Khivan Oberoi, ND
Exploring the medical complexities of male infertility and the affect of life-style, environmental, and naturopathic interventions on reproductive outcomes — with real-world case examples that display how integrative care can optimize fertility earlier than superior reproductive applied sciences are required.
Summary
This text by Khivan Oberoi, ND examines the multifactorial nature of male issue infertility, highlighting often-overlooked contributors corresponding to oxidative stress, DNA fragmentation, and life-style components. Via two detailed case research, Dr. Oberoi illustrates how naturopathic interventions — together with dietary optimization, antioxidant assist, and substance cessation — can considerably enhance sperm parameters and cut back the necessity for invasive reproductive procedures.
Male issue infertility is a major contributor to reproductive challenges, accounting for almost 40% of all infertility circumstances, both as a sole issue or together with feminine components [1]. As developments in diagnostic and therapeutic approaches proceed to evolve, understanding the nuances of male reproductive well being has develop into important for medical professionals managing {couples} going through infertility. The pathophysiology of widespread male issue infertility diagnoses encompasses a broad spectrum, together with endocrine disruptions, genetic abnormalities, and anatomical abnormalities every impacting spermatogenesis, sperm high quality, and general reproductive outcomes.
In medical observe, the complexity of male infertility is usually underappreciated, with standard evaluations steadily overlooking delicate however impactful components corresponding to oxidative stress, DNA fragmentation, and immunological responses. For common observe and first care suppliers, the reflexive response to any male issue infertility issues is to refer instantly to urology and whereas that may be a invaluable referral, a lot may be provided to those sufferers as they wait to be seen by specialists.
The intention of this text is to share a case collection of difficult male issue fertility conditions and share Naturopathic concerns with the aim of sufferers trying to develop their households and conceiving organic kids with minimal use of Superior Reproductive Know-how.
Case 1:
A 36 yo AFAB (assigned feminine at delivery) and 37 yo AMAB (assigned male at delivery) presenting after In Vitro Fertilization cycle that resulted in 26 eggs, 13 of which fertilized and 5 embryos that developed to Day 5 blastocyst. All blastocysts had been despatched for preimplantation genetic testing and one embryo was decided to be genetically suitable with life. A frozen embryo switch of that genetically wholesome embryo failed and the couple was evaluating the following steps that may assist enhance future fertility outcomes.
Whereas the feminine presenting companion had a analysis of Polycystic Ovarian Syndrome, on condition that each companions had regular genetic karyotype screenings, male issue infertility and abnormalities of the sperm grew to become my predominant concern given the dramatic attrition from the variety of fertilized eggs to the ultimate, single, genetically wholesome embryo.
Upon dialogue, I got here to be taught that the male companion’s preliminary semen evaluation on the reproductive endocrinology facility had been irregular with a sperm rely of progressive motile sperm to be <0.2ml. The supplier there decided that continuing with the egg retrieval through TESE (Testicular Sperm Extraction) could be achieved the day of retrieval except the sperm rely had improved sufficiently, after the feminine companion had accomplished roughly 10 days of injectable hormonal stimulation. Through the time between the preliminary and repeat semen evaluation, each sufferers adjusted their weight-reduction plan and the male affected person reportedly misplaced 20 lbs. The sufferers reported the semen evaluation on the day of egg retrieval was sufficiently improved so TESE was not required, and so they proceeded with the egg retrieval and accomplished fertilization with that pattern.
After the failed switch, the male affected person was referred to urology for testing. The testicular ultrasound discovered bilateral dilated seminal vesicles however a observe up pelvic MRI was primarily regular indicating doable gentle BPH, all hormonal testing was WNL Estradiol 22.9, Complete Testosterone 309, FSH 6.4, LH 3.7. The affected person was then discharged from urology care.
In my go to with the male affected person, he shared his historical past of alcohol, marijuana use for a few years and more moderen cocaine use within the yr previous to beginning IVF. Through the time between the primary and second semen analyses, he reported that he had stopped utilizing cocaine however was and has continued to drink 3-4x/week, having 5-6 beers or 2-3 cocktails every week and smokes marijuana nightly. In reviewing information from urology and reproductive endocrinology, I noticed no documentation of substance use. The affected person additionally traveled steadily for work and his weight-reduction plan consisted of primarily quick meals with uncommon consumption of fruit and veggies, and occasional, Gatorade and weight-reduction plan soda as his major drinks.
Given his in depth bodily examination and imaging and customarily regular hormonal analysis, I decided the abnormalities in his semen analyses had been seemingly attributable to substance use and dietary insufficiency of antioxidants, nutritional vitamins, and minerals. We had a protracted dialogue in regards to the prospects of him altering these life-style habits, ideally having no alcohol or marijuana for at minimal 3 months previous to pursuing conception to permit for gamete growth after which doing a repeat semen evaluation to evaluate the affect of such adjustments. The affected person reported he was keen and capable of make such adjustments.
The affected person’s repeat semen evaluation was unsuccessful attributable to spillage, however the microscopy feedback included “71 immotile sperm noticed in microcell, 1 speedy, 2 gradual and 9 non-progressive”. Whereas incomplete, this pattern seemingly displays persistent abnormalities within the genetic well being of the creating gametes. The affected person didn’t reply to requests to schedule observe up testing and visits so I can not make direct conclusions relating to any adjustments he did or didn’t make in his life-style behaviors.
My predominant takeaway from this case was the profound unfavourable affect that environmental components can have on gamete growth, even within the absence of genetic, anatomical, or physiological points. Advising {couples} who’re planning to conceive to keep away from substance use goes past merely ‘optimizing fertility.’ It performs an important position in stopping miscarriage, lowering IVF failures, and averting vital emotional trauma.
Case 2:
35 yo AMAB and 27 yo AFAB presenting after two failed Intrauterine Insemination (IUI) trials to debate optimizing baseline well being to enhance future trials of IUI. This couple required the usage of assisted reproductive expertise to conceive a organic little one due the male companion’s historical past of a spinal twine harm that prevented erectile and ejaculatory operate. They’d labored with a fertility clinic that really helpful the usage of penile vibratory stimulation (PVS) and/or electroejaculation (EEJ) to amass semen samples that may then be used for IUI.
Happily, the male companion’s semen evaluation was inside regular limits. It’s common amongst males with spinal twine accidents for sperm counts to be regular whereas sperm motility and viability are sometimes irregular [2]. Nonetheless, given the dearth of success with prior IUIs, the couple was contemplating whether or not to pursue one other spherical of PVS/EEJ, or proceed with a surgical method for sperm extraction. Each Microsurgical Epididymis Sperm Aspiration (MESA) and Testicular Sperm Extraction (TESE) are used as different choices for accessing sperm both from the epididymis or the testicles straight [2,3]. Each are minor surgical methods achieved with native anesthesia and can be utilized in a wide range of male infertility circumstances, normally together with ICSI (intracytoplasmic sperm injection) the place very small numbers of sperm can be utilized for profitable fertilization. Given the affected person had a traditional semen evaluation, his fertility workforce theorized they’d be capable of entry a enough semen pattern for IUI.
This couple had been optimistic of their probabilities for conceiving through IUI and now discovered themselves contemplating extra invasive procedures and doubtlessly even continuing to IVF, indicating fertility remedy for the feminine companion. This was a difficult scenario each morally and financially for this couple.
After their preliminary go to and reviewing the earlier semen pattern, I advised three months of fertility optimization for each companions, particularly given the feminine companion’s lately recognized subclinical hypothyroidism. I really helpful dietary modifications to extend micronutrient dense meals consumption, eliminating alcohol use and including zinc, L-carnitine and CoQ 10 as dietary supplements for the male companion.
In evaluating the semen evaluation from the preliminary IUI to the semen evaluation 3 months later, we noticed enhancements in a wide range of parameters: Complete sperm rely elevated from 16.1 million to 54.5 million, post-wash sperm counts elevated from 33 million to 119 million and motility elevated from 7% to 19.1%. Given these outcomes and the fact of getting enough samples to permit for a number of IUIs (and the normalization of the feminine companion’s TSH degree with treatment), they opted to proceed with 2-3 extra rounds of IUI earlier than reconsidering continuing with additional assisted reproductive expertise intervention.
Conclusion
In conclusion, addressing male issue infertility requires a complete and individualized strategy that considers life-style, environmental components, and medical interventions. As demonstrated in these circumstances, the position of life-style adjustments—corresponding to lowering or eliminating substance use and enhancing dietary habits—may be essential in bettering sperm high quality and general reproductive outcomes. These changes not solely present quick assist to sufferers navigating infertility but in addition contribute to long-term enhancements of general well being. For a lot of sufferers, even delicate adjustments can have vital impacts on gamete high quality, thus rising the probabilities of attaining conception with minimal reliance on invasive reproductive applied sciences.
The circumstances additionally spotlight the necessity for a collaborative strategy that features each standard and integrative views. By emphasizing life-style optimization and dealing intently with every affected person’s distinctive wants, practitioners can create a pathway towards attaining conception that’s much less reliant on superior reproductive interventions and extra targeted on sustainable well being practices that assist each companions.
Khivan Oberoi, ND, knew from childhood that she needed to observe naturopathic drugs, empowering folks to care for his or her our bodies and heal as naturally as doable. Her personal eight yr fertility journey, culminating within the delivery of her daughter with the assist of a devoted care workforce, deepened her dedication to complete individual, household centered care. Dr. Oberoi’s goal is to make sure sufferers really feel heard, revered, and supported as they navigate their very own paths to rising their households. A longtime Oregon resident, she balances her medical work with a love of journey and time outside, and may simply as typically be discovered mountain climbing Pacific Northwest trails as studying e-book on a wet afternoon.
References:
- Leslie SW, Quickly-Sutton TL, Khan MAB. Male Infertility. [Updated 2024 Feb 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Accessible from: https://www.ncbi.nlm.nih.gov/books/NBK562258/
- Patki, Prasad, et al. “Results of Spinal Twine Damage on Semen Parameters.” The Journal of Spinal Twine Medication, vol. 31, no. 1, 2008, p. 27. pmc.ncbi.nlm.nih.gov, https://doi.org/10.1080/10790268.2008.11753977.
- Anderson, Ross, et al. “Spinal Twine Damage and Male Infertility—a Overview of Present Literature, Data Gaps, and Future Analysis.” Translational Andrology and Urology, vol. 7, no. Suppl 3, July 2018, p. S373. pmc.ncbi.nlm.nih.gov, https://doi.org/10.21037/tau.2018.04.12.
- Buhling, Kai, et al. “Affect of Oral Vitamin and Mineral Supplementation on Male Infertility: A Meta-Evaluation and Systematic Overview.” Reproductive Biomedicine On-line, vol. 39, no. 2, Aug. 2019, pp. 269–79. PubMed, https://doi.org/10.1016/j.rbmo.2019.03.099.