85. Male Fertility: Improving Reproductive and Hormonal Health

When couples struggle with infertility, male factors are often overlooked—yet they play a role in nearly half of all cases. In this episode of Cycle Wisdom, Dr. Monica Minjeur dives into the crucial role of male fertility, why basic semen analysis isn’t enough, and how targeted lifestyle changes can restore sperm health. Learn how one couple avoided IVF by addressing the root cause—proving that Restorative Reproductive Medicine (RRM) can lead to natural conception and better long-term health.

Transcript

Monica: 0:02

Welcome back to Cycle Wisdom, where we empower women to restore natural menstrual cycles, to improve health and promote fertility. I'm your host, Dr. Monica Minjeur, and I'm so glad you were listening today. When couples struggle to conceive, the focus is often on the woman, but did you know that up to 20 to 30% of infertility cases may also involve male factor in addition to female factor? And another 20% of cases may be just male factor alone. Many people think that if a man can perform sexually or if his sperm counts are okay, that his fertility must be fine, but sperm health is much more complex than that. Today we're diving into why male fertility health matters, how we look for issues beyond the baseline testing. And what men can do today to improve their chances of conception. So let's start off as always with a patient story about Jake and Emily. They had been trying to conceive for about two years with no success. Emily's ob doctor ran all the standard tests on her, and everything looked great. Her cycles were regular, her hormone levels were normal, and it appeared as though she was ovulating consistently. Jake's initial sperm testing had normal counts, but decreased motility, meaning that the sperm didn't move very well, so they were referred to IVF as the next step because they had been trying for quite some time and were told that Jake's low motility on semen testing was the likely cause of the infertility and would not be able to be overcome other than utilizing some form of artificial reproductive technology. However, before moving forward with these expensive and invasive treatments, Emily and Jake came to us for a second opinion. We started off with a deeper dive into optimizing Emily's hormone health and cycle charting analysis, but also recommended that while we were looking at her that Jake would get a full fertility evaluation, not just a basic semen analysis, but an in-depth look at his sperm health. Hormone balance markers of inflammation, as well as other overall health parameters since Jake's motility was low and we wanted to dig a little deeper. I ordered some blood work as well as an additional semen test that looked at the quality of the sperm called DNA fragmentation testing. Jake's lab results showed that his testosterone levels were low for his age, and his estrogen levels were slightly elevated for a man. Now, we sometimes will see this combination in signs of stress or exposure to environmental toxins. Jake's DNA fragmentation levels were high, which could increase the risk of early miscarriages or implantation failure altogether. Instead of rushing to IVF, I put Jake on a targeted three month fertility optimization plan. We utilized what we know about lifestyle adjustments and switched him to a whole food anti-inflammatory diet. I recommended that he cut back on his alcohol consumption, start to exercise moderately, and to reduce processed foods. We also talked about trying to get rid of plastic food containers and receipts, which can be a source of endocrine disruption, and we worked with him to increase his testosterone levels using supplementations as well as these lifestyle changes without shutting down sperm production because it's not just as easy as giving someone testosterone in order to help boost their levels if they're trying to get pregnant. After we rechecked his lab tests and the DNA fragmentation test, three months later, Jake's sperm quality had dramatically improved. In fact, even his motility was now in the normal range, and the DNA fragmentation test was back to completely normal. The best part was that Jake's overall health and energy levels were on their way to healing, and Emily got pregnant naturally within the next couple of cycles. Now, this is incredibly important to realize because Jake and Emily were on the verge of spending thousands of dollars on IVF because they had been told this was their only option. The reality is that the root cause of their infertility was correctable. By taking a restorative approach, we were able to help Jake and Emily avoid invasive treatments, hormone injections, and unnecessary interventions. And this is why testing and optimizing both partners fertility is so critical. Male factor is often overlooked. Yet it plays a huge role in enlarged number of cases. So if you and your partner have been struggling to conceive, make sure that both of you get evaluated. You may just be a few small changes away from success. So let's back this up a little bit and talk about why male fertility health matters. Now, obviously on our podcast, we typically are talking about female health, but when it comes to evaluation of fertility concerns, we absolutely have to take the male factor into account. As we look at public data, we know that sperm counts have dropped dramatically by over 50% in the last 40 years across the entire world. Now, there's not just one factor that plays a role with this, but there's multiple theories as to why we are seeing this decline in sperm health. One of those areas includes environmental toxins and endocrine disruptors. As I mentioned with my recommendations for Jake in our story, endocrine disruptors can be something as simple as a receipt. Now, those receipts that are shiny and have kind of the computerized ink on'em that actually contains BPA in many cases, and bisphenol A is known to be an endocrine disruptor, so it can adjust and change how your hormones act over time. Another big area to pay attention to is nutritional deficiencies and oxidative stress. When you are not getting the good nutrients that you need, it's harder for your body to convert the precursors into the hormones that they need to become. And then the third main category, which is probably the biggest category and sometimes the most challenging to impact, is looking at lifestyle factors. Many men deal with increased stress. Whether that's the stress of infertility or other health concerns, stressors at work or balancing home life, but stress can play a huge role when it comes to hormone formation. Other things that need to be addressed are excessive alcohol consumption, smoking or illicit drug use, as well as obesity. All of these things have a direct impact that has been well studied to decrease sperm counts. As I mentioned in the introduction, it is critical that we are testing both partners when trying to conceive. Even if a woman's cycle is healthy, poor sperm quality can lead to miscarriage and failure to conceive in the first place. Again, just doing that semen analysis test sometimes isn't enough, especially if you have had recurrent miscarriages. So what do we need to look for when we're evaluating overall male factor fertility? So the first and most common thing that most people have heard of is just a standard semen analysis, otherwise called a seminal fluid analysis. This looks at the count, so the total number of sperm that are seen as well as motility, which is how well the sperm are moving. Are they moving in the right direction or are they just spinning around in circles and morphology, which is the shape of the sperm itself. Standard semen analysis also evaluates for pH and inflammation, so looking for signs of infection. Interestingly enough, even though we report all of these parameters, some of them are less problematic than others. So for example, many people will get really hung up on what's the exact count, what's the exact motility morphology, and the reality is, is that you don't need to have perfect numbers in all of these areas. In fact, myself and colleagues of mine that work in the field of restorative reproductive medicine have sometimes seen people be able to conceive with a morphology of 0%. That means that by normal criteria, 0% of those sperm are seen to be quote unquote normal. Yet we can still see people that go on to conceive and have a normal birth and a normal healthy baby. So morphology I don't pay attention to as much, although we do definitely evaluate it. Now that standard semen analysis is a great place to start. However, there are often other pieces that are missed. So as we mentioned was the case with Jake. We look at labs and hormone testing. So we're checking for things like testosterone, estradiol, FS, H, as well as the other basic things that we're looking for in female factor fertility, things like thyroid dysfunction, blood sugar issues, cholesterol problems, and other things that can. Show us there may be something else underlying going on with his health. We also can look for DNA fragmentation testing. So again, a higher number of fragmentation means poor quality of the sperm. This can lead to increased chances with miscarriages as well as decreased implantation from the start. So you may be having fertilization that occurs, but implantation can't happen because of the poor quality of the sperm. And then the last section that we look at when it comes to male factor fertility is infections. So this could be infections that are going on in the bloodstream. It could be infections that are in your gut. It could be infections that are in the urine or in the semen itself. So it could be bacteria or viruses or yeast overgrowth. And all of these things can also play a role with male factor fertility, just the same as they can with female infertility. So as far as when do we test, you can test this at any time. Many couples that work with us choose to wait to do male factor testing if the female factor is obvious. So for example, maybe you're a female who comes in and you're having really irregular cycles, you're not identifying ovulation whatsoever. And so sometimes people will assume because they know that that's a little bit more obvious as far as an issue from the female perspective, they choose to hold off on the male factor. Other couples choose to work on it at the same time, as I mentioned, we oftentimes will see an overlap where there's both a female and a male factor up to 20 to 30% of the time. The interesting thing about male factor fertility concerns are that they're oftentimes asymptomatic, meaning you don't have any other symptoms or signs that are going to tell you that there's a problem other than doing the testing. In fact, many males can find that they are incredibly healthy, they're following a good lifestyle. They seem to think that they're doing everything just right, and we can still see problems. So this is why it's important to know that this is something that needs to be evaluated at some point in time, and we don't have to get everything back to perfect, but we definitely need to know what we're dealing with in order to understand where are the critical components in order to make forward progress. As I mentioned also with the lab testing, it's important to realize that you don't need to have completely perfect parameters in order to be able to conceive. In fact, many couples are sent straight to IVF instead of treating the root cause. Especially if they see male factor infertility. They either are assuming that there's no way to change those issues, and they are noting that there is not much that they can do and under order to understand what's going on from a root cause. Unfortunately, oftentimes couples aren't told the whole story if there is a severe male factor. IVF does have lower success rates, especially in quality of sperm because DNA fragmentation is oftentimes overlooked. On the flip side, restoring sperm health can lead to natural conception and improved health. So other than getting tested, what are some ways that you can help to improve male fertility health naturally? Now I do wanna start off with saying that any of these changes can take up to two to three months before we will see a complete change. So it's not enough just to clean up your diet or change your lifestyle for a couple of weeks. These changes do take some time in order to balance the hormone levels and help to improve natural sperm production. So for this reason, we typically say that we recommend making these changes. And then rechecking levels again after two to three months to make sure that we have corrected the underlying abnormalities and moved in the right direction. So first, let's talk about some lifestyle adjustments. Now, again, a lot of these are going to be fairly straightforward, but they're not always easy. So the first big category, absolutely no tobacco, no marijuana, no illicit drugs, and no vaping. All of these have been found directly to lower sperm counts. Another recommendation that makes me quite unpopular when I mention this to a lot of the males that we're working with in our practice is that I need you to limit alcohol to no more than five to six drinks per week, and that cannot all be in the same day. So excessive alcohol will also decrease sperm counts, even if that is just in a binging fashion. Some of the other ones that are more common, that most people have heard of include getting rid of your tight underwear. So switching to boxers instead of briefs, avoiding hot tubs, avoiding excessive biking or excessive heat, all of these things can impact directly the heat that you get around the scrotum, which can decrease sperm counts. Other things as far as general lifestyle are going to be very similar to what we pay attention to for female infertility. Making sure you're getting sleep seven to eight hours per night, and along with that, evaluating and treating sleep apnea if it exists. Men with sleep apnea have been shown to have significant decreases in sperm counts, as well as disruptions in their hormone levels and doubling or even tripling the risk long-term of cardiac heart disease and diabetes. So sleep apnea is not just about getting better sleep or improving your fatigue levels, but has a direct impact to your hormone health, your sperm health, as well as your overall health. When it comes to what you're eating, we aim to focus on avoiding highly processed foods and having a good mix of fruits, vegetables, moderate carbs, fiber and protein. Try to limit your caffeine intake to no more than one drink per day, and ideally trying to get some exercise in on a regular basis. What that means is aiming for regular exercise that makes you sweat at least 20 to 30 minutes daily. This is a great way to help boost your low testosterone levels naturally, and oftentimes helps with balancing out your weight because we want to aim for A BMI of less than 30 in most cases, as a way to optimize sperm health. And the last piece as far as lifestyle adjustments, which again is simple but not always easy, is to manage your stress. If your cortisol levels are high because you have increased stress, that will actually steal away some of the DHEA hormone in order to make up for that. When we don't have enough DHEA in our system, it will actually lead to decreased testosterone production. So managing stress overall will help to stabilize and boost testosterone when things are in a good range. Oftentimes we do need to intervene beyond just these lifestyle adjustments though, and what that can look like is really variable, depending upon the unique situation for each male. The first and most important is to stop any testosterone therapy or anabolic steroids. Giving a man testosterone, whether that is directly through injections or pellets or topical testosterone absolutely will block sperm production. We have seen cases within our practices that show by getting testosterone or maybe getting these anabolic steroids from the guys at the gym. We have seen cases where sperm counts come back and they are zero. So incredibly important to understand that you must avoid testosterone therapy as well as any anabolic steroids. We're also generally discussing supplementation or food sources of getting good omega threes, antioxidants, and other supplements that would be specific to your lab results. One of the biggest things that we see is a low testosterone level, and so there are ways that we can address this through supplements, through lifestyle changes that don't shut down sperm production, because as I mentioned, if you just take testosterone, you're gonna take your sperm production down to zero. We also wanna treat any underlying medical problems. So if we find that there is a thyroid dysfunction or if there's problems with blood sugar, or insulin resistance, or high cholesterol, improving all of these things not only helps to improve sperm count, but more importantly helps to improve your overall health. And then the last section would be we want to treat any type of anatomic problems that may be affecting sperm quality, so things like enlarged veins in the scrotum. These are called varicose seals. Sometimes treating a osee can help. Sometimes we find that there's actually a blockage, that sperm can't be able to be expelled from the body. And so correcting those issues can be beneficial. And then the last area would be treating any underlying infections. So again, if we're looking for and treating these infections, we oftentimes can see that sometimes the female partner will also need to be treated. But again, knowing and understanding what infections may be present helps us to treat both partners so that we're not dealing with the inflammation, the infection, and the possible antibodies that can develop when your body is trying to fight off those infections. If you or your partner have been struggling to conceive, don't overlook the male factor, and please don't settle with being told that IUI or IVF are your only options. Imagine if you could avoid IVF. While focusing on the treatment of the root cause of infertility, evaluating and treating male factor when present not only improves your chances of natural conception, but also can greatly improve your overall health and quality of life. If you're ready to work with our elite team of healthcare professionals, go to our website, radiant clinic.com to schedule a free discovery call with me and learn more about our package based pricing for comprehensive care. We are currently able to see people for in-person appointments in the Cedar Rapids, Iowa area, or can arrange for a telehealth visit if you live in many different states. We are continuing to expand our services, so check out our website to see where we can serve you medically. Thank you so much for listening to this episode. 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