The Common and Hidden Cause of Sperm-Factor Infertility Affecting Around 12% of Patients
It is estimated in some studies that sperm-factor infertility affects upwards of 60% of infertility cases in couples. Yet, it is too common to hear from patients that very little attention was given to their male partners during the treatment plan and workup. Most patients have a simple sperm analysis and are given very little information as to the results as opposed to 'looks good' or some of the numbers are a 'little low.' It is important for patients to be informed as to which numbers are good, which ones are low, and which tests (if any) were not completed as a part of the baseline testing but are available. This is due to the fact that research over the last few years has emphasized the importance of advance sperm function tests, usually not included in the basic sperm analysis test.
A rarely discussed cause of sperm-factor infertility is the presence of bacterial and viral agents in the urogenital and reproductive tracts. A new systematic review and meta-analysis published in the Frontiers in Medicine journal evaluated the results from 72 clinical trials and found a significant association between the presence of bacterial and viral agents in the seminal fluid and risk for sperm-factor infertility. This is very important because a large portion of patients may be asymptomatic, meaning there is no obvious sign that there is an issue and underlying infection. Such low-grade infections can often go undetected unless they are specifically screened for during the medical intake and baselines testing.
How many infertility patients have reproductive infections?
In the published systematic review it was estimated that upwards of 12% of patients have a bacterial infection in the reproductive tract. This can include the urethra, vas deferens, seminal vesicles, prostate, testes and epididymis. As mentioned above, a large portion of these patients may have an infections with no obvious symptoms. Surprisingly, some studies estimated that as many as 35% of patients with sperm-factor infertility had an underlying infection.
What is the risk of infertility with bacterial and viral infections?
The cumulative data found that the presence of a bacterial infection increased the likelihood of having low sperm parameters by 3x (odds ratio 3.15) compared to patients without a bacterial infection.
The presence of a viral infection increased the likelihood of having low sperm parameters by 2x (odds ratio 2.24) compared to patients without a viral infection.
Which bacterial and viral agents are the cause of these reproductive infections?
The most common bacteria that caused these urogenital infections include: Streptococcus pyogenes, enterococci, Escherichia coli, staphylococci, and Chlamydia trachomatis bacteria. A very significant risk of chronic infections is that they may destroy the blood-testis barrier meant to protect the reproductive organs. If this does occur it can lead to the formation anti-sperm antibodies, which may also negatively affect reproductive function.
Viral agents found to be associated with increased risk of sperm-factor infertility included: Human simplex virus 1 (HSV-1), Human simplex virus-2 (HSV-2), Human immunodeficiency virus (HIV), Cytomegalovirus (CMV) and Human papillomavirus (HPV).
How do these infections cause infertility?
A few different mechanisms have been observed and hypothesized to negatively affect sperm health and lower parameters.
Increased inflammation caused by the infectious agents
Increased presents of leukocytes (immune cells) which are potent sources of reactive oxygen species (ROS). ROS have been established to negatively affect sperm integrity and health
Binding of bacteria to the cellular membrane of the sperm cell may prevent it from fertilizing the ovum when they meet in the reproductive tract of the partner
Formation of anti-sperm antibodies. Presence of these antibodies (consequence of a compromised blood-testis barrier) in the sperm has been correlated with worse sperm health. However, presence of these antibodies in the serum only may not actually affect fertility.
If you have been struggling to conceive speak with your licensed Naturopathic Doctor to discuss evidence-based approaches to supporting sperm health and fertility.
This article is being shared as educational content and is in no way a replacement for medical advice or medical care, it is advised that anyone concerned about their Health should speak with their Naturopathic Doctor. Please discuss with your healtcare provider and only make changes to your medications regimen if recommended by your doctor and under their guidance and supervision.
Gholami, M., Moosazadeh, M., Haghshenash, M. R., Jafarpour, H., & Mousavi, T. (2022). Evaluation of the presence of bacterial and viral agents in the semen of infertile men: A systematic and meta-analysis review study. Frontiers in Medicine, 9(835254).