What causes Teratozoospermia (Part 2)

The more I read up about Teratozoospermia (and not just Teratozoospermia, but male infertility in general), the more i am convinced that Oxidative Stress plays a huge role.

The building blocks behind healthy sperm are quite simple; maintain a healthy weight, exercise regularly (but not to excess), avoid stress and eat a healthy diet of protein, fruit and vegetables. This alone should give a man everything they need to create healthy sperm well into their 40's and 50's. Simple.

But for whatever reason, in some males, there appears to be something happening which impedes the healthy formation of sperm. For a healthy man to have 0% morphology at 33 years old is quite unusual, there must be something else at play, something which is constantly nuking the production process.... And almost every study out there seems to think its Oxidative stress.

There are a few things that (i think) I've come to understand over the last few months which could be impacting me;

1) Oxidative Stress on the testicles is something that can build up over time; The major culprits appear to be

• Alcohol 
• Poor diet
• Excessive heat (in fact i read in some cultures people use excessive heat to sterilise themselves!)

These things cause oxidative stress, which leads to poor sperm morphology.

But there's another source of Oxidative stress, and that's;

• Defective Sperm themselves - They essentially fall to pieces and in doing so, actually cause Oxidative Stress to the other healthy sperm.

So......

More Oxidative Stress means more Defective Sperm
More Defective Sperm leads to more Oxidative Stress

Its a vicious cycle which if left unchecked could totally trash the quality of your sperm.

This article provides a good overview of all things that can impact on sperm quality, it summarises;

"Spermatozoa are vulnerable to ROS (oxidative stress) because their plasma membrane and cytoplasm contain large amounts of polyunsaturated fatty acids.5 Excessive generation of ROS in semen by leukocytes as well as by abnormal spermatozoa could be a cause of infertility."

I think its possible my intake of antioxidants has been so low over the last few years that the build up of Oxidative Stress has pushed my sperm into this vicious cycle from which it cannot escape on its own..

2) Each cell in the body is under constant attack from Free radicals;

"Bruce Ames, a well-known scientist in the field of antioxidants, estimates that just one cell in the human body is hit about 10,000 times a day by a free radical. If that’s multiplied by the trillions of cells in the body the magnitude of this activity is tremendous."

10,000 times per day for each cell! That truly is huge, the one glass of orange juice a week i had on my old diet really wasn't enough to fight this barrage, so its no wonder my sperm production process has fallen into this vicious cycle. 

The 'cure' to all of this definitely appears to be a huge and ongoing dose of a variety of antioxidants, this should be enough to pull the sperm production process out of this funk and get things back on track. Time will tell, the next sperm test is only a few months away!

Selenium (AKA Brazil Nuts)

I'm now taking so many supplements that I'm starting to rattle, however the research continues and the latest discovery relates to Selenium. And it appears as though the jury is out.

When i received by sperm analysis results, the doctor suggested i should eat some brazil nuts and drink green tea, at the time i thanked him for his advice but in my head i was thinking 'no way that's going to make any difference'. Regardless, i started eating the brazil nuts, about a handful a day.

Brazil nuts are apparently extremely high in Selenium, which appears to be very important to the formation of sperm;

"..Selenium protects lipid shell encasing each sperm (prevents lipid peroxidation), which is especially important since sperm have a very delicate fatty acid composition."

Essentially it helps protect the sperm from free radicals.

According to the below supplement sheet, 6 large brazil nuts can contain a whole load of useful nutrients including Vitamin E, Zinc & Magnesium, but most importantly, they contain about 800% of the RDA for Selenium;

That's an extremely high dose of selenium for just 6 brazil nuts, so how many should i be eating exactly?

Well, it seems that nobody really knows for sure. Too little and there's no impact, too much and it can have a negative impact;

A study into a dose of just 0.2mg of Selenium combined with n-acetyl-cysteine (another antioxidant i haven't yet looked into) had a good result;

"after 26 weeks of Se supplementation the mean total sperm count, concentration, normal morphology percentage and motility increased from baseline relative to placebo treatment"

Good stuff, so how about a higher dose?

A study into a dose of 0.3mg Selenium alone had this to say;

"higher Se supplementation (300μg/ day orally) increased serum and seminal plasma Se concentrations but did not affect sperm Se, serum androgen concentrations or sperm parameters [22]. The lack of an increase in sperm Se suggests that testicular Se stores are unresponsive to dietary Se concentrations"

...No major impact. Ok so how about even higher?

This study tried a volume greater than 0.4mg and had this result;

"The fraction of motile sperm in the high-selenium group decreased by 32% by week 13 and ended 18% lower than baseline. Selenium concentrations changed in seminal plasma but not in sperm"

So it appears as though a high dose is a no-go. The studies show an increase in Selenium within the seminal plasma, but not the sperm itself... This suggests to me that the spermies just don't require that much selenium.

This summary sheet provides a good overview of the various Selenium studies out there, it essentially concludes that selenium is most effective at a low dose and combined with antioxidants, particularly vitamin E (which is also present in Brazil nuts).

So exactly how many brazil nuts should i be eating? This website suggests 6-8 brazil nuts can contain about 0.5mg of selenium. I need about half of that apparently, so from now on I'm going to eat just 3 brazil nuts a day for my selenium fix.

L-Carnitine

So it appears as though this one is a biggy.

There are a lot of studies out there into L-Carnitine and as far as i can see, all of them conclude the same thing, that L-Carnitine not only has antioxidant properties, but also plays a crucial (yet poorly understood) role in the formation of sperm (as far as i can tell, it appears to be primarily related to sperm motility / energy).

One study simply conducted a test into the levels of Carnitine found in the sperm of fertile & non fertile men, and they found a significantly higher amount of Carnitine in the fertile samples;

"The level of free L-carnitine in the seminal plasma of the fertile men was significantly higher than that of the infertile (P < 0.01). The lower the sperm concentration, the weaker the sperm vitality, the more significant the difference"

After searching for 'sources of carnitine', i found that its most commonly found in red meats like Beef and pork, neither of which i consume on a regular basis, so it follows that i might have low levels of Carnitine in my system which could be contributing to my poor sperm morphology.

One study had this result with 1500mg of L-Carnitine mixed with various antioxidants;

"Semen analysis data showed a significant increase in concentration, motility, vitality and morphology parameters"

But its this study which i found particularly interesting, it gave 156 people 1000mg of Carnitine a day for 3 months, and this was the result;

A significant uptick in all parameters, but its greatest impact was on morphology, so this one seems like a no brainer, its definitely something i need to add to the collection.

Vitamin C

Vitamin C (aka Ascorbic acid), i had no idea how important it was.

In my quest to understand the importance of Antioxidants in improving sperm morphology, I've stumbled across a few useful promising studies.

This study is particularly fascinating, 13 patients with low sperm counts (but normal morphology) were given a whopping 2000mg of vitamin C a day for 2 months, and this was the result;

A huge uptick across the board! Importantly for me though Morphology saw a huge increase, and it appears that the lower the starting morphology, the greater the improvement.

This study also suggested lower levels of vitamin C leads to higher rates of DNA damage within the sperm itself;

"When dietary AA was decreased from 250 to 5 mg/day, the seminal fluid AA decreased by half and the level of oxo8dG in sperm DNA increased 91%."

And this study further confirms that low levels of vitamin C appears to correlate with poor sperm morphology;

"Seminal AA in fertile and infertile (smokers or nonsmokers) males correlated significantly with the percentage of spermatozoa with normal morphology (p<0.01). Seminal AA decreased significantly in infertile men. Decrease of seminal plasma AA is a risk factor for low normal morphology of spermatozoa and idiopathic male infertility"

So I've immediately purchased some chewable vitamin C (500mg) tabs for my ever growing collection of supplements, I'm also going to add more citrus fruits to the diet... Aside from the odd glass of orange juice, this is something that admittedly has been almost totally absent for many, many years now.

CoQ10

I'm buying tome CoQ10.

While trawling the internet for more information on antioxidants, I found a useful summary which provided collection of studies on the effects of anti oxidants on sperm. Most interesting of this was this table, which provides an overview of all the studies, the anti-oxidants, and the results.

This study immediately caught my eye;

"RESULTS:

Mean sperm concentration, sperm progressive motility, and sperm with normal morphology improved significantly after 12-month CoQ(10) therapy by 113.7, 104.8, and 78.9%, respectively (all Ps < 0.05). The overall pregnancy rate was 34.1% within a mean of 8.4 ± 4.7 months.

CONCLUSIONS:

CoQ(10) supplementation improves semen quality with beneficial effect on pregnancy rate."

WOW! CoQ10 can improve sperm morphology by nearly 80%? 34% of participants had a spontaneous pregnancy during the study?! These are incredible figures!

This study was apparently a year long and involved 287 people taking 300mg of CoQ10 twice a day, so this isn't an overnight cure, but its a solid study and a promising start.

I've no idea if my poor sperm morphology is caused by oxidative stress or not, but even if its not, some CoQ10 apparently wont hurt my overall health, all of the CoQ10 studies appeared to have some sort of positive impact on sperm, with the higher doses having the greatest impact, so I'm heading over to Amazon now to do some shopping.

Lycopene (the tomato antioxidant)

I'm going to eat a lot more Tomatoes.

So, at the moment Antioxidants appears to be the way forward for improving Sperm morphology. And it turns out, there are loads of different types of Antioxidants.

In conducting my research I've come across another promising antioxidant called Lycopene. Lycopene is commonly found in tomatoes and other red vegetables. Something that my diet currently lacks.

There are a few promising articles about Lycopene and the effects on sperm (here, here, and here), the key headline appears to be 'New 'tomato pill' could SUPERCHARGE sperm by 70 per cent'

There is one old study here which suggests 4mg of Lycopene a day for 3 months had this result;

"Twenty patients (66%) showed an improvement in sperm concentration, sixteen (53%) had improved motility and fourteen (46%) showed improvement in sperm morphology."

There are clinical trials underway right now to prove whether 7mg can lead to further improvements, the supplement being tested has been developed by the university of Cambridge and can be found here.

While the previous studies appear promising, I'm reluctant to shell out cash for a somewhat unproven supplement, instead I've researched how many tomatoes I'll need to eat to get a daily dose of Lycopene.

This website suggests a simple tin of tomato soup will give me a whopping 13mg of Lycopene! so I'm going to adjust my diet accordingly to try and consume at least a tin of tomato soup a day.

UPDATE: This article reports on the effects a tin of tomato soup has on Lycopene levels in the testies (the antioxidant was detected but they didn't do any analysis into the impact on sperm).

What causes Teratozoospermia?

I've obviously been doing a lot of research into this recently, while I'm now convinced there appears to be a link between a lack of antioxidants and Teratozoospermia (see previous post), it doesn't explain everything away.

I know people who are a lot older than me, people who drink excessively, smoke, don't exercise and are generally unhealthy who have all managed to have kids.

It doesn't make sense, people have been having kids since the dawn of time without requiring huge amount of antioxidants, there must be more to it, so i did some more digging and here's what i found;

1. Nobody really knows what causes it

That's it!

Hodgkin's disease, coeliac disease, Crohn's disease, smoking, Varicocele, drugs, STD's, poor diet, pesticides, infections, excessive heat, diabetes, age, chemotherapy, excessive trauma, pollution, lifestyle.

All of these things could contribute to poor sperm morphology and lead to Teratozoospermia. But this is largely theoretical or based on limited evidence. And none of them truly impact me.

The only things i can think of which may apply to me could be Alcohol and genetics;

Alcohol; Yes, it appears as though Alcohol can really mess things up;

-  Alcohol can have profound deleterious effects at all levels of the male reproductive system.

- 'It causes impaired testosterone production, enormous testicular oxidative stress and testicular atrophy.'

ENORMOUS Oxidative stress! Time and time again it appears as a cause of poor sperm morphology, however I don't think i drink enough Alcohol to cause catastrophic damage to my sperm production, i probably only drink about 7 beers a week on average (but that's usually in one evening). That might cause some damage, but wouldn't be enough to render me totally infertile surely?

There's another study about the link between Oxidative Stress and Sperm which included some interesting figures about alcohol (see below) - people who had consumed alcohol in the last 3 months had a significantly lower sperm count, but they actually had slightly higher motility and concentration;

There are a lot more factors in play here which I'm breezing over, but essentially I'm just going to cut back on Alcohol. No more than 2 beers in any one evening should be fine, I'm not going to cut it out completely (that would be just too depressing!)

Genetics; A few websites touch upon this. They essentially suggest that the factory which produces the sperm is defective due to my genetics. Therefore the factory produces defective sperm with fragmented DNA. If this is the case then there is truly nothing that can be done for me, its simply the way I've been built, i cant change that any more than i can change the colour of my eyes... This study talks a little bit more about missing DNA sequences which could cause sperm to be defective, but it doesn't really mean much to me.

Perhaps my Dad has Teratozoospermia and its been passed on to me & amplified? Who knows (I'm hoping its not that).