By Mike Berkley
An American, and Chinese Medical Approach to The effect of sperm DNA fragmentation on infertility
Approximately 50% of infertility cases involve malefactors.
Currently, evaluation and diagnosis of male infertility mainly rely on traditional semen analysis, including the volume, concentration, vitality and morphology of the semen. However, approximately 15% of men with a normal semen analysis are diagnosed as infertile. This suggests that semen analysis alone can only provide limited information for the assessment of male fertility, and it does not fully reflect the fertilization potential of the sperm.
Sperm DNA fragmentation is an indication, from a traditional Chinese medicine perspective as ‘kidney essence vacuity’. The expression of ‘essence’ in males is sperm.
Some of the things which can negatively impact the kidneys is ‘fear and fright’. Fear and fright may be construed in part as stress, anxiety, and depression. This, obviously, is not suggestive that every man with sperm DNA fragmentation experiences any or all of these psychological issues, but I’d be hard-pressed to find any human being who does not possess at least one of these things. Of course, one would then say… “if that’s the case, then won’t all men present with sperm DNA fragmentation? ” The answer I suppose is that different men have a). different levels of these factors and b). different men react differently to these factors.
Some signs of kidney ‘essence’ vacuity may include chronic low pain back (not caused by injury), bone issues, memory issues, fear, fright, low libido, frequent urination, feeling frequently hot or warm (even during the colder months), poor memory, insecurity, lack of esteem and more.
The physical assault which can damage the testes and sperm has nothing to do with ‘essence’ vacuity -but yet, can cause it. For example: if a man underwent a vasectomy and a vasectomy reversal and became susceptible to anti-sperm-antibodies which greatly impacted the quality of the sperm, the man will become worried, depressed, anxious, causing kidney ‘essence’ vacuity. So, you can see that physical issues can contribute to psychological issues and, of course, the opposite is true.
In the absence of physical findings, (CBAVD), acupuncture can be used to ‘calm the spirit’ and to enhance and nourish kidney ‘essence’. Of course, to the novice, this may all sound like nonsense, but to those men who have had their DNA fragmentation index reduced to 15% from 40% ‘sense’, not nonsense will be their conclusion.
With the development of assisted reproductive technology (ART), traditional semen analysis has failed to meet the needs of reproductive clinical practice. We need better clinical indicators to determine the cause of male infertility and its relationships with reproductive outcomes.
I have always felt that the ‘traditional’ semen analysis was inadequate. There are so few doctors that routinely perform a sperm DNA fragmentation assay on their male patients’ that the number of tests are done, statistically speaking, is meaningless. It is my contention that this test should be part and parcel of the ‘normal’ semen analysis. Alas, it is not. This is one of the causes of ‘idiopathic’ infertility. You see, it’s really not “idiopathic” more than a case of under-diagnosis which I find is prevalent in most infertility evaluations both in men and women.
The sperm DNA fragmentation index reflects the integrity of, and the damage to the DNA, the genetic material of the sperm, thereby detecting potential sperm damage. It is considered a crucial indicator in evaluating semen quality. And yet, is hardly tested.
Interestingly, according to traditional Chinese medicine, the genetics of humans is derived from kidney ‘essence’ passed to the child from the parents.
Sperm DNA fragmentation has important impacts on fertilization, embryonic development, and paternal genetic information transmission during both spontaneous and ART pregnancies. It must be evaluated and treated with both modalities of medicine as should all pathologies with the exception of severe physical trauma where surgery is the only correct method of intervention.
Sperm DNA damage is associated with reduced pregnancy rates in IVF/ICSI.
SPERM DNA FRAGMENTATION occurs during spermatogenesis and maturation whereby broken DNA fragments are produced in sperm cells as a result of damaged chromosomes and impaired DNA integrity.
In traditional Chinese medicine, one of the ‘energetic’ functions of the liver is to facilitate the movement of energy throughout the body (and mind). If the liver energy is ‘stuck’ it will not facilitate the movement of energy. Energy is obviously necessary to facilitate hemodynamics. So, with the function of the liver in a compromised state, the blood will not circulate efficiently causing a lack of blood flow to the testes causing myriad problems which can, on occasion, be the cause of the death of sperm (a large varicocele for example). So, traditional Chinese medicine calls for stimulating the liver to move energy and blood to the testes and to nourish, stimulate and benefit the kidneys to help create a healthy environment in which sperm can prosper.
Human sperm DNA carries the paternal genetic information (the paternal kidney ‘essence’), and its integrity is required to correctly transmit genetic materials to the offspring.
It must be noted that through the utilization of acupuncture and herbal medicine in the hands of a skilled and experienced practitioner, DNA fragmentation can and often is reduced. In fact, there is no accepted Western medical modality of intervention that has been shown to reduce SDF indexes.
Many reproductive endocrinologists will give this statement short shrift, but the dads-to-be, will not, and have not, after, for example, I reduce their fragmentation levels from >30% to < 20% and facilitation of pregnancy manifests and so too does a ‘take-home-baby. Eventually, practitioners of Western medicine whether reproductive or otherwise will come to learn that Western medicine is not the only medicine and certainly not the only efficacious medicine. Much of this disconnect and discordance between Western and Chinese medicine stems from the egos of doctors of Western medicine in general. “We know, we have the studies, we have the experience, we are the experts.” Didn’t they say that 100 years ago? Is Western medicine completely different today than it was one hundred years ago? You bet. The point is that what is thought of as ‘medical ‘fact’ today is often deemed medical ‘nonsense’ several years later. During the 1970’s many medical doctors denied the value of the cessation of cigarette smoking because they didn’t believe the science. It took more than 10 years for the majority of doctors who smoked to stop smoking. It seems that medicine is not only based on data and science but on subjective opinion, which, essentially means that medicine, in part, is ego-driven as much as science-driven. I’d be interested to know which is greater. When American and European doctors eventually take on the Chinese medical approach to care, Westerners will, in fact, receive better treatment and better outcomes. Look at the Chinese model in China. All hospitals in China have a Western medicine wing and a Chinese medicine wing.
They work together. One takes the lead and the other supports. This is the meaning of “it takes a village”. This model is understandable from the sociologic underpinnings of a communist country… everything is equal and even and all get the same goods and ideas available. In other words, Chinese and Western medicine receive equal respect and utilization. I am not promoting communism -it is a failed system that can never work, but it is interesting to see how, sociologically, this has affected their view on medical intervention. Currently, the following three major factors are known to cause sperm DNA damage: abnormal sperm chromatin assembly, aberrant death of sperm cells, and excessive oxidative stress. Why would reproductive endocrinologists be averse to having their patients take herbal medicine to strongly, and efficiently, reduce oxidative stress, improve kidney and liver function? Is it ego or ignorance or both? Inflammation in the external genital tracts and varicocele can also increase the risks of sperm DNA fragmentation by inducing reactive oxygen species in the sperm. Why would reproductive endocrinologists be averse to having their patients take herbal medicine to strongly, and efficiently reduce inflammation? Is it ego or ignorance or both?
Poor lifestyle habits including smoking, alcohol consumption, environmental radiation, and pollution can all lead to increased sperm DNA fragmentation. Very few doctors of Western medicine ever offer advice on lifestyle changes and if they do it looks like this: “you need to lose weight”. Practitioners of traditional Chinese medicine are totally committed to advising their patients on necessary, beneficial, and crucial life-style changes that serve to facilitate conception and full-term pregnancy. Consistent with previous reports, sperm DNA fragmentation indexes rise significantly with age and unhealthy lifestyle habits. Some of these include smoking cigarettes, and marijuana, alcohol consumption. Many investigators believe that sperm DNA fragmentation has a negative impact on embryo quality and pregnancy outcomes following IVF/ICSI. This is an understatement. When men have a sperm DNA fragmentation index of >35%, NO pregnancies will ensue.
A high sperm DNA fragmentation index is not only related to reduced fertilization rate and poor embryo quality in IVF, but it is also associated with decreased rates of pregnancy.
It was shown that sperm DNA fragmentation is significantly elevated in the male in couples with unexplained infertility.
There are so many pathomechanisms causative of infertility that is rarely tested. For example ureaplasma urylitica, endometrioses, sperm DNA fragmentation, the existence of uterine polyps, even, amazingly hysterosalpingogram.
You can’t imagine how many patients I’ve had that have done 3-4 failed IUI with gynecologists who NEVER performed an HSG.
One might ask why this frequently occurs. It’s probably for the same reason that medicine, with the exception of critical care, is often sub-par: not enough time for patients due to insurance capitation. Quick and incomplete consults, a rush to IVF, in and out. Fail? Repeat.
Acupuncturists’ get to spend an hour or more with each patient. This is not a good thing or a nice thing; this is a necessary thing.
To have better medical care, doctors need to see fewer patients every day.
Doctors and hospitals and clinics will fight this tooth and nail as it might reduce income and cash flow. So, medicine is boldly affected by money, and lack of time with patients.
The rates of early abortion in the high, medium, and low DNA fragmentation index groups were 27.3%, 14.6%, and 4.9%, respectively, and these differences were statistically significant.
These numbers can be significantly ameliorated with the inclusion of acupuncture and herbal medicine.
Why is there not an acupuncturist and herbalist, and yoga teacher, and meditation specialist, and a psychotherapist in EVERY reproductive medicine center? If there were, there would, undoubtedly, be more positive outcomes.
With the knowledge that early abortion rates in the high and medium DNA fragmentation index groups were significantly higher than that in the low DNA fragmentation index group, why wouldn’t doctors and patients alike realize that inclusion of a medical model with a two-thousand-year history of efficaciousness is included in their protocols?