Male Fertility Case Study - Part 1


Age: 38 years

Sex: Male

Presenting complaint:

The patient was sent for a consultation by his wife who is also a patient in the clinic. This couple are having problems conceiving a second child. They have one 2-year-old child who is healthy and well but since they started trying for a second baby just over a year ago, they have had 3 miscarriages. They also had 1 miscarriage prior to conceiving their first child.

During the time that his wife has been receiving naturopathic treatment, we have discussed the need to address both partners as they contribute equally to the success of a healthy pregnancy. Although initially hesitant to the idea, he was provided some reading material from the clinic and was then quite happy to get more involved in the process.

Details of presenting complaint:

The miscarriages have all occurred at 6 to 10 weeks gestation suggesting possible chromosomal abnormalities. They are conceiving (a great sign) but are producing repeated unviable pregnancies. Other pathology, such as thyroid, autoimmune and blood clotting disorders have been ruled out.

The patient works full-time in a corporate, high-stress environment where he is working long hours to reach a promotional goal. He rates his energy as low (5/10) most days but still manages to go to the gym for a workout (spin classes, weights, cardio, boxing) every morning without fail and cherishes this time to himself. He has 5-6 hours of undisturbed sleep every night. On observation, his disposition is quite nervous or anxious.

He has found the conception process quite challenging and daunting because of the recurrent miscarriages and the physical and emotional stress this has put on his wife. As a result, he finds his libido is “not as it used to be”.

Medical Diagnosis (if any):

NIL

Medical History:

  • Fully vaccinated as a child, no major childhood illnesses
  • Shoulder surgery for a badly broken clavicle in 2001, no complications
  • Paternal Medical History: atrial fibrillation (well managed) and moderately elevated cholesterol
  • Maternal Medical History: anxiety and depression, IBS

Relevant pathology results: Blood test results

  • MCV levels were high (in last 2 results) suggesting possible megaloblastic anaemia (B12 deficiency), all other cell counts were within normal range
  • Vitamin D is 56 nmol/L which has room for improvement
  • Elevated hs-CRP and ESR suggesting systemic inflammation (test performed after gym workout, which may explain the elevation)
  • HIV and STI testing were clear, no other infections were present and white cell numbers were normal
  • Testicular examination was normal
  • Semen analysis reveal that the sample volume and sperm count were on the low end of normal and there were marked issues with morphology and DNA fragmentation percentage.
  • Testosterone levels were within normal range

Relevant symptoms/history from the following systems:

  • GIT
    • Occasional bloating
    • Regular and formed bowel motions daily after breakfast
    • Eats 3 meals per day that include protein and veg/salad, no snacks
      • Breakfast: Eggs, rocket and aioli on wholegrain toast (from café near work) most days
      • Lunch: chicken and salad wrap or left-over dinners from home
      • Dinner: meat (steak, chicken or fish) with salad/veg, stir fry, curries, pasta
    • Doesn’t like the taste of coffee or tea so does not consume it
    • Consumes 1-2 alcoholic beverages every night (wine, beer or whisky on the rocks)
  • Nervous system
    • Stressed about his wife and achieving the promotion
    • Feels he could use more sleep
  • Immune system
    • 1-2 colds per year and recovers in 2-3 days
  • Reproductive system
    • Erectile function is normal
    • Testicular examination was normal
    • Abnormal semen parameters noted on testing
  • Cardiovascular system
    • Nothing abnormal noted
  • Endocrine system
    • Testosterone levels in normal range
    • Thyroid function in normal range
  • Musculoskeletal system
    • Soreness after the gym and occasional calf cramps
    • Note: blood tests were taken after the gym but before eating which may explain elevated inflammatory markers
  • Integumentary system
    • Nothing abnormal noted
  • Renal system
    • Nothing abnormal noted

Objectives:

  • Support and reduce stress/Improve energy and vitality
  • Address nutritional deficiencies
    • B12
    • Optimise Vitamin D levels
    • Magnesium deficiency likely based on clinical presentation (high stress, exercise)
  • Improve sperm quality for a healthy conception and pregnancy
    • Focus on key nutrients for improving overall sperm health, but particularly morphology and DNA fragmentation
      • Key nutrients for sperm structure, maturation, and function
      • Antioxidants
      • Mitochondrial support
  • Modify lifestyle factors that may have a negative impact on healthy pregnancy outcomes
    • Reduce or eliminate alcohol intake
    • Reduce gym workout intensity and direct physical pressure on reproductive organs

Discussed at length with the couple about abstaining from conception for 3-4 months to reduce the chance of repeated pregnancy loss and increased stress for the wife. They were initially upset, but agreed it would be a good idea.

Interventions – Supplementation:

Initial Consultation:

  • Explained that a comprehensive prescription was required
  • Provided 2 of each supplement (one to be kept at work)

Supplement

Morning Dose

Lunch Dose

With food

Extensively tested Fish Oil (EPA/DHA)

2g (2 gels caps) morning

1g (1 gel cap)

Yes

CoQ10

150mg (1 gel cap)

150mg (1 gel cap)

Yes

Complex containing: Magnesium (300mg), full profile of Activated and Methylated B Vitamins, Zinc, selenium, alpha-lipoic acid, Vitamins A, C, D (1000IU) and E, Ascorbic acid

8g (1 scoop) dose mixed into water daily

-

Yes

N-acetylcysteine (1g BD)

1 scoop mixed with Magnesium/B complex

1 scoop in water

Yes

Herbs: Damiana, Tribulus, Withania, Ginger

7.5mL in water

7.5mL in water

Yes

Herb Mix: Damiana 70mL, Tribulus 60mL, Withania 80mL, Ginger 10mL

Interventions – Diet and Lifestyle:

  • Reduce alcohol intake each week
    • Week 1: No more than 1 standard drink each night
    • Week 2: No more than 1 standard drink every second night
    • Week 3: No more than 1 standard drink each day of the weekend
    • Week 4: Alcohol free if possible
    • Avoid alcohol completely during the fertile window and on the days/nights they are aiming to conceive.
  • Replace the two spin classes per week with 30-minute walk directly from the house. This still allows for personal time but also for a sleep in and removes the possible detrimental effects (pressure and heat) of the spin bike on reproductive organs.
  • Decrease the negative effects of stress:
    • Increase the amount of sleep each night by 1 hour: 6-7 hours per night
    • Find more balance between work and life
      • Schedule in regular breaks at work and weekends/holidays away
      • Spend quality time with the family
      • Try new things, make it all about fun
  • Follow up consultation in 1 month

Part Two available soon for follow up consultation, results and a prescription cost comparison.