Can Red Light Therapy Help Improve My Fertility?
Low Level Laser Light Therapy (LLLT) for Fertility
Written by: Taylor J. Graber MD
Whole body or targeted treatments with Red Light or Near Infrared Light Therapy can have beneficial effects for male and female fertility.
Much of this article was researched thanks to an excellent article by Red Light Man.
Background
Unfortunately, in both men and women, infertility (defined as the inability to become pregnant after 6-12 months of trying) and subfertility (reduced chances to become pregnant compared to similar aged couples) are on the rise, especially in Europe, North America, and Asia. Roughly 10-15% of couples fall into these categories, as desiring to conceive but being able to.
Fertility rates, and live birth rates, are quickly declining in many regions of the world. Part of the reason for this decline may be due to socioeconomic factors – compared to the late 1800s, many more women are as professional and career driven as their male significant others, and many are choosing to delay childbearing until later in life when their career success has been solidified. Unfortunately, the fertility rates also decline as childbearing is delayed until later in life. Environmental changes have occurred as well, as dietary staples in many parts of the world have become more processed and less healthy, which may be hormonally effecting these trying to conceive. These socioeconomic and environmental factors have had several unintended fertility consequences (sperm counts in the average male have decreased by 50% over the past 40 years). Compared to the last 1800s, men are now producing only half of the sperm as their ancestors did. In women, rates of polycystic ovarian syndrome (PCOS), endometriosis, diminished ovarian reserve (DOR), and premature ovarian failure are all on the rise.
These effects can be seen on the epidemiological (population based) level. In Japan, 1 in 6 women are infertile (17%), and the government has responded by increasing subsidies for having children and covering assisted reproductive therapy (ART) costs at a national level. In Europe, 10% of all live births come from women who conceived through ART. In Hungary, they have made it a national priority to increase the live birth rate to stop the hemorrhage of population decline, and they have eliminated the need to pay income tax for women who have >4 children.
In Europe, Asia, and North America, infertility rates and the need for assisted reproductive therapy are on the rise.
With the increase in these numbers, the frequency and availability of in-vitro fertilization (IVF), intra-uterine insemination (IUI), and medical treatments have increased as well. These can be expensive procedures which may or may not be covered by traditional medical insurance plans. It is important to be aggressive during early stages of the fertility journey to reduce or eliminate detrimental risk factors (tobacco, alcohol) and implementing helpful supplements (Vitamin C, NAD+, COQ10, Glutathione, Vitamin D3, Fish Oil,) and lifestyle changes (exercise) which can improve individual chances of success, reduce stress for participating couples, and reduce overall costs.
Fertility levels decline with advancing age. This may be related to an age related decline on the concentration or function of mitochondria and energy (ATP) production in the egg cells.
One important avenues for fertility health include the incorporation of supplements which have anti-oxidant properties (reduce free radical burden), and either directly or indirectly improve energy production at the level of the organ of interest (testes and ovaries). At ASAP IVs, we have research and implemented two different IVs for this purpose, of delivering near maximal benefits of anti-oxidant therapies by providing them in an intravenous form (see our IVs for the ASAP Fertility IV and the NAD+ IV). We prefer to combine these with several oral supplements as well, which can help the body retain several other helpful supplements which can be taken in a daily form.
A recent advance in fertility therapy includes low level laser light therapy, or LLLT (also called photobiomodulation). This has been explored in several studies to analyze the impact at improving fertility outcomes by performing targeted treatments on the area of interest (testes areas in males, lower abdominal area to cover the ovaries in females). This article will “shed some light” (see what we did there?) on the science behind these claims and provide a rationale in why we are including them as a therapeutic service with ASAP IVs.
Introduction to Low Level Laser Light Therapy (LLLT)
Low level laser light therapy is a novel, non-invasive treatment modality for improving fertility. It is considered a type of ART, but is much less invasive than medication management, IUI, or IVF. Although not considered a “definitive treatment” it is also much cheaper than traditional IUI/IVF treatments, and it is easy to be implemented alongside existing treatment protocols and therapies without adversely impacting their success rates. Over recent decades, there has been an increasing amount of published literature on benefits of LLLT for different body systems (skin health, chronic pain, wound healing, etc.). More recently, the application of LLLT for benefiting fertility has been more directly examined through publications from Japan and Denmark.
What is the Mechanism for Red Light or Infrared Light Therapy (LLLT)?
To better understand how red and infrared light therapy can potentially serve fertility benefits, it is important to acknowledge how they may work at a cellular level. As a reminder to 6th grade biology class, the mitochondria is an important organelle located in every cell of our bodies. It is the “powerhouse” of the cell and performs the critical functions for the maintenance of life. The purpose of all life is to produce adenine triphosphate, or ATP. ATP is the energy unit backbone which every cell in the body uses to function. Without it, and life stops. ATP is generated directly by the mitochondria through the electron transport chain (ETC). The ETC uses several precursors (CoQ10, NAD+, Cytochrome C Oxidase being some of the important ones) to utilize oxygen and product ATP. ATP production is extremely important for highly metabolically active cells such as sperm and egg cells. Most human cells have around ~2000 mitochondria, but human egg cells have as many as 600,000!
The benefits of red and infrared light therapy occur at this cellular level in the mitochondria. This “photobiomodulation” occurs when specific wavelengths of light (between 600nm and 850nm) are transmitted externally to the mitochondria leading to improved function and ATP production. During and after a LLLT treatment session, there is a cellular increase of nitric oxide (NO). At the tissue level, nitric oxide will promote vasodilation (increasing the luminal diameter of a blood vessel, which thereby increases blood flow). This can increase regional blood flow to an area of interest, such as the testes or the ovaries. At the cellular level red and infrared light therapy can dissociate NO from Cytochrome C Oxidase, which disinhibits the enzyme and allows it to better utilize oxygen, participate in the ETC, and create ATP. These are two of the potential mechanisms of action typically characterized of LLLT, but there many be others which are discovered with further research.
It is important to note that although these are the regional or localized effects of LLLT, there are systemic effects as well. The increased NO production can promote vasodilation of the coronary arteries, subtly improving coronary blood flow and perfusion of the myocardium as well. Application to the neck can result in systemic release of beneficial hormones, which can be harnessed for directed treatments.
Female Fertility Benefits with LLLT
Causes of infertility can be attributed to either the male or the female. Approximately 50% of the time this can be attributed solely to female reproductive issues, 30% of the time solely to male issues, and 20% to a combination of female and male issues to varying degrees.
Diagnosing the problem is not always straightforward. There can be any number of physiologic or anatomic derangements which can impact fertility. At an anatomical level, the ovaries can be absent (surgically resected due to cancer or trauma, or congenitally missing), the fallopian tubes can be blocked or disrupted (from prior tubal ligation or from pelvic inflammatory disease), the uterus can be unable to effectively receive a suitable embryo (scarring, fibroids), or endometriosis can be effecting any of the above. At a physiologic level, there can be disruptions of proper hormone release resulting in issues with egg quality or follicle development. Further, in some cases, the cause of infertility can be completely unexplained. These can be dramatically psychologically troubling and can come to effect many aspects of life outside of being unable to conceive.
With the population declining and increasing rated of fertility issues, Japan is a world leader in IVF applications, research, and development. One area of research has been the study and application of LLLT towards female fertility enhancement.
With the goal of augmenting female fertility, the organs of interest are all deep structures (ovaries, uterus, fallopian tubes, thyroid, brain). These are not located at the surface like the male testes, and thus it is more important for the quality of light being delivered to be such a wavelength that enables deeper tissue penetration. For this optimal penetration, the wavelength should be higher, around 720-840nm, which corresponds to the infrared spectrum of light.
When looking at female fertility specifically, the primary targets are the uterus, ovaries, fallopian tubes and general hormonal systems (thyroid, brain, etc.). All of these tissues are inside the body (unlike male reproductive parts), and so the type of light with the best penetration is necessary, as only a small percentage of the light hitting the skin will penetrate down into tissues like ovaries. Even with the wavelength that gives the optimal penetration, the amount that penetrates is still very small, and so a very high intensity of light is required as well. Specifically, 830nm has been studied for effects on female fertility (1-6).
LLLT on the Neck Treatment for Women
Early Japanese studies were based on the “proximal priority technique”, which is that the brain (specifically the hypothalamus and anterior/posterior pituitary) is the “master hormonal regulator” of the body. The proximal priority technique targets the central application of LLLT to have downstream release of hormones and effects. In one study, the author Oshiro used 830nm near infrared light on the neck of infertile women (1). They looked at women with a history of severe infertility and unsuccessful ART (over 9.13 years on average) between 1996 and 2012 (total of 701 women). Their intervention was the use of 830nm LLLT to the neck (for an average of ~21 sessions) and found that after treatment, pregnancy was achieved in 156/701 patients (22.3%) resulting in 79 live births (79/156 clinical pregnancies, or 50.1%). There were no adverse effects noted from treatment. These are helpful results for a non-invasive treatment.
Following on from the studies using light on the neck, researchers were interested in whether or not light therapy might improve the success rates of natural pregnancies and IVF.
In vitro fertilization is known as a last resort when traditional methods of conception have failed. The cost per cycle can be very high, even unfeasible for many couples, with others taking out loans as a gamble to fund it. The success rates of IVF can be very low, especially in women aged 35 years or more. Given the high cost and low success rate, improving the chances of an IVF cycle is critical to achieve the goal of pregnancy. Eliminating the need for IVF and getting pregnant naturally after failed cycles is even more appealing.
Implantation rates of the fertilized egg (critical for both IVF and regular pregnancy) are thought to be related to mitochondrial function (8). Lower performing mitochondria hinder the functioning of the egg cell. The mitochondria found in egg cells are inherited from the mother, and can have DNA mutations in certain women, especially as age advances. Red and near infrared light therapy work directly on the mitochondria, improving the function and reducing issues like DNA mutations. This explains why a study from Denmark showed that two-thirds of women who previously had failed IVF cycles achieved a successful pregnancy (even natural pregnancies) with light therapy. There was even a case of a 50 year old woman getting pregnant.
LLLT on the Abdomen Treatment for Women
Alternative to the “proximal treatment technique”, a group out of Denmark has explored the application of LLLT to the lower abdomen for women. In this study by Grinsted and Hillegass, they evaluated their treatment protocol in 400+ women (7). Their protocol consisted of:
Treatment starting on first day of menstruation, totaling 6 treatments over the course of 2 weeks with attempted insemination occurring at day ~12-14 (with ovulation).
If conception did not occur (natural or artificial) another treatment course is started on the first day of the next menstruation.
Treatment consists of 23 minutes of 20,000 Joules (15k Joules of near infrared light at 808nm plus 5k Joules of red light at 660nm) placed 1-2 cm above the skin with an area of 500cm2.
They noticed no adverse effects or discomfort for any patient in the study. In their study, they had 400+ patients with a diagnosis of infertility (who had tried dietary changes, exercise, hormonal treatments, IUI, IVF, ICSI) and an age range of 34-50. With their protocol they saw 260 pregnancies (260/400 or ~65%). With promising information like this (combined with emerging evidence of NAD+ therapy) it would appear that declining egg quality with age is not an entirely irreversible process.
Another protocol (used in the study by El Fasham et al.) utilized 635nm wavelength of light (red light ranges) applied to the abdomen in treatment intervals of 16 minutes, delivering 4.27J/cm2 of energy per treatment in Group A and divided into three equal sessions in Group B (26). Both study groups showed statistically significant improvements in number of endometrial cells and gene expression compared to controls. They postulated that LLLT to the lower abdomen can improve the proliferative and functional capacity of endometrial cells of the inner lining of the uterus (which can be helpful for embryo transfer success).
Mechanisms of these benefits have been explained through the improvement in age-related declines in egg function through improved mitochondrial function. Without adequate mitochondrial function, egg cells are not able to generate sufficient levels of ATP for their many processes, and they are rendered unable to grow, divide or implant (8). It is possible this may be a key explanation for most cases of unexplained infertility, and is also paralleled by fertility rate declines with advancing age. Red and near infrared light (<850nm) both improve mitochondrial health. Of cells in the body, egg cells may benefit more from the effects of red and infrared light therapy than any other.
Male Fertility Benefits with LLLT
Male factor infertility is the sole cause of being unable to conceive in around ~20% of couples. When combined with the 30% of infertility causes which are a combination of male and female issues, around half of all infertility related problems can be improved by boosting male sperm production and performance. Male infertility is defined as oligospermia (sperm density <20 million/mL), asthenozoospermia (<50% showing progressive motility), or teratozoospermia (<15% normal morphology). There are many causes of male factor infertility, such as prior vasectomy, injury to or disruption of the vas deferens, autoantibodies against sperm, low testicular function, central hypogonadism, and many other environmental or genetic factors. Trauma, cancer or cancer treatment, or significant infections can all permanent damage to the testes and their ability to produce sperm. Environmental effects like cigarette smoking and heavy alcohol consumption can each have exceedingly negative effects on conception. The presence of smoking by the male or the female can decrease IVF success by 50% (17).
However, even though there are many causes of male infertility and environmental interactions which can damage sperm production, there are supplements which can be taken which can improve sperm production and function (carnitine, zinc). Red light therapy has also been recently studied as a novel treatment to improve male reproductive parameters. We will look at some of the studies below.
LLLT and Male Fertility Benefits
Sertoli cells are the important part of the testes which are essential for the formation of testicular tissue and the process of spermatogenesis. They directly facilitate the progression of sperm cells from germ cells to spermatozoa, and controlling the microenvironment of the seminiferous tubules. Put simply, they are the manufacturing plant of sperm in the testes. The proper function of Sertoli cells are integral for male fertility and proper sperm counts and concentration. These are also packed with mitochondria, and as we learned through the above discussion of eggs, mitochondrial function is incredibly important.
Red light therapy has been studied in male for its ability to stimulate the mitochondria of Sertoli cells. These light therapy treatments involve the application of red and infrared light to the lower abdomen or testes to improve these parameters. Most studies have investigated red light at 670nm as the treatment of choice for the testes. They are a more superficial organ, and the light doesn’t need to penetrate the tissue as deeply as it does for the ovaries for beneficial effects to be seen.
The studies have looked at the ability for red light therapy to improve the amount, concentration, and motility of sperm cells before and after treatments. The results have been pretty dramatic, often with as little as a single treatment.
Grinsted and Hillegas looked at the effects of red light therapy in men (7). Their treatment protocol is as follows:
Single treatment session with near infrared laser light at 808nm
Lights are placed 1-2 cm above the testicle.
Each testicle received two 10 second treatments, for a total dose of 10 Joules per testicle.
Although their results are not from a robust study, they reported that they have seen sperm concentrations increase from 2 million/mL to 40 million/mL with a single treatment. This kind of robust result seems difficult to believe, but even if partially true, with a lack of harmful effects it would seem as though this therapy should be performed on every male before sperm collections for IVF.
Another study by Frangez et al. (11) looked at the effects of different wavelengths at how they impact sperm motility. In their study, they treated sperm directly after the sample was collected, as opposed to treating the sperm while they are in the testes. They treated donated sperm with several different wavelengths:
850nm
625nm, 660nm, and 850nm
470nm
625nm, 660nm, and 470nm
Following treatment, they looked at the percentages of motile sperm and sperm kinetics. They saw statistical improvements from all treated categories. LED significantly increased the proportion of rapidly progressive sperm (mean differences were as follows: 2.83 (1.39-4.28), 3.33 (1.61-5.05), 4.50 (3.00-5.99) and 3.83 (2.31-5.36) for groups 1-4, respectively) and significantly decreased the ratio of immotile sperm (the mean differences and 95% CI were as follows: 3.50 (1.30-5.70), 4.33 (2.15-6.51), 5.83 (3.81-7.86) and 5.50 (2.98-8.02) for groups 1-4, respectively). They found that photobiomodulation therapy using LED improved sperm motility regardless of wavelength chosen.
Increasing the amount and concentration of sperm delivered in an ejaculate, especially ones that have increased motility and improved movement, would directly increase the chances of conception, either naturally or through IVF.
Summary of Fertility Benefits for LLLT
Many different studies have evaluated red light and infrared light therapy on potential fertility benefits in males and females.
All aspects of reproduction in males and females have cells performing lots of cellular metabolism, require a lot of cellular energy to be produced, and have lots of mitochondria for this purpose (mitochondria and ATP production may decline as eggs age).
Near infrared light (830nm) has deeper tissue penetration and delivers a better dose in women due to deeper location of ovaries and uterus.
Red light therapy (620-670nm) in short treatments, even in as little as a single treatment session, improves mitochondrial energy production in the Sertoli cells, which leads to increased sperm counts, quality, and motility
References
Personal Overview of the Application of LLLT in Severely Infertile Japanese Females. Ohshiro. 2012
Treatment Of Female Infertility Incorporating Low-Reactive Laser Therapy (LLLT): An Initial Report. Iwahata et al. 2005
The Proximal Priority Theory: An Updated Technique in Low Level Laser Therapy with an 830 nm GaAlAs Laser. Ohshiro. 2012
Analysis of the curative effect of GaAlAs diode laser therapy in female infertility. Taniguchi et al. 2010
Proximal Priority Treatment Using The Neck Irradiator For Adjunctive Treatment of Female Infertility. Fujii et al. 2007
A case where low reactive level laser therapy was thought to be extremely effective in the treatment of female infertility. Fujii et al. 2004
PhotoBioModulation for Infertility. EC Gynaecology 8.9. 2019
Why do older women have poor implantation rates? A possible role of the mitochondria. Bartmann et al. 2004
Sperm motility enhancement with low level laser therapy. Harrison et al. 2008
Effect of 830-nm diode laser irradiation on human sperm motility. Yazdi et al. 2014
Photobiomodulation with light-emitting diodes improves sperm motility in men with asthenozoospermia. Frangez et al. 2015
Photobiomodulation with 810 nm Wavelengths Improves Human Sperms’ Motility and Viability In Vitro. Safian et al. 2020
Effectiveness of low level laser therapy for treating male infertility. Moskvin et al. 2018
Red light improves spermatozoa motility and does not induce oxidative DNA damage. Preece et al. 2017
Photobiomodulation therapy for male infertility. Zupin et al. 2020
The Possible Application of low Reactive-Level Laser Therapy (Lllt) in the Treatment of Male Infertility. Hasan et al. 1989.
The Effects of Cigarette Smoking on Male Fertility. Kovac et al. 2016
Effect of 655-nm diode laser on dog sperm motility. Corral-Baqués et al. 2005
The effect of low-level laser irradiation on dog spermatozoa motility is dependent on laser output power. Corral-Baqués et al. 2009
The Effects of Red Light on Mammalian Sperm Rely upon the Color of the Straw and the Medium Used. Catalán et al. 2021
Red-Light Irradiation of Horse Spermatozoa Increases Mitochondrial Activity and Motility through Changes in the Motile Sperm Subpopulation Structure. Catalán et al. 2020
Photobiomodulation improved stereological parameters and sperm analysis factors in streptozotocin-induced type 1 diabetes mellitus. Dadras et al.2018
Low level laser therapy (LLLT) modulates ovarian function in mature female mice. Oubiña et al. 2019
Red LED Light Acts on the Mitochondrial Electron Chain of Donkey Sperm and Its Effects Depend on the Time of Exposure to Light. Catalán et al. 2020
Amelioration of heat stress-induced damage to testes and sperm quality. Shahat et al. 2020
El Faham, D. A., Elnoury, M., Morsy, M. I., El Shaer, M. A., Nour Eldin, G. M., & Azmy, O. M. (2018). Has the time come to include low-level laser photobiomodulation as an adjuvant therapy in the treatment of impaired endometrial receptivity?. Lasers in medical science, 33(5), 1105–1114. https://doi.org/10.1007/s10103-018-2476-y