Infertility

Factors that Could be Impacting your Fertility:

Even if you aren’t experiencing fertility issues, there is a lot of high quality take home information on nutrition to how overtraining can impact your health. Enjoy!

Infertility impacts 15% of couples worldwide, and affects both males and females alike (1). While, the root causes may vary - the inability to conceive a child can become a frustrating experience for both sexes. While 15% is the commonly reported percentage of couples that are infertile, the number could be much higher. This is due to the fact many regions of the world do not report male infertility due to fact they consider it to be non-masculine to be infertile. As a result, these cultural views can impact reporting and thus the worldwide data may be lowered.

Based on reported data, male factor infertility is estimated to effect 40-50% of infertility cases and nearly 7% of men are impacted. The medical definition of infertility is the inability to conceive after 1 year of intercourse with a fertile female. The common results of male infertility are one or more of the following; low sperm production, abnormal sperm function or blockages that prevent the delivery of sperm (2). Male factor infertility appears to be rooted in inflammation and oxidative stress. The focus of this blog will be on the lifestyle factors that men can take to enhance overall fertility and increase sperm quality, motility and count.

Exercise:

Less than 1 in 4 individuals met the exercise recommendations set forth in the US (3). Making exercise one of the easiest lifestyle changes men can take to impact fertility. A 2017 study looked at the effects of combining 24 weeks of aerobic and resistance training and it's possible impact on infertile men. The researchers concluded " Training-induced changes in inflammation and oxidative stress status correlated with favorable improvements in semen parameters, sperm DNA integrity, and pregnancy rates" (4). A 2018 study looking at only resistance training, found that resistance exercise also improved sperm quality, integrity and pregnancy rates (5). However, there is a point of diminishing returns. A 2009 study wanted to understand the effects of long-term, intensive exercise on reproductive hormones.

The study had a fairly large sample size considering:

1) intensity of exercise a) 60% or 80% of Vo2max

2) duration of exercise (120 minutes - 5 days/wk)

3) length of study 96 weeks.

The authors concluded, that long term strenuous exercise (overtraining) has deleterious effects on reproductive health. It's important to note that these changes didn't have a long term impact when the individuals started their 36 week recovery period. During this recovery period, hormonal markers returned to pre-exercise baseline levels (6). A small study, n = 5, measured the impacts of overtraining on testosterone, cortisol and sperm count. The study found that doubling training volume resulted in a reduction in testosterone, increase in cortisol and a decrease in sperm count. While there are a number of additional studies looking at exercise and its effects on male fertility - the general consensus is not too little and not too much. Exercise is an environmental hormetic that stresses the body. Environmental stress should induce enough stress, but not so much that the body is not able to recover.

Sleep, Rest, & Relaxation:

In a previous blog post, we took a deep dive into factors that could impede (i.e. blue light) as well improve sleep (i.e. acupuncture). Sleep is an innate human instinct, however 1 in every 2 individuals do not receive enough sleep. Poor sleep has been associated with a magnitude of adverse health outcomes. A 2020 study looked at bedtime and sperm quality, the studied found that getting to bed earlier than 10:30pm was more often associated with higher sperm quality (7). A 2020 in vivo study, concluded that "chronic sleep loss alters fertility concomitantly with the disruption of the blood-tissue barriers at the reproductive tract, the mechanism involves androgen signaling" (8). While this study wasn't in humans, it still points out the importance of achieving a minimum of 7 hours of sleep nightly, to maintain blood-tissue barrier integrity within the brain and reproductive organs.

Electronics: Humans have been dealing with radiation since the beginning of time. For example, sunlight is key to biological survival (i.e. circadian rhythm, photosynthesis), yet it is a form of radiation. While radiation is a normal part of life, there certainly has been an influx in the number of possible sources. Cell phones, bluetooth, WiFi and smart meters are a few of the many electronics that have been created in the last century. Before we dive further, I think it's important to note I am not anti-technology - technology and electronics are key to how we function in today's world. Since electronics are a normal part of life, it's important to implement measures that may mitigate the amount of radiation one receives. Below are a few ideas that you may implement to reduce radiation:

1) Create more space between you and the source:

According to the inverse square law - the radiation exposure from a point source (with no shielding) gets smaller the farther away it is. A 2015 study wanted to determine how cell phone habits could impact sperm, and the authors reported "Among men who reported holding their phones ≤50 cm from the groin, a non-significantly higher rate of abnormal sperm concentration was found (47.1% versus 11.1%)(9). While not statistically significant, this study still illustrates how a cell phone kept in close proximity to the groin could impact sperm quality and quantity. A 2011, in vitro study wanted to determine how 4 hours of a laptop connected to internet via WiFi could impact donor sperm samples. Authors note the following, "4 hours to a wireless internet-connected laptop showed a significant decrease in progressive sperm motility and an increase in sperm DNA fragmentation".

2) Turn off your phone or place into airplane mode if you ave a poor signal:

A 2019 study found that when you phone has 1-2 bars of signal it's likely best to avoid using it. As the authors concluded "Limiting cell phone use in weak signal reception areas indicated by fewer than three display bars could potentially reduce [radio frequency]exposure by up to a factor of 10,000." (10). If you keep your phone in your pocket, based on the conclusion above, it would be beneficial to carry your phone another way.

Nutrition:

Today, there is a lot of chatter about nutrition; keto, paleo, carnivore, vegan, the list could go on and on. With all of these diets, the central theme is eat unprocessed, wholesome, real foods. The same philosophy can be carried when your eating to boost fertility; eat real foods. Rather than take a deep dive into nutrition, I'll save that for another blog. I want to introduce one central idea:

1) Obtain an adequate intake of vitamins and minerals: Ideally through real foods. A 2018 study notes that some of the most important vitamins and minerals are; folic acid, B12, vitamin A, D, C, E, calcium, iron, zinc, selenium and iodine (11). These vitamins and minerals mentioned above, play key roles in thyroid function, reproductive health, immune function and much more. A 2011 study wanted to determine if selenium and vitamin E supplementation could improve sperm motility, morphology, or both. The authors concluded that Supplemental Se and vitamin E may improve semen quality and have beneficial and protective effects, especially on sperm motility (12). It's important to note that before beginning any supplementation you talk to a licensed health care provider.

Stress Management: Chronic stress can interfere with many of the hormones that are responsible for optimal reproductive health. A 2014 study found an inverse association between perceived stress score and sperm concentration and motility (13). While not completely understood how or why stress can impact sperm quality, motility, and quantity. There are hypothesized explanations such as; stress triggers the release of steroid hormones, which in turn blunt levels of testosterone and sperm production. The second possible explanation could be oxidative stress, which has been shown to affect semen quality and fertility. What can be done to manage stress:

1) Breathwork

2) Acupuncture

These lifestyle modifications are simply the tip of the iceberg when it comes to optimizing health, fertility, and even longevity. It's truly remarkable how one minor lifestyle change can evolve into additional changes that can positively impact your life. Get started today!

References

1) Sharlip ID, Jarow JP, Belker AM, Lipshultz LI, Sigman M, Thomas AJ, et al. Best practice policies for male infertility. Fertil Steril. 2002;77:873–82.

2)  Cooper TG, Noonan E, von Eckardstein S, Auger J, Baker HW, Behre HM, et al. World Health Organization reference values for human semen characteristics. Hum Reprod Update. 2010;16:231–45.

3) https://www.minnpost.com/second-opinion/2018/07/fewer-1-4-american-adults-get-enough-exercise-cdc-report-finds/

4) Hajizadeh Maleki B, Tartibian B. Combined aerobic and resistance exercise training for improving reproductive function in infertile men: a randomized controlled trial. Appl Physiol Nutr Metab. 2017;42(12):1293-1306. doi:10.1139/apnm-2017-0249

5) Hajizadeh Maleki B, Tartibian B. Resistance exercise modulates male factor infertility through anti-inflammatory and antioxidative mechanisms in infertile men: A RCT. Life Sci. 2018;203:150-160. doi:10.1016/j.lfs.2018.04.039

6) Roberts AC, McClure RD, Weiner RI, Brooks GA. Overtraining affects male reproductive status. Fertil Steril. 1993;60(4):686-692. doi:10.1016/s0015-0282(16)56223-2

7) Hvidt JEM, Knudsen UB, Zachariae R, Ingerslev HJ, Philipsen MT, Frederiksen Y. Associations of bedtime, sleep duration, and sleep quality with semen quality in males seeking fertility treatment: a preliminary study. Basic Clin Androl. 2020;30:5. Published 2020 Apr 23. doi:10.1186/s12610-020-00103-7

8) Domínguez-Salazar E, Hurtado-Alvarado G, Medina-Flores F, et al. Chronic sleep loss disrupts blood-testis and blood-epididymis barriers, and reduces male fertility. J Sleep Res. 2020;29(3):e12907. doi:10.1111/jsr.12907

9) Habits of cell phone usage and sperm quality – does it warrant attention?

Zilberlicht, Ariel et al.Reproductive BioMedicine Online, Volume 31, Issue 3, 421 - 426

10) Stephen Wall, Zhong-Min Wang, Thomas Kendig, Dina Dobraca, Michael Lipsett,

Real-world cell phone radiofrequency electromagnetic field exposures,

Environmental Research, Volume 171,2019, Pages 581-592, ISSN 0013-9351,

11) González-Rodríguez LG, López-Sobaler AM, Perea Sánchez JM, Ortega RM. Nutrición y fertilidad [Nutrition and fertility]. Nutr Hosp. 2018;35(Spec No6):7-10. Published 2018 Sep 7. doi:10.20960/nh.2279

12) Moslemi, M. K., & Tavanbakhsh, S. (2011). Selenium-vitamin E supplementation in infertile men: effects on semen parameters and pregnancy rate. International journal of general medicine, 4, 99–104. https://doi.org/10.2147/IJGM.S16275

13) Teresa Janevic, Linda G. Kahn, Paul Landsbergis, Piera M. Cirillo, Barbara A. Cohn, Xinhua Liu, Pam Factor-Litvak. Effects of work and life stress on semen quality. Fertility and Sterility, 2014; DOI: 10.1016/j.fertnstert.2014.04.021