Tuesday, June 22

Rising infertility in men linked to pollution

Published in: Legalbrief Environmental
Date: Tue 22 June 2010
Category: General
Issue No: 0168

The Cape Argus notes that there is growing concern that environmental pollution may be behind increasing male infertility.

The Southern African Society for Reproductive Medicine and Gynaecological Endoscopy is compiling data from all the fertility clinics throughout the country. Dr Klaus Wiswedel, of the Cape Fertility Clinic, said they were seeing 1 200 to 1 500 male patients a year. A list of harmful pollutants that carried a risk for sperm production included an increase of lead and toxic fumes in the atmosphere, xeno-oestrogens (female hormones of plant origin) in factory-produced meats and chicken, plus an increase in the use of pesticides such as organophosphates (most of which are outlawed globally but still used here) and use of plastic wrappings. Puberty was another time when males were vulnerable to these environmental factors, the report quotes Wisdewel as saying.

Daily sex helps to reduce sperm DNA damage and improve fertility

Published: Tuesday, June 30, 2009 - 08:38 in Health & Medicine

Amsterdam, The Netherlands: Daily sex (or ejaculating daily) for seven days improves men's sperm quality by reducing the amount of DNA damage, according to an Australian study presented today (Tuesday) to the 25th annual meeting of the European Society of Human Reproduction and Embryology in Amsterdam.

Until now there has been no evidence-based consensus amongst fertility specialists as to whether or not men should refrain from sex for a few days before attempting to conceive with their partner, either spontaneously or via assisted reproduction.

Dr David Greening, an obstetrician and gynaecologist with sub specialist training in reproductive endocrinology and infertility at Sydney IVF, Wollongong, Australia, said: "All that we knew was that intercourse on the day of ovulation offered the highest chance of pregnancy, but we did not know what was the best advice for the period leading up to ovulation or egg retrieval for IVF.

"I thought that frequent ejaculation might be a physiological mechanism to improve sperm DNA damage, while maintaining semen levels within the normal, fertile range."

To investigate this hypothesis, Dr Greening studied 118 men who had higher than normal sperm DNA damage as indicated by a DNA Fragmentation Index (DFI). Men who had a more than 15% of their sperm (DFI >15%) damaged were eligible for the trial. At Sydney IVF, sperm DNA damage is defined as less than 15% DFI for excellent quality sperm, 15-24% DFI for good, 25-29% DFI for fair and more than 29% DFI for poor quality; but other laboratories can have slightly different ranges.

The men were instructed to ejaculate daily for seven days, and no other treatment or lifestyle changes were suggested. Before they started, levels of DNA damage ranged between 15% and 98% DFI, with an average 34% DFI when measured after three days' abstinence. When the men's sperm was re-assessed on the seventh day, Dr Greening found that 96 men (81%) had an average 12% decrease in their sperm DNA damage, while 22 men (19%) and an average increase in damage of nearly 10%. The average for the whole group dropped to 26% DFI.

Dr Greening said: "Although the mean average was 26% which is in the 'fair' range for sperm quality, this included 18% of men whose sperm DNA damage increased as well as those whose DNA damage decreased. Amongst the men whose damage decreased, their average dropped by 12% to just under 23% DFI, which puts them in the 'good' range. Also, more men moved into the 'good' range and out of the 'poor' or 'fair' range. These changes were substantial and statistically highly significant.

"In addition, we found that although frequent ejaculation decreased semen volume and sperm concentrations, it did not compromise sperm motility and, in fact, this rose slightly but significantly.

"Further research is required to see whether the improvement in these men's sperm quality translates into better pregnancy rates, but other, previous studies have shown the relationship between sperm DNA damage and pregnancy rates.

"The optimal number of days of ejaculation might be more or less than seven days, but a week appears manageable and favourable. It seems safe to conclude that couples with relatively normal semen parameters should have sex daily for up to a week before the ovulation date. In the context of assisted reproduction, this simple treatment may assist in improving sperm quality and ultimately achieving a pregnancy. In addition, these results may mean that men play a greater role in infertility than previously suspected, and that ejaculatory frequency is important for improving sperm quality, especially as men age and during assisted reproduction cycles."

Dr Greening said he thought the reason why sperm quality improved with frequent ejaculation was because the sperm had a shorter exposure in the testicular ducts and epididymis to reactive oxygen species – very small molecules, high levels of which can damage cells. "The remainder of the men who had an increase in DFI might have a different explanation for their sperm DNA damage," he concluded.

Source: European Society for Human Reproduction and Embryology

Monday, June 21

Male Infertility

The integrity of sperm DNA is essential for the transmission of the father’s gene contribution.

Tests which show an increased fraction of sperm DNA fragmentation often correlates to other sperm pathologies such as poor motility, count and morphology. Most reproductive endocrinology clinics do not test for sperm DNA fragmentation even when the patient presents with poor sperm parameters.

As in all areas of medicine, there is internecine battling going on between physicians as to the meaning and the effect of sperm DNA fragmentation on male fertility.

Some doctors completely disagree with its relevancy as a contributor to male infertility; some physicians accept its contribution but don’t know what to do with the findings; others think that the only real detriment to the quality of sperm rendered by DNA fragmentation is the sperms inability to penetrate the egg and they think that injecting the sperm into the egg (ICSI) effectively deals with the problem. It does not.

Sperm DNA fragmentation has a far reaching effect on fertility and surpasses the mere diminished ability of sperm to penetrate egg.

Some studies show that with higher percentages of sperm DNA fragmentation, there are increased correlations in spontaneous abortions. The proportion of patients with abnormal sperm DNA integrity is higher in couples with spontaneous miscarriage. This is not surprising as a good embryo is nothing other than the combination of a good egg with a good sperm and sperm with DNA fragmentation is not good sperm.

In sperm without DNA fragmentation the DNA is protected from damage while being transported through both the male and female reproductive tracts; if there is damage to the DNA then impaired fertility is an obvious consequence.

Causes of DNA fragmentation are many and varied ranging from genetic anomalies to reactive oxygen species due to white blood cell (leukocyte) infiltration), as well as vericoceles.

As DNA repair systems are less active in the later stages of sperm production, sperm with fragmented DNA can readily reach the ejaculate.

Men that have sperm DNA fragmentation greater than 30% are typically infertile.

Treatment options
Antioxidant therapy

Antioxidants ‘scavenge’ reactive oxygen species and can, in some instances, reduce sperm DNA fragmentation percentages. A n anti oxidant compound which has been shown to be effective in some instances is composed of lycopene 6mg, vitamin E 400IU, vitamin C 100mg, zinc 25mg, selenium 26 mg, folate .5 mg and garlic (available in pill form)1000 mg. This should be taken once daily.

Acupuncture and Herbs

Acupuncture with its ability to stimulate blood which transports oxygen and nutrients to the testes, while carrying debris away from the testes may also be an effective treatment.

Many herbal medicines also have high antioxidant properties and should be included in the treatment regimen.

Combining antioxidant therapy as described above with acupuncture and herbal medicine can potentially reduce sperm DNA fragmentation and increase fertility outcomes in men with high percentages of DNA fragmentation.

Smoking cigarettes and marijuana have been shown to contribute to sperm DNA fragmentation. Elimination of these mitigators may also reduce sperm DNA fragmentation percentages.

Mike Berkley, L.Ac.

Tuesday, June 8

Acupuncture improves fertility outcomes

Check out my new video on what acupuncture can treat from the perspective of reproductive pathology.

Click on the title 'Acupuncture improves fertility outcomes'