Abstract
Introduction.
Idiopathic male infertility is a global problem with almost no definite medicinal treatment. Most patients have to go through intrauterine insemination or assisted reproductive technology for achieving fertility. Unfortunately, success rates are low in cases with very low sperm count. Therefore it seems that improvement in sperm quality can have beneficial effects on assisted reproductive technology outcome.
Case Report.
A 39-year-old man with history of infertility for 6 years was referred to the traditional medicine clinic with a recurrent unsuccessful intracytoplasmic sperm injection trial. His sperm analysis showed severe oligoasthenoteratozoospermia. After taking a traditional remedy he had a remarkable improvement in his sperm parameters, which led to the formation of 8 embryos in the following intracytoplasmic sperm injection cycle.
Conclusion.
Traditional medicine presents various food and remedy options for treating male infertility. It seems that combination therapy can be beneficial in obtaining better results in treatment of male idiopathic infertility.
Keywords: nutrition, idiopathic male infertility, traditional medicine
Infertility or decreased fertility is one of the important issues in medical sciences. Infertility is the absence of pregnancy after 1 year’s sexual intercourse without using contraception.1 One pair in every 6 couples encounters infertility during their life.2 According to World Health Organization reports, 80 million suffer from failure of pregnancy. About 15% of couples after 1 year are still infertile.3 Infertility in men is 7%, which is common.1 Idiopathic male infertility is a condition where abnormal semen parameters are obtained due to nonspecific causes. In the majority of cases, abnormal semen parameters lead to diagnosis of oligoasthenoteratospermia, and in others, it leads to isolated abnormalities of sperm concentration, motility, and morphology.
There are several causes for male infertility such as congenital disorders (testicular dysgenesis, cryptorchidism, etc), acquired disorders, genitourinary (obstruction, tumor and testicular torsion, genitourinary tract infections, increase scrotal temperature), endocrine disorders, genetic disorders, immunological factors, systemic diseases, and external factors (medications, toxins, radiation, etc).3,4
Up to 30% to 45% of infertile men have unexplained causes (idiopathic). Genetic and environmental factors may contribute to development of idiopathic male infertility. More than 1000 genes are involved in spermatogenesis, but just a few of them are known.3
Because of the lack of differentiable or correctable etiology, patients with idiopathic male infertility are often treated by varieties of empirical medications or assisted reproductive technologies. However, the meta-analysis of controlled trials on patients with idiopathic male infertility has revealed that, with a few exceptions, the majority of the trials failed to show the efficacy of treatments. Yet, due to the success obtained among small number of patients with idiopathic male infertility, efforts in medication therapy and technology-assisted management of idiopathic male infertility continue.1
According to World Health Organization classification, normal semen specification is:
Semen volume ≥1.5 mL
Total number of sperm per ejaculation ≥39 million
Sperm concentration per milliliter ≥20 million
Total movement ≥50%
Sperm morphology (normal forms) ≥30%5
Semen analysis may represent:
Oligozoospermia: That is, reduction of sperm count,
Asthenozoospermia: motility of sperm decreased,
Teratozoospermia: shape of sperm is abnormal.
The above disorders are usually associated with a syndrome known as oligo-astheno-teratozoospermia.3
Most cases of idiopathic infertility in men are diagnosed as oligo-astheno-teratozoospermia. Medical treatment of infertile men with unknown causes consists of selenium, zinc, folic acid, l-carnitine, glutamine, zaditen, and lycopene, which are recommended to increase sperm and their motility. These treatments have different results.3,6
Reactive oxygen species are known as an important factor in sperm dysfunction. Studies show that free radicals affect the quality and motility of sperm and the reduced seminal plasma antioxidant indicates reduction of sperm quality, So antioxidants such as vitamins (vitamins C, E, and B) and minerals (zinc, selenium, manganese, copper), arginine, carnitine, Q10, and so on are advised, which inhibit oxidation in cells.7
Natural sources of antioxidants:
Arginine is an amino acid protects cells against oxidation. Nutritional sources of arginine: almonds, pistachios, hazelnuts, walnuts, sunflower seeds, sesame, coconut, and so on.8
l-carnitine is a vitamin-like compound, which is composed of lysine and methionine. Studies showed it affects the count and shape of sperm, dairy and meats are good sources for carnitine.9
Q10 is a fat-soluble vitamin-like compound with antioxidant properties. Studies showed good effects on sperm motility. It is found in meat and nuts such as almonds, pistachios, and hazelnuts.10
Zinc: Studies show that zinc deficiency affects sperm count. Meats and seafood, peanuts, pistachios, hazelnuts and walnuts are good sources of zinc.11
Selenium: Selenium deficiency affects testosterone production as well as sperm generation. Because selenium has antioxidant properties, it affects sperm motility. Meats, liver, brain, sunflower seeds, and nuts are good sources of selenium.12,13
Vitamins: Studies showed that vitamin E is effective on motility and quality of sperm.
Vitamin B12 deficiency affects sperm count and motility. Vitamin C is effective on sperm count.
Sources for vitamin E: milk, butter, almonds, hazelnuts, pistachios, sesame seeds, eggs, cashew nut, wheat germ, and so on.
Sources for vitamin B12: meat, dairy and eggs.
Sources for vitamin C: fresh fruits and vegetables.13
Patients with unsatisfactory results and mild oligoastenoteratozoopermia are advised to use intrauterine insemination; severe cases are suggested to use assisted reproductive techniques, including in vitro fertilization and intracytoplasmic sperm injection.14
Low sperm count, decreased quality and motility reduce succession of assisted reproductive technology; in case of pregnancy, the risk of abortion is increased compared with general population.
With regard to above, an effective treatment method for clinicians and researchers has a great value.
Male infertility was an important subject of traditional Iranian physicians. They use herbal remedies such as “Loboob” confection, which is a combination of almonds (15%), pistachios (15%), hazelnuts (15%), coconut (15%), cashew nut (10%), sesame (15%), frankincense (5%), alyssum (5%), and gingers (5%), which is prepared in a powder form and mixed with honey. This confection is easily prepared and is available; patient should take it (5 g) twice daily in the morning and evening before going to sleep with a cup of warm milk for 3 months.15–18
Case Report
The patient is a 39-year-old man with a history of 6 years of infertility. The sonography did not show varicoceles. The patient’s wife is healthy. In his past medical history, mumps in childhood, smoking, alcohol, drugs, and surgery were negative. His spermogram reads as follows:
Semen volume: 1.5 mL
Sperm count: 50 000/mL
Sperm movement: 1%
Normal morphology: 1%
Other laboratory tests, such as prolactin, testosterone, follicle-stimulating hormone, leutinizing hormone, and thyroid-stimulating hormone were normal. According to laboratory findings, the patient’s diagnosis was oligoastenoteratozoospermia. He passed intracytoplasmic sperm injection cycle, treated with vitamins E and C, folic acid, l-carnitine and clomiphene for 12 weeks caused to increase his sperm count up to 700 000, motility up to 5% and 5% normal morphology and volume 2.5 mL, but despite sufficient number of wife’s follicles, live fetus was not formed.
Vitamins and drugs were discontinued for 6 months before start of therapy. The patient was put on traditional medicine, treated with “Loboob” compound for 12 weeks because spermatogenesis takes 75 days. About 5 g of “Loboob” was taken twice in the morning and evening. The patient had significant improvement in sperm parameters and intracytoplasmic sperm injection resulted 8 embryos with “A” grade. The patient had no complications during the treatment.
Semen analysis after treatment was as follows:
Semen volume: 2.5 mL
Sperm count: one million per milliliter
Sperm motility: 80%
Normal morphology: 95% (Table 1)
Table 1.
Comparison of the Results of Treatments.
| Semen Analysis | Volume (mL) | Sperm Count | Sperm Motility (%) | Normal Morphology (%) |
|---|---|---|---|---|
| Before treatment | 1.5 | 50 000 | 1 | 1 |
| After intake of antioxidants | 2.5 | 700 000 | 5 | 5 |
| After intake of Loboob | 2.5 | 1 000 000 | 80 | 95 |
Discussion and Conclusion
Use of Iranian traditional medicine and herbal remedies for treatment of diseases such as infertility has a historical background. Nutrition is the base of treatment in idiopathic infertility of man. While modern medicine treats such disorder by recommending of vitamins and antioxidants which is a nutritional approach.19
Nutrition is the principle of treatment in traditional medicine.20 According to Avicenna and Canon of Medicine, healthy semen is the consequence of a good performance of brain, heart, liver, testes and healthy stomach and kidney, so health and strength of brain, and so on, is effective on semen production. In case of semen diminution, remedies with rich nutritional properties are needed.15
We chose “Loboob” among the various materials recommended in traditional medical books because of its easy preparation and inexpensiveness.
This formula is an herbal remedy, because of almonds, hazelnuts, pistachios, sesame, cashew nut, coconut, frankincense, alyssum and gingers, which are mixed with honey and should be used with milk. This confection contains different antioxidant. Traditional medical opinion believes that this formula can strengthen organs such as brain, heart, liver, testes, and is effective in fertility.
Studies show the effect of these ingredients on spermatogenesis:
In one study, Khaneshi et al21 showed that sesame significantly improved diabetes complication in rat testis. This study suggested that sesame might have a protective effect against oxidative stress–induced impaired testicular functions in diabetic rats.21
Khaki et al22 concluded that combined ginger and cinnamon have significant beneficial effects on the sperm viability, motility, and serum total testosterone, leutenizing hormone, follicle-stimulating hormone, and serum antioxidant levels and could be effective for maintaining healthy sperm parameters and male reproductive function in diabetics.
Another study shows that reduction of sperm count, motility, and testosterone level due to alcohol consumption in a group of rat, considerably increased by coconut oil.23
One study shows the levels of sperm count, sperm live percent, sperm motile percent, and sperm healthy morphology percent were not decreased in almond oil–treated diabetic group of rats versus regular diet.24
Hazelnut is the second richest source of monounsaturated fatty acids among nuts and is rich in vitamins E and B6, phytosterols, folate, l-arginine, polyphenols, and fiber. One study shows its good effect on sex hormones in diabetic rats.25
Ingestion of frankincense resin in adult male rat cause significantly increases spermatogenesis, sperm motility, and sperm density.26
According to the results obtained for our case, using nutrients with high antioxidants and potent materials is better than supplement therapy. The outcome of this treatment reveals such remedy lead to a very good consequence for infertile patients. It might be that an extended duration of treatment can lead to better results and also having the semen analysis repeated during the treatment can yield evidence of its effects.
In spite of the major improvement in male infertility treatment, there is still a need for more effective and less expensive drugs for the treatment of this highly prevalent reproductive health problem. Traditional Iranian medicine presents various food and remedy options for treating male and female infertility, which have been proven over several centuries. These treatments are administered, available, and effective, while offering fewer complications. It seems that combination of medical and herbal therapy can be beneficial in obtaining better result in treatment of male infertility; however, more clinical trials are mandatory.
Footnotes
Authors’ Note: This research was derived from an ongoing PhD thesis at the School of Traditional Medicine, Mashhad University of Medical Sciences.
Author Contributions: SM, is a PhD student of Iranian traditional medicine and this article is a part of his PhD theses. FS is his professor. SB suggested the idea of this study. SMN and FHD is his consultant.
Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding: The authors received no financial support for the research, authorship, and/or publication of this article.
Ethical Approval: The study was approved by the relevant local research ethics committees, Tehran University of Medical Sciences; reference number: IR.TUMS.REC.1394.847.
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