Male Factor Infertility

Male infertility is a common problem in which a man has a poor quality or quantity of sperm, which makes it difficult for him to father a child. In Chinese medicine, the health of the sperm is closely linked to the health of the kidneys, and several factors must be in place for a man to be able to father a child. These include sufficient production of sperm, healthy and motile sperm, and functional reproductive passageways. In vitro fertilization and intracytoplasmic sperm injection have made it possible for some men with infertility to father children, but the quality of the essence that goes into making a baby is still considered important in Chinese medicine.

Pathology

Sperm and the matrix of fluids and nutrients that support it can be damaged by a variety of factors, the most important of which are Kidney deficiency and heat. Acquired or congenital weakness of the Kidneys can lead to poor or abnormal sperm production. Heat, in the form of damp-heat, heat from yin deficiency, fire from qi constraint, high fever from an external pathogen, or environmental sources (such as saunas or tight pants) can also have a significant impact on seminal quality and quantity. Sperm function best in a slightly cool environment, and heat can congeal and thicken seminal fluids.

Causes

External Pathogens

Damp-heat can enter the lower burner through local channels and collaterals, or through the diet. When damp-heat is transmitted directly to the lower burner through sexual activity, its symptoms are largely contained within that region. When damp-heat sinks into the lower burner from the middle burner, symptoms of middle burner disharmony and weight problems may also be present. Regardless of its source, damp-heat is a common cause of sperm disorders and infertility. It can damage essence and sperm, leading to poor sperm morphology and congealed semen and seminal fluid.

Emotional Factors

Persistent internalized or repressed emotions and stress can constrain the circulation of Liver qi, obstructing the movement of qi in the lower burner. This constraint can generate heat or fire, which can damage essence, blood, and yin, leading to weakness in the sinews and the penis, and contributing to erectile dysfunction. The combination of heat and essence damage can also lead to poor sperm quality and production.

When qi is obstructed, it can fail to lead blood, leading to qi and blood stasis, and further heat accumulation. Constrained Liver qi can also weaken the Spleen, causing qi deficiency and leakage of blood from the vessels, or leading to the development of dampness that sinks into the lower burner, potentially generating heat and creating a damp-heat cycle.

Diet, Medications, and Drugs

Excessive consumption of rich, greasy, sweet, or spicy foods and alcohol can cause middle burner disharmony and the generation of damp-heat, which can sink and settle in the lower burner. Alternatively, excessive consumption of cold-natured or raw foods can weaken Spleen qi and yang, leading to dampness that can stagnate and generate heat and damp-heat. Persistent damp-heat in the lower burner can damage essence and yin, and congeal fluids, while prolonged Spleen deficiency can drain Kidney yang. A variety of pharmaceutical and recreational substances can also have a negative impact on sperm.

Constitutional Factors

Congenital weakness of Kidney essence can lead to poor sperm production. This may manifest as symptoms such as undescended testicles, delayed onset of puberty, and abnormalities in physical and mental development.

Exhaustion, Overwork, Age

As men age, the volume and quality of their essence (or reproductive fluids) can decline. This can affect the quality of their sperm and the potential quantity of essence that their children may inherit. Acquired Kidney deficiency, which can be caused by factors such as prolonged physical labor, excessive sexual activity, chronic illness, drug use, or lack of sleep, can also have a similar effect and may manifest at an earlier age.

Environmental Factors

Environmental factors can have a negative impact on sperm quality. Heat is a major contributor to this problem and can be caused by several factors, including wearing constrictive underwear, frequent exposure to hot environments such as saunas and hot tubs, long periods of motorcycle or bike riding, and the use of laptop computers. Chemical exposure can also negatively affect sperm quality. 

Treatment

Treatment to improve sperm quality should be continued for at least three months, or longer in people with significant Kidney deficiency. Both acupuncture and herbs can be effective in aiding sperm production, although herbs are particularly useful in cases of deficiency. In addition to these treatments, it is important to make changes to diet and lifestyle, and to avoid factors that can damage sperm production. There are also specific supplements, such as antioxidants, that can complement a Chinese medicine program and enhance its effectiveness.

It is common for healthy young men without discernible pathology to present with subfertility or oligospermia, which is the failure to impregnate with sperm test results that are at the low end of the normal range. In these cases, a hypothesis of Kidney deficiency is often reasonable, and treatment based on this hypothesis should have a positive impact on seminal parameters within three months. If this is not the case, blood stasis may be involved.