Male Infertility - Acupuncture as Treatment
by: Kendra Smith Hons B.Kin, CD, ND
Stone Tree Clinic
115 Hurontario St, Suite 200
Male fertility is measured by sperm quality and count. A man is considered at risk for infertility if his sperm count is less than 20 million per millilitre, and may be sterile if the sperm count is less than 500,000 per millilitre. Semen analysis is commonly done by light microscope and scanning electron microscope. Female infertility has become a medical hot topic, but what about men; the other half of the equation? One statistical analysis from the United Kingdom stated that 35% of men are subfertile; in other statistics, male infertility can account for up to 20–50% of infertility. So the exact prevalence of male infertility ranges greatly, but the take-home message is that it is a significant percentage and probably greater than most people would assume. This paper focuses on male infertility and acupuncture; the safety, efficacy, appropriate points, frequency, and duration required. Does acupuncture treatment improve sperm count and motility, and therefore improve fertility in men?
There are pretesticular and testicular risk factors for male infertility. Some common risk factors for male infertility are smoking, alcohol abuse, STIs, DDT pesticides, traumatic injury to the testicles, and anabolic steroids. The incidence of infertility is on the rise, and therefore so will demand for effective complementary treatments. This paper will investigate natural treatment options for men in the form of traditional Chinese medicine acupuncture protocol. Acupuncture stimulates the energy meridians of the body to increase the flow of energy or Qi and remove stagnation or energy blockages. The current medical literature on this topic includes mostly prospective studies and reviews. This is due to many factors including the fact that pseudoacupuncture is difficult to perform, and acupuncture on indifferent points could still benefit the patient by increasing the flow of Qi, so having a control group becomes difficult.
Acupuncture and Sperm Quality
In a prospective, controlled, and blind study, 19 patients were randomized into two groups, the acupuncture-study group or the control group (which received indifferent acupuncture points), for ten weeks. Semen analysis took place before and after the treatment course. The conclusion was that the acupuncture and moxa significantly increased the percentage of normal-form sperm in infertile patients with oligoastenoteratozoospermia without apparent cause. These are encouraging results, but there are some weaknesses to the study: 19 patients is a small group size and may not be large enough to generalize results to all men. Also, the use of indifferent points in the control group may be indirectly affecting the patients in ways unknown by stimulating the flow of Qi. This study found significant increases in normal-form sperm, therefore focusing on the parameter of sperm quality and not sperm count. This small study did have some weaknesses, but overall is a step in a positive direction for increasing fertility in men using acupuncture.
Acupuncture and Sperm Count
In 2000, another study was carried out, examining acupuncture treatment on sperm density. The last study we looked at was focused on sperm quality; this study looked at sperm count. The study group consisted of 20 patients with histories of azoospermia, and their semen samples were examined by light microscope and scanning electron microscope before and one month after acupuncture treatment. The control group consisted of 20 untreated males, who also underwent two semen examinations and who had similar andrological profiles to the men in the study group. Of the azoospermic patients, 67% demonstrated a definite increase in sperm count. Seven of the 15 azoospermic patients increased significantly, from 0 to 1.5 ±2.4 × 106 spermatozoa per ejaculate; their posttreatment spermatozoa was even detected by the light microscopy. Males in the study group with genital tract inflammation showed the most significant improvement in sperm density. The conclusion states that acupuncture may be a useful treatment
for males with very poor sperm density, especially men with histories of genital-tract inflammation. Again, another study moving in a positive direction for acupuncture treatment for male infertility, but there were some weaknesses to the study. Again, the number of participants is relatively low and may not be applicable to the general public. It could also be criticized that the control group was not undergoing similar placebo treatment to the acupuncture group, therefore one could argue that other aspects of the acupuncture treatment could have been responsible for the results, such as the healing touch of the therapy, or simply the placebo effect. The strengths of the study were the consistent and effective methods of measurement for sperm density and exact numerical values of the results. The fact that certain groups experienced significant increases in sperm density is very exciting for the future of this treatment!
The most recent study we’ll look at was the first prospective, randomized, single-blind, placebo-controlled study, and looked at 28 infertile patients with severe oligoasthenozoospermia for the acupuncture study group and 29 infertile patients for placebo acupuncture. A significantly higher percentage of motile sperm was observed in the acupuncture group, but no effect on sperm concentration or density. This study has many strengths; for example the fact that it is randomized, single-blind, and placebo-controlled put it higher on the evidence-based-medicine hierarchy of studies. There is some contrast between the results of these two studies: the latter saw increase in sperm motility, but not sperm count. A certain amount of contrast is to be expected when comparing large bodies of literature, and I don’t think it is significant in the overall conclusion of whether acupuncture is effective in treating male infertility.
Acupuncture Points Used
From the studies we have examined so far, we are finding that both sperm count and sperm quality can be improved with acupuncture treatment. A prospective controlled study from Israel included 16 acupuncture-treated subfertile patients (acupuncture treatment received twice a week for five weeks) and 16 control untreated subfertile males. Methods of measurement were expanded semen analysis, routine, and ultramorphological observations. Semen samples were analyzed before and one month after treatment. Results showed intactness of the axonema and sperm motility were greatly improved and thus, the fertility index increased significantly. Men with low fertility due to reduced sperm activity may benefit from acupuncture treatment. Another prospective controlled study was done that found general improvement of sperm quality, specifically in the ultrastructural integrity of spermatozoa. In this study, 28 of the 40 men with idiopathic infertility received acupuncture twice a week for five weeks. The following acupuncture points were used as main points: Guan yuan (Ren 4), shen shu (UB 23, bilateral), ci liao (UB 32, bilateral), tai cong (Liv 3, bilateral), and tai xi (KI 3, bilateral). Secondary points included zhu san li (ST 36, bilateral), xue
hai (SP 10, bilateral), san yin jiao (SP 6, bilateral), gui lai (ST 29, bilateral), and bai hui (Du 20). Statistical evaluation of the transmission electron microscopy data illustrated a statistically significant increase after acupuncture in the percentage and number of sperm without ultrastructural defects in the total ejaculates.
This analysis of research and synthesis of information offers hope and encouragement in the research and medical field of male fertility and acupuncture. I hope in the future we discover even more effective ways to measure and study the efficacy of acupuncture treatment. Acupuncture treatment as an option for subfertile men is safe and effective; none of the studies stated significant negative side effects or safety concerns. The average frequency and duration of acupuncture treatment ranged from once to twice per week, for five to ten weeks in duration. The needles were left in the patients on average for 20–35 minutes per session. The specific acupuncture points used in treatments varied in different studies; this is a weakness in the consistency of treatment. The majority of the studies this paper looked at were prospective controlled studies: they are not as high as randomized control trials on the evidence-based-medicine hierarchy of studies; therefore, they cannot be seen as entirely conclusive, yet they are still effective in consistently illustrating positive similar findings. Each study supports preclinical evidence and contributes new information to this field of research. Throughout all the studies mentioned above, the patients recruited were from different countries and there were no restrictions of ethnic group, so this makes the results more generalizable. All participants in the study and control groups had similar subfertile levels measured for; this maintained standardization.
Infertility is viewed largely as a female issue in our society, and hopefully this paper demonstrates the importance of including men in fertility discussions and treatment plans. Acupuncture seems to be more effective in improving sperm motility than sperm count, but positive effects on both were demonstrated in the studies examined in this paper.