Volume 4, Issue 4, December 2015, Pages 266–271
Open Access
Abstract
Objective
To
evaluate the effect of acupuncture treatment on semen parameters and
the proportion of mature and functional sperm as measured by using
sperm-hyaluronan binding assay (HBA) in subfertile Singapore men.
Methods
Singaporean
male subjects undergoing subfertility investigation were enrolled
prospectively in this pilot study. Each subject received acupuncture
treatment at fixed acupoints and two acupuncture sessions per week for
10 weeks. A total of five semen samples were obtained from each subject
at 5 weekly intervals up to 20 weeks of the study; at Pre-treatment,
Treatment 1 (5th week), Treatment 2 (10th week), Post-treatment 1 (15th
week) and Post-treatment 2 (20th week). Semen analysis was performed to
assess semen parameters and HBA score (percentage of motile sperm bound
to hyaluronan) to determine the proportion of mature and functional
sperm.
Results
Mean HBA scores improved significantly from 12.0% at Pre-treatment, to 18.4% (P = 0.03) at 5th week and was 16.8% (P = 0.07)
at 10th week of acupuncture treatment. After completion of acupuncture
treatment, HBA scores continued to increase significantly to 25.8% (P < 0.001)
at Post-treatment 1. At Post-treatment 2, HBA scores decreased to
16.3%. Sperm concentration showed similar trend but it was not
statistically significant. Other semen parameters remained unchanged
throughout the study period.
Conclusions
HBA
scores increased significantly during the first 5 weeks of acupuncture
treatment (Treatment 1) and 5 weeks after the completion of treatment
(Post-treatment 1). Hence acupuncture treatment was effective in
increasing the proportion of mature and functional sperm but had no
effect on other semen parameters.
Keywords
- Acupuncture;
- Male subfertility;
- Semen parameters;
- Sperm-hyaluronan binding assay (HBA);
- Mature sperm
1. Introduction
Men
with impaired semen parameters account for up to 50% of infertility
among subfertile couples. Conventional therapies such as over the
counter vitamins and supplements have been used widely, but it may not
be effective in improving semen parameters and the true effects on
dosing regimen could not be identified [1].
These subfertile men may not be able to get their partners to conceive
naturally. The only option of having a baby would be to undergo invasive
assisted reproduction treatment.
According
to traditional Chinese medicine (TCM), health is achieved by
maintaining the body in a ‘balance state’ and disease is caused by an
imbalance in the body. The imbalance causes a blockage to the natural
flow of vital energy, known as qi along the meridians.
Acupuncture is a medical technique unique to TCM, and has been practiced
for more than 2 000 years to treat a whole range of illnesses. It
involves inserting needles at various acupoints along the body that
connect the meridians to unblock the qi and restores the body's balance [2]. Male infertility could be due to the ‘deficiency of the kidneys’ or ‘damp heat in the genital system’ [3].
The former syndrome is usually implicated as the aetiology to
spermatogenic failure and the latter to the inflammation of the genital
tract.
Acupuncture has shown a
positive effect on sperm concentration and motility as well as increase
in testosterone level in infertile men [4].
Other studies have demonstrated that acupuncture treatment improve
sperm parameters of men suffering from impaired sperm quality [5], [6], [7], [8] and [9].
Sperm-hyaluronan binding assay (HBA) is a simple, patented and non-invasive in-vitro
diagnostic test for evaluating sperm maturity, quality and fertilizing
ability. Hyaluronan is a major constituent of the cumulus oophorous
matrix surrounding the human oocyte. During the process of
fertilisation, hyaluronan plays an important role in the selection of
functionally competent sperm. HBA is a useful indicator of completion of
normal sperm spermatogenesis, based on increased staining for various
maturity markers including creatine kinase, HSPA2 and Pisum sativum
lectin. Sperm that show binding to hyaluronan is mature and has the
capability to bind to and fertilise an egg. Sperm that shows no binding
is unable to fertilise and is likely to have other defects, including
chromosomal abnormalities and reduced DNA integrity [10], [11], [12] and [13].
Acupuncture
as a possible treatment option for subfertile men prompted the
evaluation of the effect of acupuncture treatment on semen parameters
and the proportion of mature and functional sperm for subfertile Asian
men living in Singapore.
2. Materials and methods
2.1. Subjects
Male
subjects of Asian origin undergoing preliminary subfertility
investigation either at the Singapore General Hospital or Singapore
Thong Chai Medical Institution, Singapore, were enrolled prospectively
in this pilot study between July 2009 and October 2012. Subjects were
willing to receive acupuncture treatment and had given their written
informed consent prior to the start of acupuncture treatment.
These
couples were not able to achieve pregnancy after trying for a period of
>1 year. The inclusion criteria were: Male subjects of age between
21 and 55 years old; with initial sperm concentration of >15 million
sperm/mL, progressive motility >20% and HBA score of <40%. The
exclusion criteria were: Male subjects who were azoospermic or had
undergone any surgical procedures related to male infertility within 1
year prior to the enrolment period. The investigation protocol for this
study was approved by the SingHealth Centralised Institutional Review
Board and was funded by the SingHealth Foundation, Singapore.
2.2. Acupuncture treatment
Acupuncture
treatment was performed by one of the two designated acupuncturist who
is TCM/Acupuncture trained and certified. One acupuncture treatment
cycle consisted of twice weekly sessions over 5 weeks. All subjects were
given two treatment cycles as a complete treatment regime and at fixed
acupoints, regardless of their TCM diagnosis. A total of 20 acupuncture
sessions were performed over a period of 10 weeks and to a maximum of 12
weeks, as some subjects were unable to attend treatment on time.
Twelve
subjects had completed the acupuncture treatment while the rest
discontinued treatment due to various reasons. All 12 subjects received
needling acupuncture, which were similar to the acupoints used by Pei J et al., in their study on idiopathic men [9]. In our study, Xue Hai acupoint was omitted. The main acupuncture points used were: Guan Yuan, Shen Shu (bilateral), Ci Liao (bilateral), Tai Cong (bilateral) and Tai Xi (bilateral). The secondary points were Bai Hui, Zhu San Li (bilateral), San Yin Jiao (bilateral) and Gui Lai
(bilateral). The locations of acupoints were according to the
international standardized location of acupoints. Sterile disposable
stainless steel needles [(0.25 × 25) mm or (0.30 × 50) mm], (Tian Sie,
Medical Appliance Factory, Suzhou, China) were inserted to a depth of
15–25 mm, depending on the region of the body undergoing treatment and
according to the accepted rules of acupuncture treatment. To evoke the
needle sensation, or De qi (often described as variable feeling
of soreness, numbness, tingling, warmness, and/or distension around the
acupoints), the 'lifting, thrusting and rotating manipulating
techniques' were used. When puncturing Gui Lai, and Ci Liao, the needling sensations were transmitted to the sacral or perineum area and anterior hypo gastric zone.
Electro-acupuncture
technique was used (HANS, Singapore) during the acupuncture treatment.
Acupuncture needles were inserted at two acupoint pairs; Gui Lai and San Yin Jiao, and Ci Liao and Tai Xi.
These needles were used as electrodes for passing weak electric current
(approximate frequency of 10 mA & intensity of 100 Hz). During each
session, 10 needles were inserted on the frontal part of the body and
withdrawn after 30 minutes. Six more needles were then inserted at the
back of the body while subject was lying in a prone position for
30 minutes. Thus, a total of 16 acupoints were used for every single
treatment session.
