This article was originally published in the August 2019 issue of AromaCulture Magazine (www.aromaculture.com) and has been adapted for use here with permission from the publisher.
Fertility has long been thought of as only a “woman’s issue”. Even now, a lot of people don’t realise that the partner providing the xy chromosomes in a potential pregnancy contributes to up to half of all infertility cases. Approximately 15% of couples trying to conceive experience infertility. 20-30% of those are due to infertility on the side of the partner with testes*, 25-30% being on the side of the partner with ovaries, and another 20-30% of cases are due to an issue with both partners. The rest being of an unknown cause. Worldwide, there is a lack of data on infertility rates in people with testes, largely because of the patriarchal belief - still very strong in some parts of the world - that it always falls on the shoulders of the ovary-having partner whether pregnancy can be achieved, and many teste-having people in an infertile couple are never tested or treated for fertility at all. (Ashok Agarwal, et al, 2015)
Causes of Infertility
Usually, infertility in people with testes is due to a problem with spermatogenesis. That is, the creation of sperm (Alessandro Ilacqua et al 2018). This is because sperm needs a very specific environment to grow in (Alessandro Ilacqua et al 2018). The right temperature, the right nutrients, and the right hormone levels are all factors in creating a that environment (Alessandro Ilacqua et al 2018). A diet rich in Omega-3 fatty acids, antioxidants such as vitamins E, C, A, D, selenium, zinc, and folate is beneficial (Salas-Huetos A et al, 2017),(González-Rodríguez LG et al, 2018). In real life, this looks like large amounts of a variety of vegetables, some fruit, fish and seafood, poultry, and whole grains (Salas-Huetos A et al, 2017).
A recent study has found strong ties between the mediterranean diet and healthy semen quality and motility (Albert Salas-Huetos, et al, 2019). while diets high in processed meats, dairy products, alcohol, coffee and sugar have a negative impact on sperm quality (Salas-Huetos A et al, 2017). The mediterranean diet generally consists of high amounts of olive oil, fruit, nuts, legumes, vegetables and whole grains; some fish, lean meats such as poultry, and low amounts of red and processed meats, dairy products, and sugar (Albert Salas-Huetos, et al, 2019). This is a great guideline for consuming many, if not all the nutrients listed above.
There are many environmental factors that can lead to infertility: age, caffeine intake, temperature, pollution, and stress, are just a few (Alessandro Ilacqua et al 2018). Heat stress in the testes is maybe a surprising one, though simple. Sperm cannot properly grow in high temperatures and end up with high oxidative stress, poor motility and DNA damage; that’s why it is recommended to avoid too much cycling, wearing tight underwear, and sedentary work and lifestyle while trying to conceive. - or at least get up from the desk once per hour (Mahsa Darbandi, Sara Darbandi et al, 2018),(Gill K et al, 2019),(Simon Mills and Kerry Bone, 2013).
Stress and hormones
As important as diet and nutrition are to sperm quality, stress is just as important to consider. To get to the nitty gritty of why this is, we have to understand a little bit about the endocrine system. Testosterone is produced throughout the day by the leydig cells in the testes (Mahsa Darbandi, Sara Darbandi et al, 2018). They make testosterone in response to luteinizing hormone (LH) from the pituitary gland, which is stimulated by gonadotropin-releasing hormone (GnRH) from the hypothalamus, pulse-released every 1-2 hours (Mahsa Darbandi, Sara Darbandi et al, 2018). This is called the “HP axis” or sometimes “HPG axis” (Hypothalamic-Pituitary-Gonad),(Mahsa Darbandi, Sara Darbandi et al, 2018). Both acute and chronic stress directly affect this pathway and resulting testosterone pulsing (Salam Ranabir and K. Reetu, 2011). Chronic stress leads to suppression of gonadotropins and gonadal steroid hormones, the ones responsible for successful spermatogenesis, which leads to decreased sperm count, motility problems, and DNA damage (Mahsa Darbandi, Sara Darbandi et al, 2018),(Alessandro Ilacqua et al 2018),(Daly W. et al, 2005),(Salam Ranabir and K. Reetu, 2011).
This disruption of the HPG axis is thought to be due to increased cortisol and other stress hormones (Mahsa Darbandi, Sara Darbandi et al, 2018),(Alessandro Ilacqua et al 2018). A simplistic understanding of why excess production of stress hormones leads to suppression of sex hormones has to do with the fact that they are both steroid hormones made from cholesterol. In acute and chronic stress the body prioritizes stress hormones over reproduction (Mahsa Darbandi, Sara Darbandi et al, 2018),(Kaye K. Brownlee et al, 2005). This is of particular importance because understandably, experiencing infertility and going through tests and treatment is very stressful in itself, often putting strain on relationships involved (Alessandro Ilacqua et al 2018). Using therapy, meditation, exercise, or other stress relieving activities can be invaluable while exploring fertility and trying to conceive. Later on, we’ll look at some herbs that can help regulate hormone levels and manage stress.
One of the most common causes of infertility in those with testes is varicocele, which is a weakening and widening of the veins along the cord that holds up the testicles. This causes inflammation and decreased blood flow, resulting in adverse effects such as increased scrotal temperature, increased intratesticular pressure, and even a buildup of toxic metabolites and hormonal abnormalities. A large number of people with varicocele have reduced levels of testosterone, though it is unclear whether low testosterone is caused by the varicocele and resulting leydig cell damage, or if the low hormone levels is from testicular failure that is more likely to lead to venous insufficiency and varicocele. Either way, this can be a contributing factor to infertility. (P D Kantartzi, et al, 2007)
One of the conventional treatments for varicocele is surgery (P D Kantartzi, et al, 2007). If this route is taken, we can employ herbs to help the wound-healing process and protect against recurrence. There are a number of herbs used traditionally for varicocele and similar conditions of the testes, such as inflammation and heat.
Key herbs used for increasing fertility
The health of someone’s sperm can be said to be a reflection of their overall health, so when facing fertility problems, we should look at all aspects of the person’s life and health. Allergies, food intolerances and sensitivities, autoimmunity, and gut health are common potential weak spots to look out for. There are a number of herbs used traditionally to “increase vitality”, and boost fertility. Some of these are adaptogens, which increase the vitality of the body as a whole, some are hormone modulators, and some specific to the prostate. Herbs are used to strengthen the veins in those with varicocele, thereby improving semen quality. Circulatory herbs are used for improving microcirculation, which is important for moving toxins out, and nutrients into the peripheries and pelvis. (Simon Mills and Kerry Bone, 2013)
Serenoa repens (Saw palmetto)
Traditionally known as a “male reproductive tonic”, saw palmetto is used to strengthen the reproductive system in all humans, especially if there is a history of prostatitis or BPH (benign prostatic hypertrophy). It is anxiolytic, anti-andronergic (inhibits or decreases androgens), anti-inflammatory - especially to the reproductive system and organs, and an aphrodisiac. It is used for BPH and prostatitis, erectile dysfunction, decreased libido, and testosterone deficiency. Though it may sound contradictory, studies have shown that taking serenoa over a period of time can increase testosterone levels, while decreasing other androgens, like 5-alpha-dihydrotestosterone (DHT) which is far stronger than testosterone and a large factor in BPH. Most hormones in the body have complicated pathways they follow including feedback loops which help decide whether there should be more of a specific one in the body, which is why many herbs (though not all) that affect the endocrine system have a balancing effect rather than a straightforward increase or decrease relationship with hormones. (Simon Mills and Kerry Bone, 2013)
Tribulus terrestris (Tribulus)
Tribulus has a long history of use as a urinary herb in ayurvedic tradition, but less documented use historically in western herbalism. It does however, have a strong presence in more recent herbalism in the west, along with a significant amount of research for its effects on the reproductive system.
It is known as a reproductive tonic, hormone regulator, aphrodisiac, and fertility agent. Tribulus increases sex hormone production in humans, probably by interacting with the hypothalamus and increasing gonadotropins thereby stimulating the release of either testosterone from the testes, or estrogen from the ovaries. There are several studies showing enhanced spermatogenesis, in both production and quality, increased libido, and increased overall fertility with oral doses of tribulus. (Simon Mills and Kerry Bone, 2013)
Centella asiatica (Gotu kola)
Gotu kola was long ago adopted by western herbalists, but has been celebrated in Ayurvedic tradition for probably as long as there has been Ayurvedic tradition. This important herb is fairly unique in its ability to promote tissue regeneration. According to some pharmacological studies these properties are seen also in vein walls, improving microcirculation. It is for these properties that centella is an invaluable herb for venous conditions - including varicocele. It is also an adaptogen and anti-inflammatory. (Simon Mills and Kerry Bone, 2013)
Vaccinium myrtillus (Bilberry)
Bilberry belongs to the same plant family as blueberry and cranberry; those with the dark colours that are indicative of a high antioxidant content. Bilberry is astringent, vasoprotective, anti-inflammatory, and antioxidant. A high anthocyanin content helps to protect and strengthen blood vessels. Therefore, this is another herb that supports microcirculation, used for venous insufficiency and varicocele. (Simon Mills and Kerry Bone, 2013)
Aesculus hippocastanum (Horsechesnut)
Horsechesnut is an herb that has been well studied for its positive effects on varicocele and sperm quality (Asian J Androl., 2016). In mild and moderate cases, it is able to shrink the size of the varicocele (Asian J Androl., 2016). This is due to its astringent qualities, anti-inflammatory, and venous tonic actions (Simon Mills and Kerry Bone, 2013). Horsechesnut is used in a number conditions involving venous insufficiency or venous tone problems, including hemorrhoids and varicose veins (Simon Mills and Kerry Bone, 2013). These conditions all result from weakened vein walls that eventually bulge (Ashok Agarwal, et al, 2015).
Turnera diffusa (Damiana)
Damiana grows in the warm, dry, tropical parts of North America. This is a key herb for dealing with the stress and anxiety around sex and fertility. It is a nervine tonic, aphrodisiac, and mood-lifting. It is used largely for erectile dysfunction and nervousness around sex. (Simon Mills and Kerry Bone, 2013)
There are many herbs that can be used for those experiencing problems with fertility. The herbs outlined above have specific reproductive use, though it is important to also employ nervines, herbs for digestive health, and person-specific herbs. The herbs used for stress should be based on what is right for each person. Chamomile (Matricaria), oat straw (Avena sativa), or skullcap (Scutellaria lateriflora), are all well tolerated, relaxing nervines. It is always a good idea to talk to your herbalist or health professional to get the most out of your herbal formula.