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  Male Infertility (Low Sperm Count)  
 
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Contributing risk factors | Other conditions that may be present | Recommendations

 

Causes for male infertility (low sperm count) include tight-fitting jeans and underwear that heat the scrotum and testes, thereby inhibiting sperm production. Very hot baths may hasten the death of sperm. Environmental pollution from cigarette smoke, heavy metals (lead, mercury, arsenic), pesticides, solvents, toxic chemicals, aflatoxin (a fungus found on peanuts and grains), and synthetic estrogens in poultry and dairy feed all interfere with sperm formation and protection. In a study of 100 males, aflatoxin levels in infertile men were 60% higher than in fertile men. Marginal zinc status is associated with poor sperm count and motility (especially if testosterone levels are low). Zinc supplementation improves both sperm count and testosterone levels.

Another cause of male infertility is the presence of a varicocele.

Varicocele is a mass of enlarged veins that develops in the spermatic cord, which leads from the testicles (testes ) up through a passageway in the lower abdominal wall (systeminguinal canal) to the circulatory system. The spermatic cord is made up of blood vessels, lymphatic vessels, nerves, and the duct that carries sperm from the body (vas deferens). If the valves that regulate bloodflow from these veins become defective, blood does not circulate out of the testicles efficiently, which causes swelling in the veins above and behind the testicles.

A varicocele can develop in one testicle or both, but in about 85% of cases it develops in the left testicle. A one-sided (unilateral) varicocele can affect either testicle. Because of the impaired circulation of blood created by a varicocele, the blood does not cool as it does normally. The increased temperature of the blood raises the temperature of the testes, which is believed to contribute to infertility, as heat can damage or destroy sperm. The increased temperature may also impede production of new, healthy sperm.

Incidence of varicocele is 10-20% and is highest in men between the ages of 15 and 25. The sudden appearance of varicocele in an older man may indicate a renal tumor blocking the spermatic vein. Approximately 40% of infertile men have a varicocele and among men with secondary infertilit (those who have fathered a child but are no longer able to do so) prevalence may be as high as 80%.

Physical support with snug-fitting underwear may alleviate symptoms, if infertility is not an issue. Otherwise, some form of surgery will be required to remove the mass of enlarged veins.
 

 
 

Risk factors for Male Infertility (Low Sperm Count):
 
 
Habits  Overtraining, Effects
 Moderate amounts of exercise should generally be helpful. However, running more than 100 miles per week or cycling more than 50 miles per week has caused decreased spermatogenesis.

Hormones

  Hypogonadism, Male
  Cushing's Syndrome / Hypercortisolism
  Low Testosterone Level
 We identified an endocrinopathy in men with severe male factor infertility that is characterized by a decreased serum testosterone-to-estradiol ratio. This ratio can be corrected by aromatase inhibition, resulting in a significant improvement in semen parameters in oligospermic patients." [J. of Urology, March 2001]

Infections

  STD Gonorrhea
 Men may suffer from infertility following gonorrhea if the epididymis is scarred.

Metabolic

  Cystic Fibrosis
 Infertility in men with cystic fibrosis occurs because the tube that carries sperm, the vas deferens, may have failed to form.

Nutrients

  Zinc Requirement
 Zinc increases sperm count and motility as well as raising testosterone levels when low.

Organ Health

  Fatty Liver
 Researchers in Hong Kong compared mercury levels in fertile and infertile couples. The results were as follows:

Fertile men 15% with high mercury, Infertile men 35% with high mercury
Fertile women 3.8% with high mercury, Infertile women 23% with high mercury

So for infertile men, the chance of mercury toxicity over fertile men was 2.3 times higher and for women, 6 times higher. Mercury disruption of sperm membrane permeability may be responsible for this lose of fertility.

The researchers recorded how much seafood the couples consumed and found that those eating more seafood tended to have higher blood mercury levels. [Fertility and Sterility, 78: 2, August 2002, pp. 426-428]

Symptoms - Reproductive - General

Counter-indicators:
  Having had a vasectomy
 
 

Male Infertility (Low Sperm Count) suggests the following may be present:
 
 
Hormones  Cushing's Syndrome / Hypercortisolism
 
 

Recommendations for Male Infertility (Low Sperm Count):
 
 
Botanical  Tribulus (Tribulus terrestris)
 Tribestan, an extract of tribulus, administered to males with reduced sperm count of unknown cause or with sperm disturbances due to varicocele, has been shown to result in increased concentration of sperm, increased percentage of motile sperm and, in some cases, an increase in the volume of ejaculate by 1-2ml.

  Ginseng, Korean - Chinese / Asian (Panax ginseng)
 A double-blind trial with a large group of infertile men over a 3 month period found that 4gm of Asian ginseng per day improved sperm count and motility. [Panmineva Med 1996;38: pp.249-54]

  Maca (Lepidium meyenii)
 Another study was designed to determine the effect of a 4-month oral treatment with tablets of maca on seminal analysis in adult normal men aged 24-44 years old. Nine men received tablets of maca (1500 or 3000mg) for 4 months. Serum luteinizing hormone, follicle stimulating hormone, prolactin, testosterone and estradiol levels were measured before and after treatment. Treatment with maca resulted in increased seminal volume, sperm count per ejaculation, and sperm motility. Serum hormone levels were not altered.


Not recommended:
  Marijuana
 Despite what many people believe, moderate marijuana use does not change the levels of sex hormones levels such as testosterone. A study at the University of Iowa found that use of marijuana does not affect the testosterone, luteinizing hormone, follicle stimulating hormone, prolactin and cortisol in men and women. Reproductive damage from marijuana use by males not been proven yet. One study did show that there was a relationship between marijuana use and a low sperm count. The sperm count is also increased to normal when the user stops taking marijuana.

The small number of human studies on the effects of cannabis on male reproductive function have produced mixed results. Studies have produced both positive and negative evidence of an effect of cannabinoids on testosterone, for reasons
that are not well understood. [Institute of Medicine (1982) Marijuana and Health. Washington, DC: National Academy Press] It has been conjectured that reductions in testosterone and spermatogenesis probably require long-term exposure. [Pharmacological Reviews 1986, 38, pp.1-20] Current research suggests only a possible link between the use of marijuana and low sperm count, impotence, and gynecomastia. Greater caution is advised for females who may become pregnant.

Diet

  Caffeine/Coffee Avoidance
 Research has indicated that men who drank two to three cups of coffee a day had an increased incidence of abnormally formed sperm. Having five cups a day appears to make sperm sluggish as well.

  Alcohol Avoidance
 Chronic alcohol abuse, but not moderate consumption, damages the intricate plumbing of the male reproductive system, reducing a man's ability to produce normally formed sperm. Please see the 2012 link between Infertility, Male and Chemical Avoidance.

Drug

Not recommended:
  Conventional Drugs / Information
 The use of anabolic androgenic steroids among young men is significant.These exogenous androgens depress testicular production of testosterone and, thus, intra-testicular testosterone levels. This may cause a low or zero sperm count. It has been suggested that there can be a persistent depression of the hypothalamus and pituitary which may be irreversible, even when the steroids are stopped.

Environmental

  Chemical Avoidance
 These findings were published in the journal Human Reproduction (June 2012). The researchers found that the proportion of men who had low numbers of swimming sperm was similar whether they had never been a smoker or were smoking more than 20 cigarettes a day. Similarly, there was little evidence of any risk associated with alcohol consumption.

Infertility was most strongly linked with having had previous testicular surgery, being of black ethnicity or working in a manual occupation.

Professor Nicola Cherry, now at the University of Alberta, Canada, said: "The higher risk we found in manual workers is consistent with earlier findings that chemicals at work could affect sperm and that men should continue to keep work exposures as low as possible."

  Change In Clothing Habits
 An article in The Journal of Urology showed that there was no difference in either the semen analysis or the core testicular temperature between groups of men who wear boxers or briefs. Wearing tight pants, once thought to be a factor, turns out not to be important either.

Subsequent to this, another study has demonstrated that getting rid of tight fitting underwear does improve fertility. The researchers from the Universities of Manchester and Sheffield compared some 900 men with low sperm counts with 1,300 who had high sperm counts. They found drugs, tobacco, alcohol and weight had little effect. But boxer shorts did.

Smoking, drinking alcohol, using recreational drugs and being overweight are all listed in National Institute of Clinical Excellence (NICE) guidelines as factors likely to harm male fertility. But research has found they make little difference with one exception. Changing underwear style could improve a man's chances of having a baby.

"There is no need for men to become monks just because they want to be a dad," said Allan Pacey, senior lecturer in andrology at the University of Sheffield, who was involved in the study. "But if they are a fan of tight Y-fronts, then switching underpants to something a bit looser for a few months might be a good idea."

To make healthy sperm, the testicles need to be a degree or two below body temperature, which is why evolution has seen to it that they hang outside in their own sac, where it's cooler. Tight Y-fronts risk reversing what millions of years of evolution have achieved.

Habits

  Tobacco Avoidance
 Historically there has been the suggestion that cigarette smoking has a significant effect on semen quality. One meta-analysis concluded that regular smoking causes a 23% decrease in sperm density (concentration) and 13% decrease in motility (when averages are taken from nine separate studies).

Other studies challenge this idea though. Please see the 2012 link between Infertility, Male and Chemical Avoidance.

Lab Tests/Rule-Outs

  Test Zinc Levels
 Zinc is concentrated in ejaculate, and important for prostate health. Zinc stores can be reduced by frequent ejaculation. Marginal zinc status is associated with poor sperm count and motility (especially if testosterone levels are low).

Nutrient

  Lycopene
 A study performed in India showed that lycopene supplementation proved to be beneficial to couples who try for the first time to conceive but are not successful due to unspecified male infertility problems. In this study, 50 men with low sperm counts were selected to receive lycopene supplements twice per day for three months. Within nine months after starting the lycopene supplements, 36% of the couples were successful. Amongst the 50 men, 70% had an increase in sperm concentration and 58% had an increase in sperm motility.

Physical Medicine

Not recommended:
  Hot Applications
 Urologist Herbert Sperling has warned that heated car seats, which are increasingly popular among those who live in cold climates, may cause male infertility. Reduced sperm growth, slow sperm and misshapen sperm were all more common among drivers who spend long periods on the heated seats.

The seats raise the temperature of the testicles to 38 degrees Celsius, which is 3 degrees more than normal. Sperm is extremely sensitive to changes in temperature. [The Raw Story September 5, 2006]

Surgery/Invasive

  Surgery
 Two reports from physician-scientists at NewYork-Presbyterian Hospital/Weill Cornell Medical Center (Oct 2007) shed new light on male infertility. A first report shows that a common cause of male infertility -- varicoceles, or varicose veins in the scrotum -- also results in a depletion of testosterone. In a second related finding, researchers demonstrate that once a common, simple surgery is used to treat varicoceles and thereby restore fertility, testosterone levels are also improved.
 
 


KEY
Weak or unproven link
Strong or generally accepted link
Proven definite or direct link
Very strongly or absolutely counter-indicative
May do some good
Likely to help
May have adverse consequences
Reasonably likely to cause problems







GLOSSARY

Cystic Fibrosis:  (CF) An incurable genetic disease involving a sticky buildup of mucus in the lungs (which makes breathing difficult and leads to infections), as well as pancreatic insufficiency (which leads to digestive problems). Symptoms include chronic cough producing thick mucus, excessive appetite combined with weight loss, intestinal disorders, salty sweat/skin and pneumonia. Lung-related problems are the most frequent cause of death. CF is a recessive disease, occurring only when a person inherits two mutated copies of the CF gene - one from each parent. Individuals with CF generally have a life expectancy of about 30 years.

Gonorrhea:  A sexually-transmitted disease that is often without symptoms. If there are symptoms in the female, they include frequent and painful urination, cloudy vaginal discharge, vaginal itching, inflammation of the pelvic area, and abnormal uterine bleeding. If the male has a purulent (pus-like) urethral discharge, he should assume he has gonorrhea until proven otherwise.

Lymph Glands:  Located in the lymph vessels of the body, these glands trap foreign material and produce lymphocytes. These glands act as filters in the lymph system, and contain and form lymphocytes and permit lymphatic cells to destroy certain foreign agents.

Motility:  Capacity for spontaneous movement, frequently in reference to the intestine.

Serum:  The cell-free fluid of the bloodstream. It appears in a test tube after the blood clots and is often used in expressions relating to the levels of certain compounds in the blood stream.

Testosterone:  The principal male sex hormone that induces and maintains the changes that take place in males at puberty. In men, the testicles continue to produce testosterone throughout life, though there is some decline with age. A naturally occurring androgenic hormone.

Zinc:  An essential trace mineral. The functions of zinc are enzymatic. There are over 70 metalloenzymes known to require zinc for their functions. The main biochemicals in which zinc has been found to be necessary include: enzymes and enzymatic function, protein synthesis and carbohydrate metabolism. Zinc is a constituent of insulin and male reproductive fluid. Zinc is necessary for the proper metabolism of alcohol, to get rid of the lactic acid that builds up in working muscles and to transfer it to the lungs. Zinc is involved in the health of the immune system, assists vitamin A utilization and is involved in the formation of bone and teeth.