Up to half of all causes of infertility are related to the male partner. We explore the causes, diagnoses, and natural remedies to increase male fertility.

Reproduction and childbirth are important decisions for many couples, and having a baby can be a wonderful and fulfilling experience. But when conception and pregnancy don’t come easily, feelings of anxiety, distress, and frustration often arise. It is estimated that up to half of all cases of infertility are due to factors related to the male partner. Here are some possible causes and solutions.

Infertility is widespread

Globally, as many as 14 percent of couples are infertile, which is defined as the inability of a sexually active couple to get pregnant after one year of regular, unprotected intercourse.

While social factors (such as the increasing age at which people marry) are at play, environmental factors, such as pollution and environmental toxins are other influences behind the prevalence of couples facing infertility today. Thankfully, there are simple things men can do to help boost their fertility.

Diagnosis

When infertility is in question, how is it diagnosed? Getting a thorough reproductive checkup is always a good first step. Typically, a health care practitioner will begin with a medical history, including concerns such as past infections or sexually transmitted diseases, damage to the reproductive organs, medications, and exposure to toxins.

A physical exam and a semen analysis are also done to look for the number, movement, and shape of the sperm. A sperm count of approximately less than 20 million/mL usually confirms the diagnosis. An absence of sperm in the ejaculate, also known as azoospermia, occurs in approximately 10 percent of cases.

Other tests that may be done include a scrotal or transrectal ultrasound to assess any blockages in the sperm pathway, or blood tests to determine any hormonal deficiencies.

Causes and solutions

Many different conditions can lead to infertility—some that you may be able to address yourself, and some that require expert assessment and treatment.

Examples of infertility causes that need to be addressed by a qualified health care practitioner include

• enlarged veins in the testes (varicocele)
• genetic disorders
• blockages in the passage of the sperm from the testes to the penis
• sexually transmitted diseases
• prostatitis (inflammation of the prostate)
• mumps orchitis (inflamed testicles due to mumps)
• hormone problems (see below)

Hormone problems

Hormones play a vital role in initiating and maintaining male reproductive function.

• Testosterone is essential for the growth and division of germinal cells that form into healthy sperm; a deficiency of this hormone contributes to infertility.
• The interplay of other hormones such as LH (luteinizing hormone) and FSH (follicle-stimulating hormone) comprise the delicate endocrine balance necessary for maturation of sperm cells.
• The quality of semen is also associated with another hormone, known as inhibin B.
• Research also identifies thyroid hormone receptors on the testes, suggesting the significant impact of this hormonal system on the male reproductive tract. An abnormal thyroid profile can affect semen quality and fertility by compromising testicular size, sperm motility, and ejaculate volume.

Oxidative stress

Male infertility is a complex process often diagnosed as “idiopathic” meaning that standard evaluations can’t determine a cause. Considerable evidence is now pointing toward oxidative stress as a factor in male infertility.

Oxygen is essential to sustain life, and as part of the normal metabolic process, sperm produce reactive oxygen species (ROS), which are necessary to maintain normal cell function. However, when ROS are present in excessive amounts, either due to increased generation or impaired clearance, they reduce sperm motility and cause extensive sperm DNA damage.

Seminal fluid contains the highest concentration of antioxidants of any human fluid. Antioxidants protect from damage caused by ROS, and several clinical trials support the use of antioxidant therapy such as vitamins C and E, zinc, coenzyme Q10, and carnitine to improve sperm parameters. Of course, always consult a health care practitioner before taking new supplements. Here are some examples of this recent research.

• Vitamin C neutralizes free radicals, protecting against DNA damage. One 2006 study found that administering vitamin C daily for two months increased sperm count in men.
• Coenzyme Q10 is an antioxidant that helps protect the sperm against oxidative damage and supports cellular bioenergetics by providing important fuel for sperm motility.
• Carnitine is a key transporter molecule that also has antioxidant effects. Many studies have suggested that carnitine can help improve sperm concentration and motility (giving weak sperm a much-needed energy boost) and increase pregnancy rate.
• Zinc plays a role in testicular development, sperm maturation, and production of testosterone. A 2008 study found that zinc supplementation improved sperm motility and prevented oxidative damage. Another study, this one from 2012, found that older men with higher dietary zinc intake produced sperm with less DNA damage.

Environmental toxins

Infertility in men is also influenced by occupational elements and environmental pollutants. Male reproductive function can be compromised by exposure to chemicals such as heavy metals, pesticides, and xenoestrogens.

Many toxic chemicals act as endocrine disruptors—interfering with hormonal processes—and subsequently impair sperm function. Bisphenol A (BPA) is an example of a compound that may impact male fertility. This widespread chemical can be found in plastic bottles and food containers, the lining of cans, thermal paper (receipts), medical equipment, and electronics.

Phthalates are another group of widely used substances (in soft plastics products such as shower curtains and skin care products) that have been shown to inhibit testosterone synthesis.

Limit your toxic load by avoiding the aforementioned products when possible or choosing nontoxic options. For instance, opt for organic to reduce your pesticide exposure, choose canned goods labelled with the words “BPA-free,” and look for “phthalate-free” on skin care products.

Lifestyle

Lifestyle factors play a pivotal role in the overall health and well-being of a man’s reproductive function.

• Weight: Obese men are three times more likely to exhibit low sperm quality than men of a healthy weight. Overweight men, too, exhibit increased DNA damage to sperm.
• Exercise: A healthy amount of exercise (at least three times a week for about an hour) is beneficial to improve all sperm parameters—but too much rigorous exercise may be detrimental.
• Nutrition: Try to consume a diet rich in whole foods, fibre, folate, and lycopene-containing fruits and vegetables such as tomatoes and watermelon.
• Smoking and drinking: Find support to help stop smoking, and limit your alcohol and caffeine consumption.
• Stress: Also consider reducing your stress levels by engaging in mindfulness-based exercises or attending counselling.

A complementary approach

Addressing infertility can be a very stressful and complicated process. Working with a medical doctor, urologist, psychologist, or other qualified health professional is essential to address the various elements involved.

Naturopathic doctors are also well-trained in assessing and managing this condition and often conduct an environmental toxin assay or oxidative stress test, along with using botanicals and other natural medicines to address hormonal imbalances. Ultimately, knowledge and support are instrumental in successfully overcoming infertility.

Fact or fiction?

While the type of underwear men wear likely won’t make a difference to sperm count, there are a few surprising things that can—at least temporarily—reduce sperm count by overheating the testicles, including

• frequent sauna and hot tub use
• using a laptop computer for a prolonged period of time
• cycling for a long duration