Functional Medicine for Male Infertility

Infertility affects about 1 in 6 people in the world, and about 12-15% of couples in the U.S. About a third of infertility cases are related to male factors, a third to female factors, and the remaining third to a mix of male and female factors (1), though the prevalence of infertility varies across studies.

Some causes of infertility are clear-cut, such as the complete absence of sperms in the semen (called azoospermia), blockage in both fallopian tubes (bilateral tubal obstruction), or absence of periods. However, in most couples, the picture is less than crystal clear (such as a reduction in sperm numbers or infrequent periods), because there are few research data that can definitively link any single abnormal test result to the infertility. As a result, it may be difficult for reproductive specialists to weigh the findings of non-definitive abnormal test results when counseling couples experiencing infertility.

Couples who have been unable to successfully conceive, despite evaluations by reproductive specialists and in vitro fertilization attempts, may find the integrative medicine and functional medicine approach to fertility to be a powerful one.

Male infertility can be caused by endocrine (hormonal) disorders, congenital disorders, defective sperm production (with abnormalities in sperm number, morphology, and/or motility), and sperm transport disorders. Over 80 percent of men with infertility have low sperm concentrations, increased abnormal sperm morphology, and decreased sperm motility. However, in 10 to 20 percent of male infertility cases, the man has a normal semen analysis and no apparent cause for infertility (2).

There has been a global decline in sperm quality over the last few decades, an observation supported by recent high-quality studies. Potential proposed causes for this phenomenon include increased prevalence of obesity, poor diet, and exposure to environmental toxins (3).

A functional medicine treatment for infertility includes considerations of several crucial factors fundamental to reproductive health that may have been previously overlooked in a couple’s attempts to conceive.

Male infertility has been referred to as “a complex lifestyle-related disorder” (4). A good functional medicine evaluation comprehensively looks into the potential sources of risks, including environmental factors, dietary choices, and lifestyle choices, that may contribute to male infertility. Although each factor alone may not be adequate in causing infertility, a sizeable accumulation of these factors, often unaware to the man, will eventually reach the threshold that results in infertility in the individual.

An important factor affecting male fertility and sperm quality is oxidative stress (4). In a nutshell, oxidative stress happens when the oxidants (or, more precisely, reactive oxygen species) overwhelm the antioxidant capacity in the cells of the body, and there are not enough antioxidants to counteract the harmful effects of the oxidants. Oxidative stress can lead to damages in molecules, cells, and tissues, with potential health consequences such as aging, cancer, and infertility. Sperms are highly vulnerable to the damaging effects of oxidative stress. There is abundant evidence to suggest that such damage to the sperm is a major contributor to the pathology of infertility in 30-80% of men with impaired fertility (4).

Sources of oxidative stress abound in our lives: processed foods, fried foods, sugary foods, saturated fats, alcohol, cigarette smoke, environmental toxins, including pesticides and herbicides (such as those used in conventional farming), heavy metals (such as lead and mercury), air and water pollution, and electromagnetic radiation (from cell phones, for example), among many others. Environmental toxins can induce sperm DNA damage, affect sperm numbers, morphology, and/or motility, and exert hormonal effects (5). There are also internal sources of oxidative stress, including emotional stress, physical stress (such as overtraining in exercise, lack of sleep, and chronic illness), sedentary lifestyle, inflammation, and mitochondrial dysfunction.

It does not come as a surprise, then, that functional medicine interventions that mitigate oxidative stress and improve sperm health are an important part of the fundamental treatment of male infertility. The first step starts with an extensive evaluation of dietary choices, environmental exposures, and lifestyle factors that may affect fertility, along with laboratory testing, so that an individualized treatment plan can be strategized.

Restoring antioxidant defenses begins with using food as medicine. Examples of antioxidants in some foods include vitamin C (citrus fruits, broccoli, tomatoes), vitamin E (almonds, walnuts, avocados), flavonoids (black beans, soybeans, lentils, berries, grapes, green tea), glucosinolates (broccoli, cauliflower, bok choy), carotenoids (carrots, sweet potatoes, kale), selenium (Brazil nuts, brown rice), curcuminoids (turmeric), and many other foods. (Foods in parentheses above are only a limited list of examples.) Anthocyanins (a subclass of flavonoids) are powerful antioxidants that give berries and other fruits and vegetables their dark purple, blue, and red colors. Zinc supports the body’s antioxidant defenses and can be found in pumpkins seeds, cashews, almonds, lentils, chickpeas, and many other foods.

It is important to note here that reactive oxygen species (the oxidants involved in oxidative stress) play important roles in the body’s normal immune responses. However, in oxidative stress, the reactive oxygen species have overwhelmed the cell’s antioxidant defense mechanisms. So, the aim in a prudent integrative and functional medicine approach to oxidative stress is to restore the delicate balance between reactive oxygen species and antioxidants in cells—the balance that characterizes the state of health or recovered health—rather than indiscriminately eyeing only one side of the balance.

Because oxidative stress results in defective sperms, interventions targeting oxidative stress is important not only to improve fertility, but also to decrease the risk of recurrent miscarriages, childhood mortality, genetic disorders, autism, and childhood cancers in children fathered by men with defective sperms (4). Therefore, it is crucial to address oxidative stress and sperm DNA damage in couples with a history of miscarriage or failed IVF cycles.

It is also important to note here that men with infertility who have abnormal semen parameters (such as reduced sperm count and motility and abnormal sperm morphology) have a risk of developing testicular cancer that is 20 times higher than the general population and certain other kinds of cancer (extragonadal tumors) 4-5 times higher. Oxidative stress and DNA damage are believed to be the common thread (4). So, addressing oxidative stress in the treatment of male infertility can also benefit the health of the future father for this and many other reasons.

As an example of a relatively simple lifestyle intervention, meditation and yoga have been shown to reduce oxidative stress levels in the semen within 10 days of practice and reduce oxidative DNA damage after 6 months of practice (4). These mindfulness practices can improve the integrity of sperm DNA by regulating oxidative stress, reducing oxidative DNA damage, and promoting DNA repair and anti-inflammatory effects.

The liver is the main “detox organ” that helps the body fight oxidative stress and detoxify toxicants that we may encounter in the environment or through our lifestyle choices. The liver produces antioxidant enzymes such as glutathione, superoxide dismutase, and catalase. The functional medicine approach supports the liver in doing its work optimally, including helping the liver to synthesize glutathione, the body’s master antioxidant, and detoxify all sorts of chemicals and substances that may negatively impact reproductive health, such as heavy metals, organophosphates in pesticides, and alcohol.

The gut microbiome also appears to be associated with male infertility (6). While more studies are necessary to better understand this association, addressing the gut microbiome is fundamental to the integrative and functional medicine approach to health and benefits the body in many ways. It is also worth noting that during pregnancy, the gut microbiome shapes the mother’s immune system as well, and even the baby’s immune system (6). Prebiotics and probiotics play important roles in recovering and maintaining an optimal gut microbiome, and using food as medicine is a sustainable way of maintaining a healthy gut microbiome lifelong.

Environmental toxins are potential causes of male infertility (5, 7). The pesticide dibromochloropropane (DBCP) and the heavy metals lead, cadmium, and mercury are well-known associations (8). Studies examining the association between endocrine disruptors and male fertility have found that phthalates, PCBs, PBDEs, pyrethroids, and organochloride pesticides are negatively associated with male fertility (9).

Some data suggest that phthalates—found in many everyday items, such as plastics (including plastic food packaging and takeout containers), fragrances (in personal care products), and vinyl—are associated with lower testosterone levels, decreased sperm motility, and increased sperm DNA damage (5).

Bisphenol A (BPA), another well-known endocrine disruptor, can be found in plastic bottles, the lining inside cans, and the coating of thermal paper receipts. Higher urine BPA levels have been associated with lower sperm concentration and motility, abnormal sperm morphology, and sperm DNA damage (10), although it should be pointed out that inconsistent data exist. Microplastics have been suggested to reduce sperm production as well (7).

Organophosphates are pesticides widely used in agriculture. While their full impact on male reproductive health still needs to be better understood, organophosphates have been associated with reduced sperm count and motility, abnormal sperm morphology, increased sperm DNA damage, and testosterone reduction (5).

Medical problems such as disorders of the testes (infections, varicocele) and abnormalities in the sperm transport system (epididymis, vas deferens, ejaculatory duct) may underlie male infertility, and should be evaluated and treated by a urologist. Nevertheless, conventional medical treatments do not negate the importance of concurrently addressing the environmental, nutritional, and lifestyle factors in order to improve sperm quality.

Many of the above factors affect women’s reproductive health as well. While female fertility is not a topic of this blog, the obvious importance of addressing the fertility and health of the future mother through an integrative and functional medicine approach should not be overlooked. While acupuncture for fertility, done skillfully, can be effective in achieving conception, we should not forget that a truly holistic treatment for infertility ensures that the mother prepares her body holistically so that she is in optimal health to be able to successfully carry the baby to term, and ensures that both of the future parents are in their best health—in body and mind—to able to provide a nurturing environment for the mental, emotional, and physical wellbeing of their child.

References

1.   National Institute of Child Health and Human Development. How common is male infertility, and what are its causes? Accessed April 24, 2025. https://www.nichd.nih.gov/health/topics/menshealth/conditioninfo/infertility

2. Winters BR, Walsh TJ. The epidemiology of male infertility. Urol Clin North Am. 2014;41(1):195-204.

3. Mann U, Shiff B, Patel P. Reasons for worldwide decline in male fertility. Curr Opin Urol. 2020;30(3):296-301.

4. Bisht S, Faiq M, Tolahunase M, Dada R. Oxidative stress and male infertility. Nature reviews Urology. 2017;14(8):470-85.

5. Mima M, Greenwald D, Ohlander S. Environmental Toxins and Male Fertility. Curr Urol Rep. 2018;19(7):50.

6. Fu ZD, Wang Y, Yan HL. Male infertility risk and gut microbiota: a Mendelian randomization study. Front Microbiol. 2023;14:1228693.

7. Daniels D, Berger Eberhardt A. Climate change, microplastics, and male infertility. Curr Opin Urol. 2024;34(5):366-70.

8. Sengupta P, Banerjee R. Environmental toxins: alarming impacts of pesticides on male fertility. Hum Exp Toxicol. 2014;33(10):1017-39.