The clinical definition of male infertility is the presence of abnormal semen parameters in the male partner of a couple who have been unable to conceive after 1 year of unprotected intercourse (Dohle 2010).
The World Health Organization defines male factor infertility as the presence of one or more abnormalities in the semen analysis, or the presence of inadequate sexual or ejaculatory function (Rowe 2004). In 50% of involuntarily childless couples, a male infertility associated factor is found together with abnormal semen parameters (Dohle 2010).
Male fertility requires normal sperm production and sperm transport, and adequate sexual performance, functions that require normal levels of testosterone. Male infertility can be due to a number of factors, including abnormal spermatogenesis; reproductive tract anomalies or obstruction; inadequate sexual and ejaculatory functions; and impaired sperm motility (Patki 2004; Isidori 2005; Dohle 2010). In 30-40% of men, no cause for infertility is found (Dohle 2010). However, in such men, semen analysis reveals a decreased number of spermatozoa (oligozoospermia), decreased sperm motility (asthenozoospermia) and many abnormal forms of sperm (teratozoospermia) (Dohle 2010). Factors that alter spermatogenesis include endocrine disturbances such as low testosterone levels, exposure to medicines or environmental toxins, varicocele, increased scrotal heat, systemic diseases, smoking and alcohol, and testicular torsion and trauma (Cherry 2001; Kunzle 2003; Shefi 2006; Arap 2007). Erectile and ejaculatory dysfunction may be associated with psychological factors, hypogonadism, spinal cord disease, and metabolic and vascular conditions such as diabetes (Dohle 2010). Sperm motility can be reduced in immotile cilia syndrome or in the presence of antisperm antibodies (Arap 2007).
Treatment for male infertility should be targeted to the aetiological factors whenever possible, and includes hormonal treatment, hormonal modulators, corticosteroids, antioxidants, and surgery. Assisted reproductive techniques are often the fastest and most effective method to achieve pregnancy regardless of the aetiology (Isidori 2005; Dohle
Arap MA et al. Late hormonal levels, semen parameters and presence of antisperm antibodies in patients treated for testicular torsion. J Androl 2007; 28: 528-32.
Cherry N et al. Occupational exposure to solvents and male infertility. Occup Environ Med 2001; 58: 635-40.
Dohle GR et al. Guidelines on male infertility. European Association of Urology; 2010.
Isidori A et al. Treatment of male infertility. Contraception 2005; 72: 314-8.
Kunzle R et al. Semen quality of male smokers and nonsmokers in infertile couples. Fertil Steril 2003; 79: 287-91.
Patki P et al. Effects of spinal cord injury on semen parameters. J Spinal Cord Med 2008; 31: 27-32.
Rowe PJ et al. WHO manual for the standardized investigation and diagnosis of the infertile male. Cambridge, UK: Cambridge University Press; 2004.
Shefi S, Turek PJ. Definition and current evaluation of subfertile men. Int Braz J Urol 2006; 32:385-97.
How acupuncture can help
Some clinical trials suggest that acupuncture improves sperm motility (Dieterle 2009), increases sperm count (Siterman 2009, Siterman 2001), improves sperm quality (Pei 2005; Gurfinkel 2003) and has a beneficial effect on psychogenic erectile dysfunction (Engelhardt 2003) (see Table overleaf). The research results are promising but still at a preliminary stage in terms of numbers and quality of studies.
Acupuncture may help in the treatment of male infertility (Stener-Victorin 2010), by:
- lowering scrotal temperature (Siterman 2009);
- enhancing local microcirculation, by increasing the diameter and blood flow velocity of peripheral arterioles (Komori 2009);
- reducing inflammation, by promoting release of vascular and immunomodulatory factors (Zijlstra 2003)
- by improving sperm maturation in the epididymis, increasing testosterone levels, and reducing liquid peroxidation of sperm (Crimmel 2001)