azoospermia: Effect of acupuncture study

Farnoosh Bidouee, Ali Shamsa, Mohsen Jalali
Department of Urology, Mashad University of Medical Sciences, Ghaem Medical Center, Mashad, Iran
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The effect of acupuncture on male infertility, especially on the azoospermic male, is challenging and is a matter of debate.  Here, we present a case of an azoospermic male in whom spermatogenesis occurred and he had sperm in his ejaculate after two courses of acupuncture.

S. M. H., a 31-year-old male, was referred to us because of azoospermia and infertility. His wife had been evaluated earlier elsewhere for female factors and was found normal.

Both his testes were normal with normal volume and normal vasa deferentia. His hormonal assays were as follows: follicular stimulating hormone (FSH) 0.6 mIU/mL (normal 1.5-12 mIU/mL) and testosterone 140 ng/dL (normal 300-1000 ng/dL). As his testosterone level was low, he was given human chorionic gonadotrophin (HCG) 5,000 IU once per week for 10 weeks. Since he had normal FSH and testis volume, testicular biopsies were done on him. On 4 May 2009, under general anesthesia, five pieces of cream-colored tissue pieces from the right testis and three pieces from the left testis were taken, measuring a total of 0.7 cm and 0.5 cm, respectively. On the right side, testis biopsy showed hypospermatogenesis to the level of spermatozoa in 75% tubules, complete maturation arrest in 15% of tubules and incomplete maturation arrest in 10% of tubules, whereas on the left side, it showed hypospermatogenesis to the level of normal spermatozoa in 90% of tubules and incomplete maturation arrest in 10% of tubules.

Earlier percutaneous sperm aspiration (PESA) and intracytoplasmic sperm injection (ICSI) had been done for his wife at Montaserieh Research and Clinical Center for infertility, Mashhad, University of Medical Sciences, but it had failed. Therefore, this case was allocated for acupuncture treatment. The patient underwent a course of 20 acupunctural treatments (two treatments per week). Sterile disposable stainless steel needles (0.25 × 25 mm and 0.25 × 50 mm) were inserted in acupuncture point locations. The depth of needle insertion at each point was determined according to the accepted rules of the acupuncture treatment. Rotation of the needle caused soreness, numbness or distention around the point. The needles were left in place for 25 minutes and then removed. In accordance with the principles of traditional acupuncture and syndrome diagnosis, [2] acupuncture points appropriate for the deficiency of the kidneys (hormonal imbalance) and damp-heat syndromes (inflammation of the genital tract) were regarded as the main points. Points Sp-6 (Sanyinjiao), Ren-4 (GuanYuan), Lu-7 (Liegue), KI-6 (Zhohai) and ST- 30 (Qicong) were used for both syndromes. Four additional main points, KI-3 (Taixi), BL-23 (Shenshu), KI-ll (Henggu) and BL-52 (Zhishi), were used only for the kidney-yang deficiency syndrome (spermatogenic failure). At all these points, the needles were inserted using the re-inforcing method. Five other main points, Sp9 (Yinlingquan), Liv-5 (Ligou), Li-li (Quchi), ST-28 (Shuidao) and Gb-41 (Zuliqi), were used only for damp-heat in the genital system (inflammation of the genital tract). The needles were inserted at five points using the reducing method. The following acupuncture points, which, according to the principles of traditional acupuncture, are not associated with the kidney-yang deficiency or damp-heat syndromes, were considered as secondary points: LI-4 (Hegu), ST-36 (Zusanli), SP-l0 (Xuehai), HT-7 (Shenmen), Bl-20 (Pishu), PC-6 (Neiguan), Ren-l (Huiyin), Ren-2 (Qugu), Ren-6 (Qihai), Du4 (Mingmen), Du-20 (Baihui), Gb-20 (Fengchi), Liv-3 (Tai-chong), 1(1-7 (Fulu) and Gb-27 (Wushu). Specific combinations of main and secondary points are selected for each patient during treatment, according to the principles of traditional acupuncture. No more than 12 points were punctured during any single session. [2]

The treatment was finished when, by the criteria of Chinese medicine, an energetic balance was achieved and along with this, the patient experienced a constant feeling of heaviness of the testicles. His next spermogram showed a sperm count of 10 million/mL, with 10% good and progressive motility and 60% normal shape, in the same lab.

Following this, he received a second course of acupuncture. His third spermogram, in the same lab, showed a sperm count of 18 million/mL, with 30% good and progressive motility and 60% normal sperm.

Treatment of azoospermic infertile male, especially when testis biopsy shows hypospermatogenesis, is very difficult. [1] The reports on the effect of acupuncture on sperm parameters in the literature are rare, but it has been reported that traditional Chinese medicine (TCM) has positive effect on patients with severe oligospermia. [3],[4]

TCM is actually a system of medicine with a history of 5,000 years. It makes use of acupuncture and various herbs. TCM is used in many Asian countries along with Western medicine.

Tempest et al for the first time showed the effect of herbal treatment with TCM on six infertile men with disomy. All six patients had reduction in the number of sperms with disomy. [4]

Recently, Siterman et al had reported on the effect of acupuncture on 26 azoospermic males. Seven out of 26 patients had sperm in their ejaculation and surprisingly 4 out of 7 had a sperm count of nearly 100 million/mL and the other three had severe oligospermia. [5] They concluded that acupuncture may increase testis blood flow. [5]

Our case, indeed, has a history of failed PESA + ICSI before acupuncture, but he has a sperm count of 18 million/mL in his ejaculation, after two courses of acupuncture.

As far as our knowledge is concerned, this is the first report of successful treatment of non-obstructed azoospermia with acupuncture in Iran.

In conclusion, we can consider acupuncture as a successful and an alternative method of treatment and may be more effective than empirical therapy for idiopathic and non-obstructive azoospermia.

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Note:

Based on cases I treated azoospermic condition,  acupuncture can help. Combining with herbs, there
can maintain more continuous improvement.

Successful stories:

My husband and I were very successful using acupuncture. I will try to make our very long story short. My husband was diagnosed with azoospermia about 4.5 years ago. He went for a biopsy which showed a zero sperm count but were still advised to proceed with the TESE procedure in hopes of finding a few sperm for IVF. We did TESE a year later and only few sperm were found. We ended up with bad quality embryos that didn’t take. We were required to take two years off before we tried again because the surgery was so invasive. I took those two years to do a little research to see if there was anything my husband could do. I came across some great research on acupuncture and male infertility and decided to give it a try. While it is very expensive, we figured it was minimal compared to the cost of IVF/ICSI with the TESE procedure. We were willing to try anything. We were scheduled for IVF in June and my husband started going for acupuncture around Jan/Feb of that year. He went once a week. I began going around April once a week (I had no issues) and we both increased our sessions to two times per week in May. We went in for our scheduled IVF without having done a sperm analysis prior. I was hoping the acupuncture helped my husband have a few dozen sperm- the dr. came in that morning after doing a required sperm analysis before the surgery and my husband had 20 million sperm! He went from zero to 20 million! We couldn’t believe it. We proceeded with the IVF because I was already cycling and now we have beautiful twins. I HIGHLY recommend acupuncture. It changed our life!