Learn About Infertility, Female
What is Infertility, Female?
When a woman hasn't conceived after a year of regular, unprotected intercourse during her most fertile times of the month (before and during ovulation), infertility is a possibility that she and her partner must consider. The problem affects about 10 million Americans. In 40% of infertile couples, it's the woman who has problems that prevent pregnancy. In another 40% of cases, the primary cause lies with the man. In the remaining 20%, both partners have factors that stand in the way of conceiving a child.
A diagnosis of female infertility does not mean that you cannot conceive a child; it simply means that becoming pregnant may be more challenging for you and your partner. There are many methods and technologies today that can assist you in your pursuit to become parents.
Today women are waiting longer to start a family. As fertility declines with age, a woman who is over 35 and trying to conceive is advised to seek help after six months of trying to become pregnant. By seeking professional advice you can prevent further delay to your goal of starting a family.
Key Symptoms
No conception after six months to a year of unprotected intercourse
Endometriosis, a history of pelvic inflammatory disease or previous pelvic surgery
Infrequent, irregular or absent menstruation
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What Causes Infertility, Female?
Under normal circumstances, one of a woman's ovaries releases an egg (ovum)at the midpoint of her menstrual cycle (this is called ovulation). The egg moves through the Fallopian tube, where fertilization can occur if the couple has intercourse.
An interruption in any part of this sequence can make conception difficult or impossible. Some women ovulate irregularly or not at all. Irregular ovulation becomes more likely as a woman enters her late thirties. Weight problems, heavy exercise, and anorexia nervosa can also cause hormone imbalances, disrupting or inhibiting ovulation. Even a small hormonal imbalance in the hypothalamic-pituitary axis can affect ovulation and impact your ability to conceive. About 25% of female infertility is caused by a disruption in the hormone cycle.
Women diagnosed with polycystic ovarian syndrome(PCOS) may also have trouble conceiving due to irregular periods. Polycystic ovarian syndrome is characterized by increased androgen production that prevents the follicles in the ovaries from producing a mature egg.
Even if a woman does ovulate, medical conditions such as endometriosis, underactive thyroid, benign uterine fibroids, or pelvic inflammatory disease can cause scars and obstructions in the Fallopian tubes that keep egg and sperm apart.
If you are 35 and experience long term absence of menstruation, you may want to consult with your physician regarding early menopause. The causes of early menopause are not well known however there are a number of risk factors such as autoimmune disease, radiation or chemotherapy especially for cancers of the reproductive organs, and tobacco smoking.
A medical evaluation can often pinpoint the reason for the infertility, but in some cases, extensive testing reveals no cause. In all cases, a good thyroid disease evaluation is important, as sometimes low thyroid problems can be overlooked even at infertility centers
The male partner should also have an initial evaluation see " Infertility, Male" in the Whole Health MD ailments library.
Conventional Treatments
Conventional treatments for female infertility are geared toward the specific blocks that may be preventing you in your attempts to conceive. Therapies are chosen based on the duration of the problem, the age of the partners, and your specific concerns. Conventional Infertility treatment generally falls into three categories fertility drugs, surgery or assisted reproductive technology(ART).
The aim in the administration of fertility drugs is the induction of ovulation. Women will often be prescribed fertility drugs that correct the deficiencies in their hormonal cycles. Generally these drugs mimic the action of follicle stimulating hormone (FSH) and luteinizing hormone (LH).
Assisted reproductive technology (ART) combines the knowledge and services of many fields to help couples in their quest to conceive. ART teams can include: physicians, psychologists, embryologists, laboratory personnel, and nursing professionals. ART can refer to any number of procedures. Some of the most widely used procedures include:
In vitro fertilization (IVF). In vitro fertilization is the most commonly used ART technique. IVF involves harvesting mature eggs from a woman and fertilizing them in a laboratory setting with a man's sperm. The fertilized eggs are then implanted in the woman's uterus three to five days after being fertilized.
Gamete intrafallopian transfer (GIFT). In a laboratory setting, a woman's eggs are retrieved and combined with a man's sperm in a Petri dish, then surgically injected into a woman's fallopian tubes using a laparoscope. Fertilization happens in the fallopian tubes, and the fertilized egg implants naturally in the uterus.
Zygote intrafallopian transfer (ZIFT). This technique is similar to GIFT, as a woman's eggs are combined with a man's sperm in a laboratory setting. But, in ZIFT once the eggs and sperm are surgically injected into a woman's fallopian tubes, the doctor waits until the eggs are fertilized to implant the embryos in the uterus.
Donor eggs or embryos. This procedure uses another woman's egg to combine with your partner's sperm. The resulting embryo is then implanted into your uterus. Women can also donate embryos for other women to carry to term.
Surogacy. Another woman can act as a surrogate and carry your embryo to term. After birth the surrogate returns the baby to you.
ART technologies have large success rates. Over 70,000 babies are born in the U.S. through the use of these technologies. However, ART can be very expensive, invasive, and can pose special considerations. The most common complication of ART is multiple pregnancy. ART can cause multiple births, but is not the cause of the extreme number of births so often publicized by the media. The couple decides how many viable embryos are kept and matured into fetuses. Couples can elect to undergo multifetal pregnancy reduction in order to reduce the number of fetuses. This may increase the odds of survival for the remaining fetuses.
Medications
Common medication used to treat female infertility include:
Clomiphene citrate (Clomid, Serophene). This drug is administered orally. It is used to treat ovulation disorders such as polycystic ovarian syndrome. It causes the pituitary gland to release greater quantities of FSH and LH, thereby stimulating the growth of ovarian follicles containing eggs.
Human menopausal gonadotropin, or hMG (Repronex, Pergonal). This prescription drug directly stimulates the ovaries. It is often prescribed for women don't menstruate due to the failure of the pituitary gland to stimulate ovulation. It contains both FSH and LH and is administered by injection.
Follicle-stimulating hormone, or FSH (Gonal-F, Follistim, Bravelle). FSH works by stimulating the ovaries to mature egg follicles.
Human chorionic gonadotropin or hCG (Ovidrel, Pregnyl). Used in combination with clomiphene, hMG and FSH, this drug stimulates the follicle to release its egg (ovulate).
Gonadotropin-releasing hormone (Gn-RH) analogs. This treatment is prescribed for women with irregular ovulatory cycles or who ovulate prematurely - before the lead follicle is mature enough - during hMG treatment. Gn-RH analogs deliver constant Gn-RH to the pituitary gland. Follicle growth is then further stimulated using FSH.
Bromocriptine. This medication is for women whose ovulation cycles are irregular due to elevated levels of prolactin, the hormone that stimulates milk production in new mothers. Bromocriptine inhibits prolactin production.
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Tests and Procedures
To asses where in the cycle you may be experiencing problems your doctor will ask questions regarding your health history, menstrual cycle and sexual habits. This is followed by a general physical examination and gynecologic exam. Specific fertility tests may include:
Blood tests to asses the hormone levels that contribute to successful ovulation.
Hysterosalpingography is a test that evaluates the condition of your uterus and fallopian tubes. Fluid is injected into you uterus and an x-ray is taken to determine whether the fluid has free movement out of the uterus and into your fallopian tubes. This test is used to detect blockages and problems in the gynecological tract.
Laparoscopy is a procedure that allows a physician to view your fallopian tubes,ovaries, and uterus. A tube is inserted into your abdomen through a small incision made below your navel. Carbon dioxide gas is inserted into you abdominal cavity to allow room for the insertion of the laproscope. The laparoscope is a small illuminated fiber optic telescope that will project pictures to your physician during the examination. After the procedure the laparoscope is withdrawn and the incision is closed. This procedure is used to help detect endometriosis and scarring. Laparoscopy is generally preformed as an outpatient procedure.
Urinary luteinizing hormone (LH) detector kits are sold over the counter. These test your LH level in your urine. However, these tests can be inaccurate and prone to error. You should consult your physician before attempting this method of testing.
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Treatment and Prevention
Before beginning conventional treatments for infertility, which can be expensive, time-consuming, emotionally draining and laden with side effects, it may be worthwhile to consider a course of herbal and nutritional supplements. For many women, these can offer a more convenient, affordable, and equally effective alternative.
Women considering taking supplements for infertility should know that patience is essential because supplements may take three to six months to work. If a woman doesn't conceive with the help of these strategies, she should be sure to contact a fertility specialist, who would be able to offer a variety of conventional treatments, such as fertility drugs, in-vitro fertilization, and ovum transfer. Usually, supplements for infertility can safely be used along with conventional approaches.
Chronic stress is well known to diminish fertility. Stress-reduction mechanisms, especially meditation and biofeedback, have been shown to considerably increase a woman's chances of getting pregnant. Likewise, acupuncture and Chinese herbal medicine are commonly used to aid fertility and also can assist in stress reduction.
Other conditions which may affect your ability to conceive are tobacco smoking and consuming caffeine or alcohol. Recent research has shown that women who smoke cigarettes and drink alcohol while attempting to become pregnant experience a lower success rate and more miscarriages (1). Caffeine consumption that exceeds two or more cups a day has been linked with infertility due to tubal disease or endometriosis (2,3). It is best to avoid smoking and drinking alcohol or caffeine not only during pregnancy but, also in the time leading up to conception.
Just a reminder: If you have a serious medical condition or are taking medication, it's always a wise idea to talk with your doctor before beginning a supplement program.
How Supplements Can Help
Chasteberry, also known as vitex, can help stimulate ovulation and is especially helpful if infertility is due to irregular ovulation. This herb appears to stimulate production of the female hormone progesterone and suppress production of the lactation hormone prolactin, creating a hormonal environment more conducive to ovulation. Chasteberry should be taken on those days each month when you're not menstruating and stopped altogether if conception occurs (4).
The herb false unicorn root also appears to prompt ovulation. Known as blazing star, fairywand, and starwort, this root has been called a "uterine tonic" in the past but has not been as widely studied as chasteberry. But like chasteberry, it's thought to work best taken daily until menstruation begins and stopped if pregnancy occurs.
The B vitamins play a key role in reproductive health and also in early fetal development; folic acid, especially, can prevent certain birth defects. Experts recommend that women trying to conceive take a vitamin B complex supplement that contains vitamin B12, biotin, folic acid, and all other B vitamins, plus extra vitamin B6.
Zinc is a mineral that plays a role in cell division. Those who take zinc daily for more than a month should also take copper to prevent a copper deficit associated with long-term zinc supplementation.
Essential fatty acids, found in evening primrose oil, flaxseed oil or borage oil, can be taken daily to promote the healthy functioning of the uterus and help regulate hormone production. These essential fatty acids should be taken with vitamin E, which also helps stabilize hormones.
Siberian ginseng is likewise important for balancing the hormones and maintaining uterine health. Like other herbs, Siberian ginseng should be stopped if you get pregnant.
L-Arginine is a protein amino acid that is vital to all living organisms. It is an essential building block in protein synthesis and contributes to the production of many substances throughout the body. Preliminary research has shown that arginine supplementation may help increase fertilization rates in women undergoing IVF. More research is necessary to investigate L-arginine's role as an adjunctive therapy to ART (5).
Get supplement dosages and tips in our WholeHealthMD Supplement Recommendations for Female infertility.
Self-Care Remedies
Don't smoke and reduce or stop your intake of caffeine. Women who do smoke and consume large volumes of caffeine have more trouble conceiving than nonsmoking women.
Reduce alcohol intake. Alcohol affects chromosomes and can interfere with conception.
Bring your weight into the normal range using a sensible diet and an exercise plan. This applies not only to women who are overweight but also to those who are underweig
Don't overdo exercise. Frequent hard workouts can interrupt the ovulation process.
Use a home ovulation test to pinpoint the time of ovulation. Couples interested in conceiving should have intercourse as soon as ovulation is indicated. The window of opportunity for conception is on that day and the five days before. Ovulation tests may be more useful in providing information about a woman's monthly pattern. Temperature testing is unreliable and usually by the time the temperature rises ovulation has occurred.
Make use of relaxation techniques to help ease the emotional and physical stress that can plague women as they try to successfully conceive. Science is learning more everyday about how emotional stressors express themselves physically in the form of impediments in the body. Seek the help of a mind-body skills instructor to help teach you techniques such as meditation or guided imagery. These therapies can help you to better control your emotional and physical responses to stressful events. These skills can be helpful to anyone, but especially so to women feeling the pressures associated with unsuccessful attempts at starting a family.
Alternative Therapies
Recent efforts to determine beneficial alternative therapies in the treatment for female infertility have shown mixed results. The most promising outcomes have been demonstrated with acupuncture and acupressure (6). Researchers have not determined the mechanism by which these therapies work to facilitate pregnancy, but it is suspected that acupuncture may play an important role in the regulation of the hypothalamic-pituitary-ovarian system and thereby the pelvic organs(7). The mechanism by which acupuncture is thought to benefit the body is through the stimulation and release of neuropeptides in the central nervous system. Work is now underway to see how this release impacts the gonadotropin secretion and thereby the menstrual cycle. Petti et al. showed that acupuncture causes a significant increase in beta-endorphin levels during treatment. These reductions lasted up to 24 hours after acupuncture treatment (8). Beta-endorphin is derived from the precursor protein pro-opiomelanocortin. Pro-opiomelanocortin is present in high levels in many body structures including the hypothalamus and ovaries.
Because acupuncture impacts beta-endorphin levels which in turn effects GnRH secretion and the menstrual cycle, scientists suspect that acupuncture may influence ovulation and fertility. Preliminary animal tests have shown that acupuncture treatment normalized GnRH secretion. Positive effects on the regulation of the menstrual cycle and hormonal levels have been demonstrated with both acupuncture and electroacupuncture (9). In certain cases of Polycystic Ovarian Syndrome (PCOS) acupuncture is judged to be a valuable alternative or adjunct to commonly prescribed pharmacological therapies.
Acupuncture has also been shown to be a valuable adjunctive therapy when administered during IVF treatment. Paulus et al. conducted a trial comparing pregnancy rates in 160 patients undergoing IVF. Acupuncture was administered to 80 patients 25 minutes before and after ET. After controlling for confounding variables, the pregnancy rate for the group receiving acupuncture was 42.5% compared with the control group at 26.3% (10). This significant difference in pregnancy rates with a combination IVF and acupuncture program is promising. More studies are needed to further examine the possible benefits of acupuncture as an adjunctive therapy for ART treatments.
Preliminary study data demonstrate that acupuncture may not only have an effect on the pelvic organs via the endocrine system, but also hypothesize that acupuncture may help a couple's chance of conceiving by reducing stress (11). The psychological effects of prolonged attempts at conception cannot be underestimated. The social, interpersonal, and emotional stress that a woman often undergoes can create an equally as destructive strain on her body. Secretion of stress hormones can negatively influence many body processes including the menstrual cycle and the balance of the hypothalamic-pituitary axis. Acupuncture through its actions to regulate these levels, may offer a viable alternative to anti-anxiety and antidepressant drugs whose effects have not been investigated in conjunction with infertility treatments.
An acupuncture practitioner who works with infertility problems might also consider treating you with or referring you for Chinese Herbal Medicine treatments as part of your fertility enhancement program ,either before or in complement to the standard infertility treatments.
In traditional Chinese medicine herbal mixtures were used to shore up the physical and energetic stresses in women's bodies to increase their receptivity to fertilization and their ability to carry a baby to term. Some studies are underway regarding the use of Chinese herbs for male infertility, as well as for females in promoting conception and avoiding miscarriage,(12, 13, 14, 15, 16) but the level of evidence is not enough to recommend specific herbal mixture or standard protocols for infertility. Due to the delicacy of prescribing an individual traditional herbal mixture before and during pregnancy, consult a Chinese herbal practitioner with at least 5 years experience who is familiar with the traditional herbal protocols for infertility.
Learn About Infertility, Male
What is Infertility, Male?
Conceiving a child is always far from predictable, but when a couple has not succeeded after a year of having sex without any form of contraception--especially during the woman's most fertile days of the month--there may be a fertility problem. It was previously believed that the inability to conceive occurred equally in males and females. However, a multi-center study by the World Health Organization found that males contribute to a couple’s infertility less frequently than females. The study found that about 20% of cases are attributable to the male and 38% to the female while both partners are infertile in 27% of cases: in the remaining 15% of cases, the cause is unknown. (1)
In addition to inability to conceive after a year of trying, male infertility is defined by a total sperm count of less than 5 million per ml, the presence of more than 50% abnormal sperm, and/or inability of the sperm to impregnate an egg in the laboratory.
While some causes of infertility in men cannot be reversed, a diagnosis of male infertility does not always mean that conceiving a child is impossible; it simply means that becoming pregnant may be more challenging for the couple. There are many methods and technologies today that can assist in the pursuit of parenthood. Seeking professional advice early can prevent delays in the goal of starting a family.
Despite the prolonged frustration that results from infertility, the statistics are encouraging: Up to 60% of couples who haven't conceived after a year of trying will do so eventually—with or without treatment.
Key Signs or Symptoms
The inability to conceive after a year of unprotected sex.
What Causes Male Infertility?
Unlike a woman's fertility, which declines after age 35, a man's fertility is less affected by aging. When a man is thought to be infertile, the exact cause can be due to any of a number of factors and may be difficult to identify.
While there's no minimum number of sperm needed to fertilize an egg—all it takes is one—the higher the sperm count, generally, the greater the chances of conception. A low sperm count—called oligospermia—can be the result of smoking, alcohol consumption, or certain medications. Particularly harmful to sperm are cannabinoids, the active chemical compounds in marijuana smoke. More than 30 laboratory trials have shown that cannabinoids inhibit motility and sperm binding. (2) The most common physiological reason for a low sperm count is the presence of a varicocele (varicose veins above one or both testes). These increase blood flow—and, in turn, heat—to the area, which can then reduce sperm production. Varicoceles can be corrected with minor surgery.
Infertility can also be attributed to a deficiency of the sex hormone testosterone, which can be boosted with medication. Another cause of infertility (for which there is no treatment) is an earlier infection, such as a case of the mumps after puberty that resulted in an inflammation of the testicles.
Sometimes, the seminal fluid is at fault. If its volume is inadequate, the sperm will not be able to survive in the acidic environment of the vagina. Or the fluid may fail to re-liquefy, as it normally does, a short time after ejaculation. This would prevent the sperm from passing through the cervix. In this scenario, the best option may be artificial insemination.
In some cases, the sperm itself is defective. If a large number of sperm are abnormally shaped or if they are not active enough, they may not be able to penetrate an egg--a problem for which there is no conventional medical treatment.
Anatomical defects can also cause infertility. An infection (often from a sexually transmitted disease) or scar tissue (resulting from surgery, an injury, or a long-healed infection) can block the duct system that carries the sperm from the testes. Active infections can be treated with antibiotics, and scar tissue can sometimes be remedied by microsurgery.
Exposure to certain drugs (such as cimetidine and ranitidine HCL) and toxins can sufficiently reduce the sperm count to render a man infertile. The doctor should review any prescription drugs for this possible side effect, and a patient should consider any exposure to toxins in his workplace. Various metals, including cadmium, nickel, and manganese, may affect sperm ability to find and penetrate an egg. Various research studies also indicate that caffeine (more than four cups of caffeinated coffee a day) and smoking (more than 20 cigarettes a day) also seem to affect fertility by decreasing sperm motility.
Conventional Treatments
Conventional treatments for male fertility are geared toward the specific blocks that may be preventing couples in their attempts to conceive Conventional infertility treatment generally falls into three categories: fertility drugs, surgery or assisted reproductive technology (ART).
The aim in the administration of fertility drugs in men is to improve sperm production and normalize hormone levels. If the sperm count is low, or the sperm appear defective for no apparent reason, a supplement program may be the best option, especially if the cause is unknown and no medical procedures will help.
If a definite anatomic defect is found to be the cause of infertility, surgery will likely be the only option available.
Assisted reproductive technology (ART) combines the knowledge and service of many fields to help couples in their quest to conceive. ART is particularly helpful in achieving a pregnancy in female partners of men with moderate or severe oligospermia (low sperm count) and azoospermia (absence of living sperm in the semen).
ART teams can include: physicians, psychologists, embryologists, laboratory personnel, and nursing professionals. ART can refer to any number of procedures. While not all are appropriate for strictly male infertility, a review of the most widely used procedures includes:
Intrauterine insemination (IUI). This procedure, which takes place in a laboratory setting, involves using a small catheter to inject washed sperm (whole semen causes a severe allergic reaction) directly into the uterus just prior to ovulation.
In vitro fertilization (IVF). In vitro fertilization is the most commonly used ART technique. IVF involves harvesting mature eggs from a woman and fertilizing them in a laboratory setting with a man's sperm. The fertilized eggs are then implanted in the woman's uterus three to five days after being fertilized.
Gamete intrafallopian transfer (GIFT). In a laboratory setting, a woman's eggs are retrieved and combined with a man's sperm in a Petri dish, then surgically injected into a woman's fallopian tubes using a laparoscope. Fertilization occurs in the fallopian tube, and the fertilized egg implants naturally in the uterus.
Zygote intrafallopian transfer (ZIFT). This technique is similar to GIFT, as a woman's eggs are combined with a man's sperm in a laboratory setting. But, in ZIFT the doctor waits until the eggs are fertilized to surgically inject the embryos into a woman's fallopian tubes.
Donor eggs, sperm or embryos. This procedure uses another woman's egg to combine with the male’s sperm, or another man’s sperm to combine with the female’s egg, or both egg and sperm may be donated. The resulting embryo is then implanted into the woman’s uterus.
ART technologies have large success rates. Over 70,000 babies are born in the U.S. through the use of these technologies. However, ART can be very expensive, invasive, and can pose special considerations. The most common complication of ART is multiple pregnancies. ART can cause multiple births, but is not the cause of the extreme number of births so often publicized by the media. The couple decides how many viable embryos are kept and matured into fetuses. Couples can elect to undergo multi-fetal pregnancy reduction in order to reduce the number of fetuses. This may increase the odds of survival for the remaining fetuses.
Studies are underway to develop potential treatments for male infertility and genetic diseases in men that can be corrected and eradicated in germ cell lines. Researchers also are trying to develop methods to prevent infertility through early diagnosis of any underlying causes of male fertility.
Medications
Conventional medicine has not been especially effective in combating sperm quality issues like oligospermia (low sperm count) and azoospermia (absence of living sperm in the semen). However, some medications that enhance the factors that promote sperm formation may be useful.
When the glands that produce hormones are not working correctly, hormone imbalances may affect sperm production. Gonadotropins, protein hormones that normally come from the brain to stimulate the cells that produce testosterone, may be used to improve sperm production and quality. This hormone therapy is sometimes useful in men with unexplained infertility, abnormally low sperm count, or poor sperm motility. Common gonadotropins used in men include human chorionic gonadotropin (hCG) and follicle stimulating hormone (FSH), which can be administered by injections.
Glucocorticoids, steroid hormones used to treat inflammation arising from the immune system, may be necessary to improve fertility. When the immune system produces antibodies to ward off an infection, the antibodies can bind to sperm and cause sperm to stick together. This process, called agglutination, interferes with sperm motility and ability to reach an egg. High doses of prednisone (40 to 60 mg daily) taken for up to six months to combat agglutination have been shown to improve fertility and lead to pregnancy. (3) However, high doses of glucocorticoids have adverse side effects that many patients cannot tolerate.
Clomiphene citrate and tamoxifen, which are anti-estrogens typically prescribed to treat female infertility, also may be used to boost sperm production in men with low sperm counts or poor motility. However, the FDA has not approved the use of clomiphene in men, and neither drug has been found to be especially effective in men. (4-7)
Tests and Procedures
To pinpoint the cause of infertility, a couple can ask their doctor--usually a urologist for the man, and a gynecologist for the woman--to start a diagnostic workup. In the man's case, this will start with a semen analysis to determine several key factors: the number of sperm, their movement (motility), their shape (morphology), the volume of semen, and its thickness (viscosity). All of these elements are vital to ensure that enough of the man's sperm can survive to fertilize one of the woman's eggs. The man will also be examined for physical abnormalities such as a varicocele that may be contributing to the problem. Blood tests may be done to check for any hormone imbalances, and complex cases might be referred to a fertility specialist.
Treatment and Prevention
Before beginning conventional treatments for infertility, which can be expensive, time-consuming, emotionally draining and laden with side effects, it may be worthwhile to consider a course of herbal and nutritional supplements. For many men, these can offer a more convenient, affordable, and effective alternative.
Men considering taking supplements for infertility should know that patience is essential because supplements may take three to six months to work. If the female partner doesn't conceive with the help of these strategies, be sure to contact a fertility specialist, who may be able to offer a variety of conventional treatments. Usually, supplements for infertility can safely be used along with conventional approaches.
Other conditions that may affect the ability to conceive are tobacco or marijuana smoking andconsuming caffeine or alcohol. It is best to avoid smoking and drinking excess alcohol or caffeine in the time leading up to conception.
Just a reminder: If you have a serious medical condition, it’s always a good idea to check with your doctor before starting a supplement program.
How Supplements Can Help
Antioxidants--including vitamin C, vitamin E, and mixed carotenoids (a powerful blend of antioxidants)--protect the fragile sperm from naturally occurring molecules called free radicals. Damage from free radicals can lead to abnormal sperm and sperm counts. Vitamin C is especially important for smokers, who tend to have low vitamin C levels and whose sperm counts are frequently depressed as a result. In an early study of 30 infertile but otherwise healthy men who received either 200 or 1,000 mg of vitamin C or placebo daily, taking vitamin C significantly improved sperm count, viability, and motility, and reduced agglutination, abnormalities and immature sperm forms. And, most significantly, at the end of 60 days, all of the vitamin C groups had impregnated their wives, compared with none in the placebo group. (8) In a more recent study of 97 healthy, non-smoking men, higher antioxidant intake was associated with higher sperm numbers and motility. Specifically, vitamin C intake was positively correlated with sperm number, sperm concentration and motility; higher vitamin E intake led to improved motility; and increased beta-carotene intake positively affected sperm concentration. (9)
Vitamin E is the main antioxidant in sperm cell membranes, making supplementation of this vitamin especially important in improving fertility. Vitamin E has been shown to play a role in inhibiting free radical damage to the sperm membrane and in enhancing the ability of sperm to fertilize an egg in test tubes. (10) In one study of 52 infertile men, treatment with vitamin E supplementation resulted in eleven pregnancies and nine of those pregnancies ended with normal term deliveries. (11) In a study of fertilization after IVF, men who previously had low fertilization rates were treated with vitamin E supplementation for three months. Treatment led to a significant increase in fertilization rates (from 19% to 29%) after only one month. (12) In another study, taking 400 mg of vitamin E and 225 µg of selenium daily significantly improved sperm quality in infertile men. (13) However, while taking vitamin E plus selenium seems to improve sperm functionality, it did not seem to improve fertilization rates. (14) And taking high-dose vitamin E in combination with vitamin C did not improve sperm functionality either. Interestingly, while most of the above studies show positive results, other trials have shown no significant effects of antioxidant supplementation in improving sperm quality. (15-16) One explanation for this discrepancy is that supplementation produces significant results only when oxidative stress is present. (17) Larger trials are needed to confirm or refute efficacy and who may most benefit from these treatments.
Zinc plays a key role in male reproduction, boosting testosterone levels and raising the sperm count. Zinc deficiency, thus, could lead to decreases in both testosterone levels and in sperm counts. Infertile men with low sperm counts typically have low zinc levels, indicating a potential contributing factor in the infertility. (18, 19) Several studies have shown zinc supplementation to positively impact sperm counts and motility. (20-23) In one of the studies, mean sperm count and testosterone levels both increased significantly after zinc supplementation. In the study, 37 men with infertility for more than five years and sperm counts of less than 25 million/ml were treated with zinc sulfate (60 mg of elemental zinc daily) for 45 to 50 days. In 22 patients with initially low testosterone levels, mean sperm count increased from 8 to 20 million/ml, testosterone levels increased significantly, and nine of the 22 wives became pregnant during the study. In contrast, the fifteen men who had normal testosterone levels at the start of the study showed no change in testosterone levels, only slight increases in sperm count, and no pregnancies. (20) In a larger study, 101 infertile men received 440 mg of zinc sulfate daily for 60 days to two years. Half of the men also underwent varicocelectomy. At the end of the study, 27% of the zinc only group successfully impregnated their wives, and 50% of the zinc plus varicocelectomy patients impregnated their wives. In this study, zinc effectively improved fertility, especially in association with varicocele correction. (22) For long-term use, zinc must be taken with copper, because zinc inhibits its absorption.
The amino acid arginine may help in treating male infertility caused by circulation problems: it seems to help increase blood flow to the penis. Additionally, arginine is needed to produce sperm, so supplementation may prove beneficial in increasing sperm count, quality and motility, thus improving fertility. A three-month regimen of at least 400 mg of arginine daily was shown in early studies to increase sperm count and enhance motility. (24-26) In one of the studies, 74% of 178 men with low sperm counts had significant improvements in sperm counts and motility after arginine therapy. (25) More recent, but small, trials also showed three or more months of arginine supplementation increased sperm count and improved motility. (27-28) More large trials are needed to confirm or refute efficacy.
The amino acid carnitine is essential for sperm development, function and motility and has been better studied for the treatment of male infertility. Several studies have shown that carnitine helps to normalize sperm counts in men with previously low levels and to significantly increase motility. In the Italian Study Group on Carnitine and Male Infertility, 100 subjects taking 3,000 mg of L-carnitine daily for four months showed significant increases in sperm counts and motility. A subgroup of men with the poorest sperm motility saw the most significant improvements, with the percentage of motile sperm increasing from 19.3% to 40.9% and the percentage of sperm with rapid linear progression increasing from 3.1% to 20.3%. (29) Since then, several double-blind studies have confirmed these results. (30-33) A 2007 meta-analysis of trials evaluating L-carnitine to treat male infertility found treatment significantly improves sperm quality, motility and pregnancy rates. However, no significant difference was found in the sperm concentration or semen volume. (34)
The herbs Panax ginseng and Siberian ginseng are believed to stimulate the production of testosterone and the formation of sperm. Studies in animals show potential benefits, but human studies are lacking. Some studies of Panax ginseng have shown efficacy in promoting growth of the testes, raising sperm formation and testosterone levels, and increasing sexual activity and mating behavior in animals. (35, 36) And Siberian ginseng (Eleutherococcus senticosus) has also shown some benefit in increasing reproductive capacity and sperm counts in vitro and in animals. (37, 38)
Coenzyme Q10 is an enzyme involved in energy reactions throughout the body. Studies have demonstrated that raising blood levels of CoQ10 has increased sperm counts. Preliminary evidence indicates taking 200 mg of coenzyme Q10 daily may increase sperm motility after six months of treatment in men with low sperm motility. (39) A newer study involving 60 infertile men with low sperm motility found that taking 200 mg of coenzyme Q10 daily for six months significantly improved motility in these patients. (40) More research is needed to confirm or refute efficacy.
Flaxseed oil is an outstanding source of omega-3 essential fatty acids (EFAs), which are necessary for healthy sperm and for hormone production. The EFAs in flaxseed oil seem to help prevent swelling and inflammation of the prostate and to improve blood flow to the penis, which may help to increase sperm count and sperm quality. (41) More research is needed regarding efficacy for infertility.
Vitamin B12 is necessary for maturation of cells. Several studies have shown that raising levels of B12 has improved sperm counts in infertile men, even without a vitamin B12 deficiency.(42-44) In one study, 27% of men with sperm counts less than 20 million/ml were able to achieve a total sperm count greater than 100 million/ml after treatment with 1,000 µg of vitamin B12 daily. (21) In a preliminary study in Japan, dosages of 1,500 mcg of the methylcobalamin form of B12 were administered daily to 26 infertile men for four to 24 weeks. After eight weeks, a semen analysis showed sperm concentration increased in 38% of the men, total sperm counts increased in 53%, sperm motility increased in 50%, and total motile sperm count increased in 50%. (43) However, in a later multi-center study involving 375 infertile men, taking 6,000 µg of vitamin B12 daily for three months did not produce significant benefits to the group as a whole, though supplementation did seem to improve sperm count in a subgroup of men with sperm counts less than 20 million/ml. (45) While these studies are over two decades old and further research is limited, a 2000 review of nutritional and environmental therapies indicated that vitamin B12 has been shown to improve sperm production and motility. (46)
The herbal supplement, Pygeum africanum may help to improve fertility in men with diminished prostatic secretions. Pygeum, which gets its name from the tree where it grows, has been shown to increase the amount and improve the composition of seminal fluid. (47-49) Pygeum also has been shown to improve the capacity to achieve an erection in patients with benign prostatic hypertrophy or with prostatitis, which in turn may help to improve sexual function. (50)
Self-Care Remedies
Avoid smoking and drinking.
Wear boxer shorts rather than briefs to keep the testicles away from the warmth of the body, which can reduce sperm count.
Alternative Therapies
Men with reduced sperm activity may benefit from acupuncture treatments, during which hair-thin needles are inserted in specific points on the body. In a 1997 study of 38 men who were either treated with acupuncture or went untreated for two to eight months, treatment led to significant improvements in total functional sperm, percentage of viability, and total motile sperm compared to the control group. (51) In a 2000 study, 20 patients with a history of varying levels of poor sperm density underwent acupuncture treatment. In the severe group, 67% of the men showed definite increases in sperm count, seven of those men showed significant increases, and two pregnancies resulted after treatment. (52) More research is needed to confirm or refute these findings.
Although few studies have examined the effectiveness of homeopathic treatment, practitioners may choose individualized homeopathic remedies for improving fertility based on specific problem areas and general constitutional and person attributes. In a 2002 prospective observational pilot study of individualized homeopathy, 45 infertile men treated with single homeopathic remedies for an average of ten months showed significant improvements in sperm density, percentage of motile sperm, and proportion of sperm with good motility. Researchers noted the rate of improvement in sperm count after homeopathic therapy was comparable to conventional therapy. (53) More research is needed in this area.
Joining a support group or seeing a behavioral health practitioner may provide relief from anxiety about infertility. A 1999 study of 17 couples with male infertility of unknown cause received behavioral therapy for six months that focused on optimizing the chance of conception, improving sexual functioning and satisfaction, reducing thoughts of helplessness and, if necessary, improving marital communication skills. During therapy, the couples showed improvements in sperm concentration, reductions in thoughts of helplessness and a decrease in marital distress. After six months, problem-focused thoughts had decreased, and the live birth rate was higher in the therapy group than in epidemiological samples. (54) In a similar 2002 study of 26 couples involved in IVF treatment, both men and women reported psychological benefit from group therapy, during which facilitators used cognitive behavioral techniques to help the couples process their feelings about their infertility. At the completion of the group sessions, women reported less anxiety and men reported greater optimism. (55)
Chronic nutrient deficiencies and obesity can lead to infertility. A dietitian can make sure infertile men get the right nutrients and vitamins to lose weight or correct deficiencies, thereby improving fertility.
Some alternatives that relieve stress, such as meditation or yoga, may be useful in facing the challenges of infertility. These techniques, which combine mind and body, promote clarity of the mind, help maintain healthy body chemistry, and support the patience required to undergo infertility treatments. Additionally, specific yoga postures are thought to stimulate both brain and organ functions that may improve hormonal and blood circulation. Practicing these mind-body techniques also puts patients more in tune to their bodies, which can benefit doctors and patients in assessing specific symptoms and body processes. (56)
When to Call a Doctor
If you suspect that you, or your partner, may be infertile.
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Evidence Based Rating Scale
The Evidence Based Rating Scale is a tool that helps consumers translate the findings of medical research studies and what our clinical advisors have found to be efficacious in their personal practice into a visual and easy to interpret format. This tool is meant to simplify the information on supplements and therapies that demonstrate promise in the treatment of certain conditions.
Supplement/
Therapy
Rating
Explanation
Acupuncture
Preliminary studies indicate potential efficacy. More research is needed to confirm or refute these preliminary findings. (51, 52)
Arginine
Several studies, including one large trial, indicate efficacy in increasing sperm count and improving motility. Larger trials are needed to confirm or refute efficacy. (24-28)
Behavioral health practitioner
Preliminary evidence indicates potential efficacy in reducing stress associated with infertility. More research is needed. (54, 55)
L-Carnitine
Several studies and a meta-analysis have shown efficacy in improving sperm development, function and motility. But the meta-analysis found no effect on sperm concentration or semen volume. (29-34)
Coenzyme Q10
Preliminary studies indicate potential efficacy in improving motility. More research is needed to confirm or refute efficacy. (39, 40)
Flaxseed
A preliminary study indicates potential efficacy. More research is needed to confirm these preliminary results. (41)
Ginseng (Panax)
Preliminary studies in animals indicate potential efficacy. Research in humans is needed. (35, 36)
Ginseng (Siberian
Preliminary in vitro and animal trials indicate potential efficacy. More research is needed to confirm or refute efficacy. (37, 38)
Homeopathy
A pilot study indicates potential efficacy. More research is needed. (53)
Meditation
Evidence indicates the relaxation technique can help to reduce the stress of infertility and improve mind-body connection. (56)
Pygeum africanum
Preliminary studies indicate potential efficacy in improving prostatic secretion, semen quality and overall sexual function. More research is needed to determine efficacy. (47-50)
Vitamin B12
Several small studies and a review of studies indicate efficacy in improving sperm production and motility. Larger studies are needed to confirm or refute these results. (21, 42-46)
Vitamin C
Most small studies indicate efficacy, particularly in men who smoke. Some conflicting evidence exists. Larger studies are needed to confirm or refute efficacy. (8, 9, 15-17)
Vitamin E
Most small studies indicate efficacy, but some conflicting evidence exists. Larger studies are needed to confirm or refute efficacy. (10-17)
Yoga
Evidence indicates the relaxation technique can help to reduce the stress of infertility and improve mind-body connection. (56)
Zinc
Several studies indicate efficacy. (18-22)
