Dr Sarah King, ND

Health Status of Male Partners Cannot be Overlooked in Pre-conception Stage

When couples are attempting to conceive, we often put the weight of nutritional and overall health status on women. This is largely attributed to the fact that post-conception a woman’s body must provide the energy, sustenance, blood supply, and nutrition for the growing fetus. But what about in our pre-conception stage? Women generally tend to take a more active role in fertility support measures, however, for couples deciding to conceive, the health status of male partners cannot be overlooked.

Infertility describes couples who have been trying, unsuccessfully, to conceive for over a year. Within these couples, male factor infertility accounts for 40-50% of these cases.^1,2 These factors include: 1) Sperm production problems: Infection, testicular injury or varicoceles, drug use, and/or DNA fragmentation; 2) Physical blockage of sperm transport; 3) Sexual problems including erectile dysfunction; and 4) Idiopathic reasons, which account for 30% of infertile men.³

Idiopathic male infertility is largely attributed to diet and lifestyle and may be associated with poor nutrition and diet, alcoholism, smoking, marijuana use, and toxicity or exposure to toxins. Many of these factors are largely intertwined with hormonal dysregulation, resulting in abnormal levels of testosterone, estrogen, follicle stimulating hormone (FSH) and luteinizing hormone (LH).

Male Health and Spermatogenesis

It takes about 100 days to produce sperm as they undergo normal development and maturation. During development, male germ cells are extremely susceptible to damage from toxins, but also from oxidative stress via reactive oxygen species (ROS), and DNA fragmentation. These factors can cause sperm abnormalities ranging from low sperm counts, to non-motile sperm.³

Generally, the body has antioxidants in place to help scavenge these ROS, such as vitamin C and vitamin E obtained through dietary sources. However, when the rate of ROS production exceeds antioxidant reactions, sperm are vulnerable to negative changes.³ Obesity in men has been linked to increases in this DNA damage of sperm³. These changes have even shown to be transmitted to offspring via genetic and epigenetic alterations of the germ cell DNA.¹ In cases of idiopathic male infertility, higher concentrations of antioxidants may be needed through supplementation. One recent study showed that vitamin C dosed at 1g daily improved sperm concentration and motility.³

Obesity and Testosterone

Obesity is considered a chronic low-grade systemic inflammation⁴, so it’s reasonable to expect that these inflammatory processes can affect both hormonal regulation and reproduction for both men and women. In fact, recent literature has shown that obese men are at a greater risk for developing hypogonadism, impaired sperm production, and erectile dysfunction.¹

There are many ways by which sperm production is affected by obesity, ranging from thermal effects to hormonal dysregulation via increased estrogen levels and lower testosterone levels.¹ Obesity induces multiple pathways which result in increased aromatization of testosterone to estradiol.¹

Adipocytes (fat cells) release a hormone called leptin. When leptin levels are chronically elevated, men can develop “leptin resistance” which results in decreased testosterone levels.¹ Additionally, insulin resistance and sleep apnea can both down-regulate testosterone and the androgenic axis. Fragmented sleep alone can decrease nocturnal LH production, further reducing circulating testosterone levels.¹

The higher estrogen and lowered testosterone levels that develop from these pathways leads to decreases in FSH, sex-hormone binding globulin (SHBG), and an overall reduction in human spermatogenic function.¹ Even more so, high estrogen levels in men upregulate the phagocytosis of Leydig cells by macrophages, essentially engulfing and destroying the testosterone-producing cells in the testicles.¹

On a sex hormone level alone, obesity can have major negative influence on male fertility. Studies have shown that overweight and obese men are at a higher risk of decreased sperm count and semen volume, as well as DNA fragmentation causing effects of low sperm motility.^1,3,5 Reducing body fat mass of infertile male partners can help increase production of testosterone and restore healthy function of hormonal pathways.³

Diet and Semen Quality

Recent studies of lifestyle factors and sperm quality have shown that diet and nutritional factors play an important role in spermatogenesis. Specifically, folate and vitamin B12 are both required for DNA, phospholipid, and protein synthesis.⁶ Low intake of dairy, sugar, and processed meat, along with a high intake of fruits, vegetables and healthy fats such as olive oil (also including EPA and DHA) favorably lead to less DNA damage in sperm.⁶ Healthy diets in men have also been associated with higher sperm concentrations, sperm count, and motility.⁶

Other studies have shown that testosterone levels are positively affected by high intake of fish, chicken, fruits, cruciferous vegetables, tomatoes, and leafy green vegetables.⁶ Diets consisting of these foods have also been associated with a lower incidence of chromosomal disorders in offspring.⁶

Conclusions

Infertility investigations in men are crucial for couples trying to conceive. Infertility notwithstanding, couples in the pre-conception phase should be taking 3-6 months to address health concerns, and adjust diet and lifestyle factors. Just because sperm are competent enough to fertilize an egg, doesn’t mean that these sperm are entirely unaffected in obese men, nor that normal embryonic development will progress uninhibited after fertilization.¹ The safest way to obtain a healthy body composition is through a healthy diet and regular exercise, which tends to result in a gradual, progressive and sustained weight loss and overall improved health.⁷ A healthy reduction in body fat mass in obese infertile men can improve hormonal function and testosterone production.

Additionally, antioxidant support may be helpful in improving sperm health parameters, but should be appropriately prescribed through a naturopathic doctor or other health care provider.

References

1. Craig, J.R., Jenkins, T.G., Carrell, D.T., and Hoteling, J.M. Obesity, male infertility, and the sperm epigenome. (2017) Fertil Steril. 107(4): 848-59
2. Yu, W., Zheng, H., Lin, W., et al. Estrogen promotes Leydig cell engulfment by macrophages in male infertility (2014) J Clin Invest. 124(6): 2709-21
3. Rafiee, B., Horowvat, M.H., and Rahimi-Ghalati, N. Comparing the effectiveness of dietary vitamin C and exercise interventions on fertility parameters in normal obese men. (2016) Urol J. 13(2): 2635-9
4. Broughton, D.E., and Moley, K.H. Obesity and female infertility: potential mediators of obesity’s impact. (2017) Fertil Steril. 107(4): 840-7
5. Belloc, S., Cohen-Bracrie, M., Amar, E, et al. High body mass index has a deleterious effect on semen parameters except morphology: results from a large cohort study. (2014) Fertil Steril. 102(5): 1268-73
6. Oostingh, E.C., Regine, P.M., Steegers-Theunissen, M.D., et al. Strong adherence to a healthy dietary pattern is associated with better semen quality, especially in men with poor semen quality. (2017) Fertil Steril. 107(4): 916-23.e2
7. Meldrum, D.R. Introduction (2017) Fertil Steril. 107(4): 831-2

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Dr. Sarah King is a licensed Naturopathic Doctor, graduating from the Canadian College of Naturopathic Medicine in 2014. Prior to completing her medical studies, she attended Nipissing University where she received her Honors Bachelor of Science in Biology. Sarah has a passion for women’s health and is a birth doula in Durham and Toronto Region. She treats a wide variety of health conditions including menstrual disorders and hormone balancing, fertility, prenatal care, digestive concerns, skincare and mental health/anxiety. Outside the office Sarah is an avid runner with a love of the GTA’s best forest trails. She also continues to improve her yoga practice and teaches breath work as part of stress management counselling to her patients.