, an indicator of AGE activity in sperm.
Omega-3 fatty acids improve sperm count
In addition to the need of traveling long distances, spermatozoa must have very specific characteristics in their membrane in order to be able to attach to the ovum membrane. Many of these special characteristics come from the high level of omega-3 fatty acids in semen.
Men with reduced sperm quality characteristics usually have low levels of omega-3 fatty acids or a low proportion of omega-3 and omega-6 fatty acids in their semen. Higher omega-3 levels, on the other hand, are directly associated with improved sperm motility, concentration, and morphology.
Laboratory studies revealed that spermatozoa after omega-3 fatty acid supplementation presented improved motility and decreased biomarkers of oxidative stress in comparison with the control samples. Omega-3 fatty acids (especially EPA and DHA) have been found to restore fertility and reduce sperm production in experimental animals. Studies in humans show that supplementation with 1.840 mg per day of DHA and EPA combination improves total sperm count and concentration. Rich in omega-3, the Mediterranean type diet increases the chances of a successful pregnancy in infertile couples by 40%.
Vitamin D deficiency contributes to infertility
The 44% of the men, who participated in a study for the estimation of sperm quality, had blood 25-hydroxyvitamin D levels below 20 ng/mL (optimal level is above 25 ng/mL). Serum vitamin D levels are positively correlated with sperm motility and normal morphology.
Almost in 2006, the molecule of vitamin D receptor was detected for the first time on the surface of spermatozoa. Since then, this receptor has been found in all tissues of the male reproductive system.
Vitamin D deficiency reduces the ability of male mice to deposit sperm in the female reproductive system by 45% and the rate of successful pregnancies in females receiving sperm from males with vitamin D deficiency is reduced by 73%.
When vitamin D is added to human sperm in the laboratory, there is a sharp increase in sperm motility, combined with the rapid development of the "acrosome reaction" that allows the sperm to penetrate the ovum.
Although there are no studies on the effect of vitamin D supplements on male infertility in humans, it seems that the intake of this vitamin can have positive effects on male infertility in humans. At least, men can consider supplementation in order to reach plasma vitamin D levels within the range considered sufficient (greater than 25 ng/mL). This can be achieved by taking a daily vitamin D3 supplement of 1000 to 2000 IU. However, the intake of up to 5000 IU is considered safe and may be required in some cases.
Ashwagandha improves sperm quality
Stress is an important factor in the modern epidemic of infertility, as it increases oxidative damage, inflammation, and other harmful conditions that reduce sperm quality.
Ashwagandha intake can provide an effective way to combat stress-related infertility. This plant has been used in Ayurveda and other traditional medical systems to reduce stress. Studies have shown that Ashwagandha (Withania somnifera) can cure stress-related infertility.
When 60 infertile men took Ashwagandha root powder daily for 3 months, they observed reduced stress, increased antioxidant levels, and improved overall sperm quality. By the end of 3 months, 14% of men succeed in conception.
The global decline in sperm quality, especially evident in industrialized countries, has the potential to threaten human survival. Many reasons have been proposed for this reduction, the most important of which have to do with environmental and nutritional factors.
Male infertility concerns more than half of all infertility cases. So, it is up to men to optimize their sperm quality. Unfortunately, there is no medication or conventional medical treatment capable of reversing this dangerous tendency.
Dietary supplements often give hope where pharmaceutical medicine fails and sperm quality is no exception. Antioxidants and cell-activating nutrients can improve sperm motility, sperm count, normal sperm count, and reduce sperm DNA damage, thus improving the chances of a successful pregnancy.
Diagnostiki Athinon provides a wide range of services for the accurate diagnosis of male infertility. As a clinical diagnostic laboratory is able to provide all the laboratory tests required in order to fully investigate male infertility. Thus, in addition to standard laboratory tests, Diagnostiki Athinon can and does provide specialized andrology tests such as the examination of hypoosmotic swelling test of spermatozoa, the fragmentation of sperm DNA, the determination of oxygen free radicals, and the measurement of the total antioxidant capacity of semen. The receipt of the medical history in combination with the results of the medical examinations allows the creation of a complete picture of the health state of the patient and the evaluation of the male factor in the infertility of the couple.