In my fertility practice it is very common that only the wife of the couple comes in for treatment. Often I never see the husband. This reflects the fact that there remains in our culture a sense that fertility issues are a woman's problem. However, current estimates suggest that 30% of fertility problems result from male factor infertility issues, including problems with repeated miscarriage. An additional 30% of couples show problems for both partners. So, there is good reason for evaluation and treatment to include the male partner for any couple experiencing problems. This is becoming a bigger issue as human male sperm counts continue to decline, an issue that has been well-documented and well-publicized over the past few years and is a factor of increasing concern.
A study presented at the European Society of Human Reproduction and Embryology looked at the effect of regular ejaculation on sperm quality, specifically DNA damage.
The study was conducted with 118 male test subjects; all of whom had a history of infertility. Infertility includes such conditions as damaged sperm, repeated miscarriages and recurrent failure of in vitro fertilization. Samples from all 118 test subjects showed over 15% of their sperm showed DNA damage.
The test was very simple: for a week each man was required to ejaculate daily. At the end of the week, a sperm test sample was provided for clinical review. The results showed that DNA damage was reduced in a whopping 81% of the men; by any standard that is a very significant change.
Nineteen percent of the test subjects actually showed increased damage to the DNA in the sperm. The study concludes that the 19% that showed increased DNA damage most likely had underlying problems that were not “treatable” with the ejaculation method.
The results here are a little mixed, showing improvements in DNA quality for most (81%) of the men. One item to note is that the testing period was only one week long. The effects of daily ejaculation over a longer period of time are not addressed in this study, and Chinese Medicine would expect a decline in fertility over the long-term for most men due to over-taxing the Kidney Jing (or vital essence).
The traditional Western medical advice has been for men to refrain from ejaculation from 3-7 days before their partner's ovulation time. A number of research studies are showing that this is not true and that more frequent sex during the fertile window can improve the chances of pregnancy.
Chinese Medicine makes a prescription for ejaculation based on a person's age and state of health - particularly the state of the Kidney Jing. For a healthy man in his mid-30's, the number tends to be 3-4 times a week. I see great variation in my patients, from those who ejaculate 5-6 times a day, to those who ejaculate 1-2 times a month. This reflects differences in basic constitution as well as current health and it is not helpful to state a single number that is right for all men or all situations. For instance, one of my patients who ejaculated multiple times a day had problems with insomnia and migraine headaches if he cut back on that number. I've had other patients who experienced sore throats and frequent colds with increased sexual activity beyond a couple times a month. So, it is important to evaluate your state of health and how sexual activity plays into that. Remember also that there is a very long tradition in Chinese Medicine for maximizing virility and fertility into old age. This was a very important issue in Chinese culture and many treatments were developed to address this issue.
When fertility is the goal, we want to maximize the health of the Kidney Jing and the quality of the sperm. Acupuncture has been shown to do that when low sperm quality is an issue. Herbs like Huang Qi have been shown to improve specific factors like sperm motility. Another possible approach that is recommended in Taoist texts is frequent sexual activity without ejaculation. This has a strong effect on increasing testosterone levels, and higher testosterone levels have been linked with higher quality sperm. In a general sense, balancing the body and improving general health reduces demands on the vital (or constitutional) essence, leaving more body resources for creating healthy sperm.
Lastly, here is a look at current research from the World Health Organization (WHO), via the Oxford Journals on sperm quality parameters for fertility.
semen volume, 1.5 ml (1.4–1.7);
total sperm number, 39 million per ejaculate (33–46);
15 million per ml (12–16);
vitality, 58% live (55–63);
progressive motility, 32% (31–34);
total (progressive + non-progressive) motility, 40% (38–42);
morphologically normal forms, 4.0% (3.0–4.0)
These numbers came from a study of men whose partners became pregnant in 12 months or less.