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In ancient China, it was found that stimulating specific areas of the body can relieve pain. In addition, nearly 50% of cases do not have a clear pathogenesis and refer to as "idiopathic infertility" (24). It is well known as obstructive azoospermia, which is caused by obstruction of sperm transport during ejaculation, therefore absenting the spermatozoa in the ejaculate (22).
This natural stimulation may lead to elevated testosterone levels, as acupuncture aids in alleviating stress and promoting relaxation—two critical components for maintaining hormonal health. With the increasing number of male infertility patients, there are more and more studies on acupuncture treatment of male infertility. In the present paper, the efficacy and mechanism of acupuncture in the treatment of male infertility were analyzed from different perspectives such as regulating hormone secretion, reducing inflammation, and improving semen parameters. While acupuncture shows promise in enhancing testosterone levels, it is important to view it as a complementary therapy rather than a standalone treatment. This method is believed to regulate hormonal balance, including testosterone levels, through mechanisms like muscle relaxation, skin and brain stimulation, and activation of the parasympathetic nervous system. Enhances Energy and Sleep Acupuncture treatments improve sleep quality and energy levels, both essential for maintaining hormonal balance. Chronic stress and inadequate sleep have been linked to decreased testosterone production, so addressing these factors through acupuncture may help optimize hormone levels.
After the treatment, compared with the control arm who received acupuncture and moxibustion at non-therapeutic acupoints, the ratio of the normal form sperm increased significantly in the treatment group. After the treatment, the sperm quality of the man and ovarian function of the woman were restored, and their endocrine system was balanced (58). Compared with the sperm motility and vitality in baseline, TEAS treatment, either 2 or 100 Hz, significantly increased sperm motility and the percentage of grade a+b sperm in the asthenozoospermic patients. By analyzing the included 94 studies, they noticed that a total of 69 acupoints can be needled to treat male infertility, including 3 extra-meridian acupoints, 18 auricular acupoints, and 3 scalp acupoints. A study evaluating the effect of transcutaneous electrical acupuncture point stimulation (TEAS) on sperm parameters found that 2 Hz TEAS can improve sperm count and motility in patients with abnormal semen parameters (51).
By addressing stress through acupuncture, individuals can reinforce their hormonal balance and overall wellness in a comprehensive manner. Consequently, lower stress levels can contribute to enhanced testosterone production, establishing a beneficial feedback mechanism that supports both mental and physical health. As energy levels rise, individuals are more inclined to participate in exercise, which can further stimulate testosterone production.
A study conducted by Siterman Shimon et al. (95) to verify whether acupuncture has an effect on the sperm output in patients suffering from inflammation of the genital tract with low sperm density. The debate that varicocele causes male infertility has been going on for more than half a century. LH could act on interstitial Leydig cell, which is in synergism with the action of FSH on SCs (61), to aid in steroidogenesis and production of testosterone, thereby taking part in the appropriate regulation of spermatogenesis and consistency in semen quality.
The downregulation of CatSper channel in the sperm might be a contributor or a downstream indicator for asthenozoospermia, while 2 Hz TEAS or EA can be beneficial to recover through inducing the functional upregulation of CatSper channels in the sperm (74). The research carried out by Jin ZiRun et al. found a novel mechanism for the pathogenesis of asthenozoospermia. Its mechanism that EA enhances germ cell proliferation by improving the function of SCs facilitates the recovery of spermatogenesis and normal semen parameters in subfertile men (73).
Chinese herbs address the imbalance of energy rooted in the Kidneys and can improve testosterone levels. Acupuncture treatments improve testosterone production by balancing hormones and increasing blood flow to the groin and testes. In Chinese medicine, an imbalance in the Kidneys is seen as the cause of fertility and genital related issues, including low testosterone levels.
In addition, the adverse effects of acupuncture were substantially lower than those of drugs or other conventional medical procedures under identical conditions (38). Up to now, there are 103 countries around the world that approved the use of acupuncture, of which 29 have formulated corresponding laws or regulations, and even several countries have covered this treatment in their medical insurance system (36). Transcutaneous acupoint electrical stimulation (TAES) is another extension of acupuncture, in which electrodes are placed on acupoints to stimulate them through electric current to exert analgesia or other therapeutic effects (35). In the nineteenth century, Louis Berlioz, a French doctor, first proposed the idea of electroacupuncture (EA), which is a modern treatment derived from traditional acupuncture, and by doing so, he has added electrical stimulation to the acupuncture science and increased the stimulation methods (32). Testosterone levels and sperm concentration decrease with age, although some aging men can still be fertile by attempting multiple intercourse (25). Meanwhile, it was also reported that CAM could increase the pregnancy rate and decrease stress and anxiety levels (17). During fertility treatment, CAM could increase hope by incorporating cultural traditions of health and fertility (16).
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