MALE FERTILITY PROFILE

Male-specific diagnostics now play a key role in the care of infertile couples

The management and treatment of male infertility has undergone a reformation with the spectacular success of IVF.  In addition, the well documented increased delay in childbearing by reproductive age women has led to re-evaluation of the overall effectiveness of male infertility treatments, as it introduces a newfound urgency into the reproductive equation. Male-specific diagnostics now play a key role in the care of infertile couples.


Infection


Infections involving Chlamydia trachomatis, Mycoplasma genitalium and hominis, Ureaplasma uealyticum, E-Colii, Gonorrhoea, Syphillis, Mycobacterium tuberculosis, herpes simplex virus I and II, and Trichomonas vaginalis have been shown to reduce sperm motility and also sperm function. The treatment of infection is will continue to be recommended.


Lifestyle


The best-studied fertility supplements are the antioxidants, notably Vitamins E and C, acetylcysteine and glutathione. In small studies, Vitamin E (tocopherol) has been shown to improve sperm function and IVF success rates. Ascorbic acid (vitamin C) has been reported to protect sperm DNA from the damage induced by exogenous oxidative stress in vitro. Other studies have also shown that higher levels of sperm DNA fragmentation, a marker of oxidative stress and possibly reduced fertility, are associated with lower levels of seminal ascorbic acid.

Combination therapy with essential fatty acids has been shown to improve sperm concentration in men with low sperm counts and significantly reduce reactive oxygen species (ROS). Sperm membranes play an important role in fertilization capacity as they harbour a higher concentration of polyunsatured fatty acids (PUFA) than other human cells. Sperm with the highest concentration of PUFA are thought to have the most normal morphology. The most protective antiperoxidative mechanism protecting PUFA uses thiol- or glutathione-dependent enzymes. For these reasons, ROS scavengers, such as Glutathione, are thought to maintain cell membrane stability.


Folate also plays a role in RNA and DNA synthesis during spermatogenesis and has antioxidant properties. Newer studies suggest that there may be benefit, especially for tobacco users. Most recently, when combined with zinc, folate supplementation was shown to increase sperm concentration in infertile men in a blinded, randomized, controlled trial.

Zinc plays an important role in testicular development, spermatogenesis and sperm motility. In fact, the zinc level in male genital organs is considerably higher than that in other tissues. It is predominantly secreted by the prostate and is also found in maturing spermatozoa. Among infertile men, studies have shown significant increases in testosterone levels after 40-50 days administration of zinc. Zinc deficiency has also been linked to oligospermia (very low sperm counts). Studies have shown resolution of oligospermia after a 24-40 week period of zinc supplementation.


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