Whenever we talk about infertility, the first thought is women’s problem. Actually, this is not true at all. Male infertility explained 40-50% of infertility cases. Sperm defect including low sperm count and/or poor quality of sperm is the main cause of male infertility. Semen analysis is very simple and important test to check male infertility. In this test, sperm concentration (sperm numbers), sperm motility (percentage of them are swimming forward) and shape of sperm are checked. If you have abnormal sperm, this may be the cause of your infertility.
If you have infertility associated with sperm abnormality, acupuncture can help to correct them. Current research provided evidence that acupuncture increased sperm concentration. As early as 1980’s, there was research on improvement of sperms after acupuncture treatment from Germany. 28 patients with subfertility participated the study. These patients received 10 acupuncture treatments for a period of three weeks. After acupuncture treatments, total sperm count, concentration and motility were improved significantly. They also evaluated subjective parameters by written psychological tests. The psychological test showed no change caused by acupuncture. This excluded that the effect of acupuncture on sperm quality was caused by placebo-mechanisms. Siterman S et al. studied 40 patients with low sperm count in two groups: acupuncture group and control group. They found that after 5 weeks acupuncture treatment sperm numbers were significantly increased compared to the control group. Pei J et al also studied the effect of acupuncture on sperm count. There were 28 patients with low sperm count in acupuncture group and 12 patients with low sperm count in untreated control group. After 5 weeks acupuncture treatment (twice a week) the sperm count was significantly increased in acupuncture group compared to control group. They also found that acupuncture improved sperm quality as well. Siterman S et al and Fischl F et al also investigated the effect of acupuncture on sperm quality. They found that after 10 acupuncture treatments acupuncture treatment, sperm quality was significantly increased compared to the control group.
It is widely accepted that men with low sperm count is associated with high scrotal temperature, and this impaired sperm output. Recently Siterman S et al investigated the mechanism of acupuncture increasing sperm count to see if this is related to decrease scrotal temperature. There were 39 patients with low sperm counts in acupuncture group. They found that the result was agreed with previous studies that men with infertility have high scrotal temperature. This was caused by testicular inflammation. After 8-10 acupuncture treatments, the scrotal temperature was significantly decreased and sperm counts were significantly increased. This is because acupuncture increased blood supply of testicular artery and acupuncture stimulated immune response and reduced inflammation.
Acupuncture is effective for antisperm antibodies associated male infertility
10% of male infertility is caused by antisperm antibodies. Immune system can respond to produce antisperm antibodies in some circumstances such as infection. These antibodies tend to destroy sperms causing infertility. The antibodies can be present in tail of sperm which may cause mobility problems; they can be found in the head of the sperm as well which may prevent sperm binding to eggs resulting in fertilisation problems. Fu B et al have reported that effectiveness of acupuncture and herbal medicines on male with positive antisperm antibody associated infertility. In this study 50 cases in acupuncture and herbal group and another 50 cases in control group treated with prednisone. Antisperm antibodies were monitored in the two groups for measuring the effect. They found that antibodies were decreased in both groups but acupuncture group had significantly better effect than that for prednisone group.
Acupuncture helps fertilisation of ICSI in male infertility
There was a case report that acupuncture improves sperm quality and the outcome of intracytoplasmic sperm injection (ICSI). 22 male patients with infertility who failed ICSI participated the study. They received acupuncture treatment twice a week for 8 weeks followed by ICSI. At the end of the treatment, sperm motility and normality was improved. The fertilisation rates after acupuncture treatment were 66.2% significantly higher than that before the treatment (40.2%). Embryo quality was also improved. Acupuncture has a positive prospect for men with infertility undergoing ICSI treatment.
A case report: acupuncture increased sperm count
A 31 year old man was diagnosed azoospermia (no measurable level of sperm in his semen). His testis and vasa deferentia were normal. The tests showed that his sperm production was impaired which was difficult to cure. The couple failed one cycle of percutaneous sperm aspiration and intracytosplasmic sperm injection. He was referred for acupuncture treatment. He received a course of 20 session acupuncture treatment (twice a week). After a course of acupuncture treatment, his sperm count was 10 millions/ml with 10% good motility and 60% normal shape of sperms. With continuing another course, his sperm count increased to 18 millions/ml with 30% good motility and 60% normal shape of sperms.
Poor sperm quality could contribute to the causes of recurrent miscarriage.
There was a case control study by Li B et al. They compared semen analysis results from men whose spouses had a history of miscarriage (case group) with those without spouses with recurrent miscarriage (control group). They found that men in case group had lower volume of semen, low sperm concentration and higher misshaped sperms. Other parameters including percentage of grade B sperm, acrosomal enzyme activity and sugar content etc were lower in case group compared to control group. This research finding suggests that there could be a link between poor sperm quality and recurrent miscarriage.
Brahem S et al did a research to evaluate standard sperm parameters and sperm DNA fragmentation by comparing men whose partners had s history of recurrent pregnancy loss (RPL) with control group with proven fertility. They found that there was significant lower sperm motility in RPL group compared to control group. The mean number of sperm cells with fragmented DNA was significantly increased in RPL group compared to control group. The results suggest that poor sperm motility and high incidence of sperms with fragmented DNA could contribute to a cause of recurrent miscarriage.
A systematic review just published in Human Reproduction journal studied the association of sperm DNA fragmentation with miscarriage. There were 16 studies involved in 2969 couples. They found that a significant increase in miscarriage in patients with high DNA damage (DNA fragmentation) compared with those with low DNA damage. Because of this finding, selecting sperm without DNA damage for use in assisted conception treatment may reduce the risk of miscarriage.
Varicocele and male infertility
Infertility affects about 1 in 6 of the couples of reproductive age1. The male factor is involved in 40% - 50% of infertility cases. The most common type of male infertility is unexplained infertility, which is unknown cause. Another common cause of male infertility is varicocele which is enlarged veins in testicles. 78% - 93% of cases varicocele is located on the left side. The left internal spermatic vein inserts into the left renal vein at a right angle which leads to an increase in the hydrostatic pressure of the left spermatic vein causing its dilation. Also internal spermatic veins lack functional valves, which can lead to regression of blood. Possibly there is a partial obstruction of the left spermatic vein due to the compression of the left renal vein between the aorta and the upper mesenteric artery . Varicocele causes elevated temperature of the scrotum possibly due to reflux of warm blood from the abdominal cavity. High temperature causes thermal damage of the DNA and proteins in the nucleus of spermatic tubules' cells and / or Leydig cells. The increased vein pressure can influence testicular blood flow, cause accumulation of toxic metabolites which leads to chronic vasoconstriction and subsequent dysfunction of the spermatic epithelium. Men with varicocele have high FSH level and low sperm counts. Surgical repair of varicocele has been shown to restore the temperature in both animals and humans. However fertility potential is not always improved after surgical repair of varicocele though semen parameters were improved.
Oxidant stress and male infertility
Half of all cases of infertility have male factor involved. Oxidant stress damage to sperm is a significant contributing pathology in 30–80% of cases. What is oxidant stress? In cellular metabolism, there are free radicals produced and they can damage cells and also there are antixodants against this damage. If balance between free radicals and antioxidants is broken, oxidant stress occurs. If oxidant stress occurs in sperm, it reduces the sperm's motility and ability to fuse with the egg by damaging the sperm membrane and sperm DNA. This may cause male infertility. Oxidant stress is not screened nor treated. The possible causes of oxidant stress come from many sources such as life style including smoking, drinking alcohol, stress, environmental factors including heat, pollutions, infections, autoimmune problems, chronic disorders etc.
Management of oxidant related stress include: change life style, reduce exposure to toxic environment, treat infections and inflammations etc. Taking some supplements such as vitamine C, B complex, and E may help reducing oxidant stress. Acupuncture may help reduce oxidant stress by improving blood circulation and taking toxic free radicals away.
Sperm is impaired by inflammation and acupuncture can help
Semen quality is affected by prostate and genital tract inflammation. There was a study on 382 voluntary male subjects who underwent the screening for prostate health. Sperm motility and prostate-related parameters were significantly impaired in patients with chronic prostatitis syndromes and lower urinary tract symptoms in comparison with controls. Elevated seminal markers of inflammation were in positive association with body mass index, prostate-specific antigen, and estradiol level in serum while in negative association with semen volume, total sperm count, and sperm motility. It was suggested that one of the possible pathways for impaired reproductive quality in male subjects >45 years could be related to infection and inflammation in the genital tract with subsequent (partial) obstruction and damage of prostate and other male accessory glands. Previous study has shown that acupuncture could improve sperm parameter in men with genital tract inflammation.
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