When we think of infertility, most of us immediately think, "that's a female problem." But did you know that up to 50% of infertility cases have a male factor playing a role?

Men may not know if fertility is an issue for them, as no apparent symptoms accompany this condition. Instead, the main sign of male infertility is the inability to conceive a child.

Multiple risk factors may make certain men more likely to have fertility complications. For example, men with endocrine disorders or hormone imbalances may struggle to conceive. Also, men who have had physical injuries to the testicles, undescended testes, surgery on the testis (or in the general area, such as a hernia repair), use of testosterone or other anabolic steroids, a physical blockage of the sperm travel route, or even exposures to toxic chemicals, which include chemotherapy or radiation are all at an increased risk.

Alarmingly, sperm counts worldwide have halved, and sperm quality has declined over the past 40 years, where now, 1 in 20 men are facing a decrease in their fertility. While there are likely a few factors playing a role in this decrease, the internal environment of our bodies and the external environment we are exposed to daily seems to be having the most significant impact.

Functional medicine can help discover the underlying causes of male factor infertility so that you can have a more holistic plan to boost sperm and overall health.

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What is Infertility in Men?

Infertility is a reproductive disease. Male infertility is the inability of a man to start a pregnancy with a female partner after one year of having regular unprotected sex.

Sperm are tiny cells that fertilize eggs to create embryos. Healthy sperm will typically be ejaculated during sex into the woman's body, where conception can occur. The sperm are produced in both testicles, as is testosterone, and leave the testicles via a structure called the epididymis. The epididymis leads to a set of tubes called the vas deferens, where the sperm mixes in with the fluid from the seminal vesicles and prostate to form semen. Finally, during ejaculation, semen travels through the urethra (the same tube where urine comes out) and out of the penis. Infertility can occur if there is an issue anywhere within that pathway.

What Causes Infertility in Men?

There are multiple known causes of male infertility, such as:

• Genetic or chromosomal abnormalities
• Varicoceles, which are enlargements of the veins in the scrotum where the testes are and can interfere with sperm production
• Retrograde ejaculation, which is when the semen enters the bladder during an orgasm instead of leaving through the penis
• Hormone imbalances
• Immunologic Infertility, which is when 50% or more of the sperm is bound to an antibody

Certain lifestyle choices can also trigger an infertile state. Some of the more notable causes are:

• Poor Diet: Diets high in saturated fats and low in nutrients can decrease sperm production. Obesity can also interfere with hormones.
• Smoking: Tobacco products have been shown not only to damage sperm but also to decrease the survival rate of embryos that are conceived.
• Alcohol: Heavy drinking is associated with lower testosterone levels and erectile dysfunction.
• Heat Exposure: Excessive time spent in hot tubs or saunas can reduce sperm counts. Laptops also create a lot of heat and can contribute to reduced sperm if placed on a man's lap while working.
• Medication & Drugs: Anabolic steroids, marijuana, opiates, and many other prescription and illicit drugs are associated with lower sperm counts.
• High Stress: There are clear associations between high stress and low sperm counts.
• Chemical Exposures: There has been a significant increase in exposure to endocrine disruptors, chemicals that interfere with our hormones.
• There is an association between the health of the gut microbiome and male fertility.
• Oxidative stress is a significant contributor to sperm DNA fragmentation.

7 Functional Medicine Labs to Test for Root Cause of Infertility in Men

Men need a complete physical exam to rule out specific causes such as varicoceles and retrograde ejaculation. Your physician should also order special genetic testing to rule out chromosomal conditions affecting fertility. Once those have been completed, functional medicine can help diagnose underlying root causes that may otherwise be unnoticed in a conventional setting.

Comprehensive Hormone Panel

The DUTCH Plus test is a thorough test analyzing sex and adrenal hormones. This test will be able to tell us if there is an underlying hormone imbalance going on. It also assesses cortisol and the Hypothalamus-Pituitary-Adrenal (HPA) Axis function, which is the communication pathway of your endocrine (hormonal) system.

Toxin Testing

Because toxins and endocrine disruptors are contributing factors, a test, such as the GPL-TOX panel by Great Plains Laboratory, analyzes the exposure of 173 environmental toxins. This test is beneficial because toxins are ubiquitous in our society, and it may be near impossible to otherwise pinpoint which toxins you have been exposed to.

Comprehensive Gut Health Panel

Since there is an association between gut dysbiosis and male infertility, assessing the microbiome through a comprehensive stool analysis, such as the GI-MAP by Diagnostic Solutions, can give excellent guidance on the overall health and makeup of the microbiome. This test analyzes the gut microbiota DNA to provide an overview of the present and absent microbes.

Immunologic Infertility Testing

Immunologic infertility occurs when there are antibodies to the sperm present. The Anti-Sperm Antibody (DIRECT) test by BioReference Laboratories tests for IgG and IgA antibodies to sperm, which can rule in or rule out this cause of infertility.

Oxidative Stress Profile

Oxidative stress significantly impacts sperm DNA, so a test such as the Oxidative Stress 2.0 Urine test by Genova Diagnostics tests for two markers for oxidative stress to evaluate if this is potentially affecting your sperm quality.

Comprehensive Thyroid Panel

If there is a known or suspected thyroid condition, a complete Thyroid panel is warranted because studies show that thyroid disease can be a factor in male infertility.

Lipid Panel

Research also shows an association between lipids and altered sperm parameters. A lipid-rich environment is detrimental to the healthy development of sperm. Therefore, a basic lipid panel is helpful for screening, especially if the diet is poor.

Integrative Medicine Treatment for Infertility in Men

For an integrative approach to be successful, some fundamental lifestyle changes must be made. Discontinuing tobacco use and illicit drugs, reducing alcohol consumption, reducing or eliminating any time spent in saunas or hot tubs, and speaking with your physician regarding any medications you may be on should all be the first step toward healthier sperm.

Nutrition

Diet changes can have a significant impact on sperm quality and overall fertility. Certain foods have been shown to be harmful to sperm health, and certain foods have been shown to be beneficial to sperm health.

For example, there are a few foods that should be reduced if trying to improve sperm health. Processed meats, including hot dogs, salami, beef jerky, and bacon, negatively impact sperm health. The consumption of soy products has also been associated with lower sperm counts. A cross-sectional study also associated full-fat dairy with lower sperm parameters.

However, some foods have a positive impact on sperm quality and health. For example, fruits, vegetables, and fish have all been associated with benefits for sperm health. The Mediterranean Diet includes these foods, and it has specifically been linked to better sperm parameters. This way of eating also promotes a healthy weight, a healthy microbiome, and even hormone balance and health.

Complementary and Alternative Medicine

Zinc has been shown to be a significant contributor to reducing sperm antibodies. It may be beneficial to supplement with zinc if antibodies to sperm are detected.

Probiotics can be a great addition to a male fertility treatment plan. While probiotics have long been associated with a healthier gut microbiome, more specific evidence has examined their role in optimizing sperm quality and even reducing oxidative stress.

Maca is a cruciferous vegetable that grows in the Andes Mountains and has been used as food and medicine for approximately 2000 years. Studies have shown that it can increase sperm counts and motility.

Ashwagandha is an herb that has been associated with hormonal balancing in males. A study found that after eight weeks of ashwagandha extract consumption, there were increased levels of DHEA-S and testosterone.

A healthy, gentle liver detox may be helpful if environmental exposures are present. Supporting the liver by adding cruciferous vegetables and herbs like curcumin can significantly impact your body's ability to detoxify chemicals.

Yoga has been shown to be a stress reducer and specifically improve male reproductive health.

Summary

About half of the time, male factor infertility affects a couple. So clearly, when we think of infertility, we have to think about men, too. There are some genetic and chromosomal considerations to look into. However, much of the time, the environment plays a significant role in hormone health and sperm health.

Functional medicine testing can help get to the root cause of why a man is struggling with fertility. Often, some factors that would otherwise go unnoticed without functional labs can be found.

These tests can also help devise a plan of action for the holistic treatment of male infertility, which can span from diet to herbs to yoga and even a liver detox. Overall, a lot can be done to boost fertility and help men create the healthiest sperm.