In this webinar, Birol Aydin, Clinical Embryologist, Head of the Embryology Lab at IVMED has been talking about sperm quality and how it changes over time. He also talked about how to improve sperm quality and how it can be managed when preparing for IVF treatment.
A healthy male can produce about 400 million sperm every day, it depends on the organism, social life, and habits, and this number can change. If the male will produce more sperm, this will increase the chance of fertilization. The purpose of sperm is to provide protection and transport of the genetic material DNA from the male to the female egg for fertilization. It takes 64 to 74 days for sperm to develop in the testes.
There are 3 critical hormones that are involved in the process. LH, FSH, and testosterone. LH is stimulating most of the Leydig cells (the primary source of testosterone or androgens in males) and is producing testosterone, which controls the regulation of FSH and LH. When the sperm count is high, it means a restricted FSH is released, and when the sperm count is low, it allows the FSH release to continue. FSH stimulates sperm production in seminiferous tubules (coiled tubes, the walls of which contain cells that produce sperm). It helps to mature the Sertoli cells (somatic cells of the testis that are essential for testis formation and spermatogenesis). Testosterone production increases FSH and LH release.
Hormonal assessment should be:
When spermatozoa consist of the head which contains acrosome enzyme, which helps to penetrate the egg cell. Then, there is a midpiece that contains mitochondria which is producing ATP energy for swimming and moving and a tail, which contains a flagellum which is uh important for movement. A normal sperm needs to have an oval head, 2,5 to 3.5 micrometres of head diameter and 4 to 5.5 micrometres of length.
Looking at the male infertility classification, there are 3 causes, pre-testicular causes, testicular causes and post-testicular causes. Male infertility disorder is mostly coming from the varicocele, it’s up to 35%, and another 25% are idiopathic causes, there can also be obstruction, testicular failure and semen disorders.
There can also be lifestyle risk factors for male infertility. There are personal factors such as reproductive age, obesity, excessive exercise, psychological stress and diet. Toxins, radiation, electromagnetic effects, temperature, alcohol, smoking, marijuana, cocaine, and steroids will also affect male infertility. Advancing male age can also decrease sperm volume, motility and morphology, increases aneuploidy, and higher sperm DNA fragmentation, it can also lead to a lower pregnancy rate and higher miscarriage rate.
What effect do alcohol and smoking have on sperm quality? Sperm concentration can drop dramatically depending on whether being a heavy smoker or a regular smoker, but it can also impact sperm morphology. Alcohol has an even worse effect on sperm morphology, motility and especially total sperm count directly.
Concerning diet, it has also an important role in infertility, before starting any treatment, doctors often ask to try to regulate male hormones with a diet.- Questions and Answers
DNA fragmentation can’t be solved with vitamins. Antioxidants are working well for DNA fragmentation, but still, if you have high DNA fragmentation and if you are not planning to do IVF, of course, you need to have a diet and take antioxidants for a longer period. I am not a urologist to give you a whole program for that, but if you are going with IVF, the solution is in the lab to use some advanced technologies and to avoid sperm DNA fragmentation and increase your chances.
This kind of treatment will improve the chances, but 77% is high DNA damage, especially for IVF. As I showed on my slides, there are two things you have to do. First, you have to use the SpermChip technologies. Second, when you try to give a sperm sample the first time, it will have more DNA fragmentation than the second time.
My recommendation would be to use a SpermChip to avoid centrifugation because that can increase sperm DNA damage. Try to leave a second sample which they will use for fertilization. When your partner will give a sample wait one hour, two hours and give a second sample and use that second sample, it will be much more beneficial. Three months of such preparation actually can make a difference. However, as I said, DNA damage is not like concentration or morphology, so it’s difficult to change DNA damage, but the advanced lab technologies will increase the chances for sure.
Maca is indeed a good way to try to increase the quality of sperm, but it is not something that can solve everything. When you take Maca, you should take care of your lifestyle, if you are drinking alcohol or smoke, you should avoid it, follow a diet, exercise, in this case, Maca can be helpful.
I believe from all antioxidants and different vitamins, Maca is much more effective than others. I cannot say there is some publication or research on Maca saying that it has a better effect than others. Still, it can help to increase the quality of sperm.
When we do a testicular surgery, we are just going to the production centre of sperm, so we just take it, especially with a micro testicular surgery, we just take tubules, and inside of tubules, we find like a first production of the sperm. The first production of sperm is not passing through channels, has a lower DNA fragmentation.
This is a kind of strategy, of course, especially if a male has a low count of sperm, low concentration, low volume, yet testicular surgery can be effective, but before that, at least you should have a two IVF trial with a regular sperm if there is a no result still if there is a fertilization failure or embryo development problem then testicular surgery should be an advantage to avoid the DNA fragmentation.
When there is advanced reproductive age, the sperm quality and concentration will decrease, but I’ve seen men over 60 who was normozoospermic, others had a low count, but with a good lifestyle, they can increase it. The patient should have a healthy lifestyle, shouldn’t smoking, avoid taking any medication, but after 60 years old using a kind of antioxidant therapies, a vitamin therapist and such things to increase the sperm quality is not a perfect idea. It can have a different effect on other parts of the body as well.
Improving sperm will not be as easy as in someone between 40-50 years old. After 50, the aneuploidy rate of sperm will increase dramatically, when we talk about sperm quality, we cannot only talk about the morphology of sperm, how the head, tail or neck looks like, DNA capacity is really important and with advanced reproductive age aneuploidy rate will increase while apoptotic programmed cell mechanism will drop a lot.
Yes, it’s similar to a microfluidic sperm sorting chip, and ZyMot is working perfectly. It will be a priority even if there is a problem with the sperm count, sperm morphology, it should be routine. In most countries, most clinics start to use it as a routine. They don’t prepare sperm differently and just use ZyMot or Microfluidic sperm chip, and they prepare sperm for intracytoplasmic fertilization, so it’s a good way to use it.
It can have a negative association because it’s partly related to cholesterol and partly with hormonal effects. As I said, FSH and LH should have a balance. Our andrologist would be much better to answer this, but we should keep these hormones in balance for sure. Studies are showing that such kind of diets, especially with nuts, can affect FSH regulation. If FSH is affected, testosterone regulation is affected as well.
We all are eating such kind of products, but when we try to take them to increase the sperm parameters, and the patients eat them almost all day, they are damaging hormonal regulation. That is why it can have a negative association. Regular usage of any kinds of vitamins, antioxidants or nuts will not have a direct effect, but when you use that as a diet purpose with a high amount, it will directly affect the regulation of hormones.
I am an embryologist, in the lab, for us, there is no difference between 100 million spermatozoids or 1 million spermatozoids. We need sperm in the same amount of egg. If we have 15 eggs, we need only 15 spermatozoids and believe me, it is so easy to find inside this 1 million or 100 million high-quality spermatozoids. If you have problems, especially with low concentration and low motility or morphology, my suggestion is not to lose time. Such treatment cannot change the profile in one month, two months or three months, you should wait a minimum of 6 months to get a direct effect, but this effect will not dramatically increase it.
If you have 1 million of concentration and if you are thinking that after such treatment you will get 15-20 million, that will be difficult, so that’s why for the natural conception, the most important thing is if you have about the 20 million of the concentration. If you don’t achieve a pregnancy, you should get a consultation with your gynaecologist and try to manage the ovulation time and implantation window, which will be much more effective. Reproductive age is really important with such kind of supplements because they will affect after a long period.
I don’t have experience with this, but I read some articles about this. There is no significant difference according to articles I read and its impact on improving sperm DNA. Glutathione is also a kind of antioxidant, and it can improve sperm DNA, any antioxidant can improve sperm DNA problems because it’s directly connected with oxidative stress, so it can decrease oxidative stress.
When oxidative stress decreases, sperm DNA fragmentation will get much better, so for sure, there is a direct effect, but according to publication, the effect is not so significant.
When you use the IMSI procedure, you should support the IMSI procedure with another, as I said, if you are using microfluidic sperm chip technology, or let’s say ZyMot technology to firstly eliminate a DNA fragmentation, and then you can use IMSI technology to choose a high morphologic quality of spermatozoid because with IMSI technology you can still see especially head part.
With standard 40 zooms of the objective, you cannot see organelle parts like a vacuole or some defect. With 600 times of magnification, you will be able to avoid such sperm. It will also affect it because the vacuole can absorb the energy from sperm and decrease fertilization potential. That’s why IMSI is important. First, we have to avoid the risk of DNA. Then we can use advanced technology as IMSI to choose high-quality spermatozoid.
Yes, it can affect the quality. It is related to the apoptotic mechanism because this will cause a traumatic effect to a testicular part, in a way. Apoptotic cells work when sperm production is continued. If there is some effect like prostatic hyperplasia, sperm production is getting much slower, sperm is moving in the channel, but half of the channel because of acidic part, starts to die.
Sperm can make some barrier on the channel, the new production of sperm is occurring, but talking about this barrier, part of sperm is still passing from the barrier, but part of them is staying there. Which sperm is passing your barrier? Firstly, the concentration drop, second, of course, some quality of sperm stuck in the barrier may be of low quality and is just passing from the barrier, so that is the main negative effect on sperm quality.
That will be a perfect combination to get better quality sperm. If you support IMSI with different technologies such as MACS, microfluidic sperm selection, ZyMot sperm selection, it will give a much better outcome.
Even in very difficult cases, I see a very high blastocyst rate. When we talk about blastocyst rate, we need to know what kind of blastocyst rate we will have when there is a low sperm count and low morphology, high sperm fragmentation. Especially if you have a low sperm quality, high sperm DNA fragmentation and are in advanced reproductive age, it doesn’t matter at what reproductive age female is, for sure, you have to test that your embryo with NGS technology to get a genetic profile of your embryos while those kinds of problems can increase aneuploidy risk that can be different kind of genetic abnormalities and gene mutation. That’s why NGS will be really important to do before embryo transfer.