By Christina Jackson
It is a common practitioner’s dilemma: many women show up in our clinics for fertility support, but getting male partners to come for treatment can be a challenge. The American Society of Reproductive Medicine reports that the male factor is responsible for one-third of fertility problems in this country, and male and female factors together are responsible for another third of fertility problems (www.asrm.org). 48% of miscarriages are thought to be due to abnormal sperm issues.
During the intake of a female fertility patient, we often hear her report that her male partner’s sperm is “fine”, therefore we commonly don’t pursue treatment of the male factor. When in fact, what is often classified as a “fine” semen analysis in a fertility clinic really indicates that the sperm are healthy enough for use in assisted reproductive technology (ART) procedures such as intrauterine insemination (IUI) or invitro fertilization (IVF). In these procedures, sperm are “washed” by using a centrifuge to separate the sperm cells from the seminal plasma. Then only the healthy and more mobile sperm that remain are used. Though this is an effective technique in IUI and IVF procedures, often couples are not counseled that their sperm analysis parameters may not show adequate quantity or quality for conceiving through natural intercourse.
Recent research shows a concerning decline in male reproductive health, including low testosterone levels and sperm counts. Evidence also shows that semen quality may have a greater impact on IVF and miscarriage outcomes than previously thought. These factors, combined with statistics showing that children conceived through IVF have a 25-40% higher prevalence of birth defects than for babies conceived naturally, should renew our interest in the Chinese medical approach to male fertility issues. http://www.bestpracticeobgyn.com/article/PIIS1521693406001040/fulltext
Semen Analysis and Declining Male Fertility
The main assessment tool used for evaluating male fertility is the semen analysis. It is always important to obtain a copy of this laboratory report, even if the patient claims that it showed all parameter were normal. The semen analysis includes:
- Sperm count: normal is 40-300 million
- Volume of sample: normal is 2.0-5.0 ml
- Morphology (percentage of normal sperm that are present): should be at least 30%
- Motility (percentage of sperm moving in forward progression): should be at least 50-60%
For more information on semen analysis and other male fertility testing, visit: http://www.resolve.org/site/PageServer?pagename=lrn_wdigfh_tmwu_sa.
In recent years, fertility research has increasingly focused on clarifying the role of the male factor beyond just the classic semen analysis. With the wider use of donor egg programs, research has been better able to isolate the male impact on fertility and miscarriage. It is becoming apparent that men do indeed have a biological clock, much like women. Semen volume and motility decrease with age, particularly when men reach 45 and older. Men are at increased risk for failure to conceive after age 35. http://www.fertstert.org/medline/record/ivp_00029378_189_901
Another recent study has showed that there is a greater incidence of miscarriage in the partners of men over 40. http://aje.oxfordjournals.org/cgi/content/abstract/161/9/816
Male age also appears to be linked to higher rates of chromosomal abnormalities. http://www.fertstert.org/medline/record/ivp_00150282_81_925
Environmental Factors
Increasing evidence is available showing that environmental pollution poses a significant source of fertility and miscarriage problems in both men and women. Endocrine disrupting chemicals such as bisphenol A found is plastics, dioxins found in paper products and bleach, pesticides in produce, and chemicals found in medical/dental procedures, computers, and personal care products, have all been found to decrease semen quality. http://www.healthandenvironment.org/infertility/vallombrosadocument
Using IVF and ICSI with Low Functioning Sperm
Scanning electron micrograph of human spermatozoa fertilizing an egg in vitro. (X3500)
Many couples undergoing treatment in a traditional fertility clinic are under the impression that the procedures performed will compensate for their male factor fertility issues. This is partially true as the sperm washing procedure in combination with IUI or IVF, can compensate for lower sperm counts, sexual dysfunction, retrograde ejaculation, and motility problems. Intracytoplasmic Sperm Injection (ICSI) is a newer procedure in which a high functioning sperm is directly injected into an egg. This increases fertilization rates by compensating for low functioning sperm that have trouble penetrating and fertilizing eggs. However, very recent studies have shown that in IVF and ICSI procedures resulting in successful conception, if the sperm has a high percentage of damaged DNA, the pregnancy is more likely to end in miscarriage, even though fertilization rates for these men are unaffected. http://www.fertstert.org/article/PIIS0015028207013611/abstract
Chinese Medicine Perspectives
From a TCM perspective, this suggests that it may be important to support the health of the Jing essence in the male fertility partner, regardless of their use of assisted reproductive technology (ART).
In Chinese medicine, the most common causes of male fertility problems are: Kidney yin deficiency, Kidney yang deficiency, Damp heat in the lower jiao, and Liver qi and blood stasis. Some representative formulas that may be used in these cases would be:
- Zhi Bai Di Huang Wan (Anemarrhena, Phellodendron, and Rehmannia Pill)
- You Gui Wan (Restore the Right Pill)
- Long Dan Xie Gan Tang (Gentiana Drain the Liver Decoction)
- Ge Xia Zhu Yu Tang (Drive Out Stasis Below the Diaphragm Decoction)
Often a practitioner assess her patient to have a combination of one of the above 4 patterns. In these cases, two formulas may be combined. With as little as lifestyle counseling, acupuncture once per month (preferably timed close to their partners ovulation), and a simple constitutional herb formula taken regularly, sperm parameters can be significantly impacted within 1- 3 months.
For patients undergoing IVF procedures, this support can result in healthy quality sperm, leading to greater conception rates and healthier babies. When couples experience recurrent miscarriage problems, even in the absence of a problem on a semen analysis, it can be helpful to support any constitutional deficiency on the male side. For those with only a mild to moderate male factor issue, this may be enough to allow that couple to finally conceive on their own.
For practitioners interested in fertility issues and dedicated to the outcome of healthy children as well as helping patients attain a healthy pregnancy, we must pay attention to the growing problem of male fertility. Regardless of the Western fertility assessment, by counseling and treating both partners with Chinese medicine, couples will have the best chance of successfully conceiving, and passing on the healthiest Kidney jing possible to their children.