In our current culture, we still associate “reproductive health” as a “woman’s issue,” and that “fertility planning” applies only to “her.” This fallacy is distracting our attention from the role that male factors contribute to infertility. While we have gynecologists to manage women’s fertility problems and a small club of urologists and andrologists for managing the less-common fertility problems, we do not have a parallel equivalent/ specialization for men’s reproductive health.
Although fertility problems are equally shared between men and women, (35-40%-female; 35-40%-male, and 20-30%-shared or unexplained), medical practice and technology are more invested in “treating” the bodies of women, as they are the ones who get pregnant and deliver babies. Decades of research and high-tech wizardry have aided in the development of treatment protocols for women, while ignoring the equally-pressing need for research and treatments for men. Is it carelessness or indifference that explains why the medical and public health communities are not sounding the alarm about the number one cause of male infertility- poor sperm quality (motility and morphology) and a steep decline in male fertility?
Some respected researchers are sounding the alarm (about the infertility crisis) but few are listening, perhaps because the assisted reproduction technology (ART) marketplace has turned into a $21 billion industry! Sperm counts have dropped by more than 50 percent in the last 50 years. Erectile dysfunction is increasing and testosterone levels are decreasing. Which is why it behooves us to bring men into the conversation and to start promoting low-tech ways to improve male fertility and health, particularly sperm quality.
First, don’t take fertility for granted, Contrary to what many people believe, our fertility status and our overall health go hand-in-hand. Paying attention to lifestyle is a first step to taking responsibility for reproductive health:
Genital heat is a form of stress which poses a serious risk for male infertility. Normal body temperature is about 37 degrees. Sperm functions efficiently at 32 degrees. Therefore it is important to take regular breaks from driving or prolonged sitting which can raise the temperature of the pelvic area. Likewise, sitting in hot tubs or saunas on a regular basis should be avoided. Wear loose-fitting clothing and underwear.
Avoid keeping cell phones in pant pockets or near the pelvic area. Working for a prolonged time with laptops on the knees is also problematic. Research is accumulating that these devices emit heat and low-dose radiation to the most sensitive party of the body. These accumulated exposures can impair sperm quality by increasing oxidative stress. A recent study has also found that smartphone and tablet light emissions used in the evening and after bedtime was correlated with a decline in sperm quality.
If you are not in a long-term, committed relationship, always have safe sex. Exposure to sexually transmitted diseases and other infections can raise the risk for fertility problems.
Some medications can harm sperm quality. These include several types of antibiotics, hormonal medications, steroid blood thinners, antifungal medications, acetaminophen, high doses of painkillers (which lower testosterone levels and disrupt the hormonal system). It can take up to six months for this effect to clear up. Non-steroidal anti-inflammatory drugs are considered safer but there are studies and a growing consensus that these drugs too can harm sperm. Many men unknowingly use steroids to strengthen body muscles which can lead to testicle shrinkage and reduce sperm formation. A physician should always be consulted before using these medications.
Heavy and binge drinking can cause hormonal havoc and sperm damage. Alcohol interferes with the secretion of testosterone (a primary male hormone) and it accelerates the process of converting testosterone to estrogen, and reduces sperm count as well as libido. The byproducts of alcohol metabolism and breakdown are toxic to semen. Studies show that alcohol consumption (more than 10 units/drinks per week) can lower sperm volume, motility, concentration and morphology. For men wanting to have children, it is recommended to abstain from alcohol six months before trying to conceive.
Smoking increases the amount of free radicals that damage cells in the body, including sperm cells. Smoking reduces sperm count and motility and increases the number of abnormal sperm – their shape and size. The use of recreational and medical cannabis is on the rise and many studies have found that using marijuana more than once a week can lead to up to a 30% reduction in sperm count and concentration. This effect can last for many weeks or months after cessation. Cannabis interferes with LH (luteinizing hormone) which regulates testosterone levels. Long term use is associated with testicular atrophy (which causes the testes to shrink) and with erectile dysfunction.
While studies have been inconsistent and inconclusive, some researchers believe that high doses of caffeine consumption may impair reproductive function as a result of sperm DNA damage, particularly from cola-containing beverages and energy drinks. Some studies have also found that coffee drinking is associated with a prolonged time to pregnancy.
The importance of nutrition cannot be overstated. In order to function properly, a man’s reproductive system requires a balanced and sufficient intake of vitamins and minerals. Many of the key components of semen, essential for proper sperm production, maturation and function, are sourced from food. Nutritional deficiencies can impair hormonal activity, slow sperm production and increase the probability of sperm damage. A (Mediterranean) diet rich in fresh fruits and vegetables, whole grains, fish, chicken, legumes, olive oil, nuts and seeds is recommended. Processed foods should be avoided, together with white flour, sugars, fried foods, saturated fat, trans fat, and margarine. Organic is preferred. Best to replace saturated and trans fats with olive oil. For those with restrictive diets (e.g. keto, vegan or vegetarian), consulting with a nutrition professional is recommended.
Many foods can cause damage to sperm and fertility, including processed meats, trans fats, high-fat dairy (estrogenic) and excessive soy products (phyto-estrogenic). Pesticides end up in our food because they are used in industrial agriculture and taint our fruits and vegetables. Pesticides and herbicides like DDT, phthalates, and other contaminants found in food and water can also impair sperm quality. Another common chemical, bisphenol A (BPA) is a plastic absorbed in the body because it is used in food packaging and canned products. More than 90% of people in western countries have detectable levels of BPA in their urine. Both BPA and pesticides mimic the hormone estrogen, and this “endocrine disruption” can damage sperm concentration and quality. More high-quality studies are needed to confirm this effect.
Sperm quality can be enhanced by drinking water based on body weight. For example, a man weighing about 70 kg should drink at least 2 liters of water per day.
Studies show that various supplements can increase sperm count and motility. Certain vitamins and minerals are essential for sperm production. Vegans and vegetarians should take extra precaution to make sure their bodies are getting the necessary nutrients for fertility. Here is a list of vital, fertility-enhancing nutrients:
Eating the right foods can eliminate the need to purchase expensive antioxidants. An abundance of fruits and vegetables, preferably organic, provide good sources which contribute to sperm quality. Free radicals are responsible for about 40% of damaged sperm so recommended antioxidants are: vitamin C or E, beta carotene, selenium, zinc, blueberries, pomegranates, strawberries, sugar-free dark chocolate, garlic, cabbage, kale, sprouts, broccoli, red pepper, and grape seed extract.
Amino acids are the building blocks of protein and play an important role in hormone synthesis. They are vital in the production of ovarian follicles and sperm. L-arginine is one of the important amino acids necessary for sperm formation. Food sources include meat, fish, eggs, dairy products, lentils, peas, beans, nuts, whole rice, sunflower seeds, pumpkin seeds and quinoa.
Vitamin A is important for sex hormone production. It’s antioxidant properties help protect sperm from free radicals. Vitamin A deficiency impairs sperm count and increases the number of sperm cells with abnormal morphology (shapes and size). Good food sources are: eggs, yellow vegetables and fruits, whole (fat) dairy products, green beans and fish oil.
When combined with zinc, vitamin B6 is an essential ingredient in the production of sex hormones. Food sources include: molasses, brewer’s yeast, nuts, whole grains, whole rice, meat, egg yolk, fish, leafy green vegetables, seeds, and legumes.
Folic acid and vitamin B12 are essential for DNA and RNA synthesis. Low levels can cause disruption in sperm cell development, causing abnormal sperm, low sperm count, and low vitality. It is recommended to consume about 1000 mcg of B12 per day, especially if one’s sperm count is less than 20 million per ml or with a motility rate less than 50%. Food sources include: meat, sardines, and salmon. Calcium aids in good absorption. The recommended dose of folic acid is 400 mcg per day. Food sources include: leafy green vegetables, broccoli, meat, brewer’s yeast, root vegetables, whole grains, salmon, milk, asparagus, legumes, oats and avocados.
Vitamin C is an antioxidant that helps protect against free radical damage. It is important for the production of sperm. Low levels increase the risk of birth defects. Studies show that vitamin C prevents sperm cells from sticking to each other which improves sperm count and motility. Recommended dose is at least 500 mg per day. Food sources include: citrus fruits, cherries, alfalfa sprouts, strawberries, broccoli, tomatoes, peppers, mangoes, kiwis, pineapples, asparagus, peas, parsley, and spinach.
Vitamin E is an antioxidant that helps protect sperm cells. Because vitamin C improves the production of vitamin E, they can be taken together. Taking vitamin E for three months can significantly improve the chance of conception. Vitamin E deficiency can lead to testicular tissue degeneration. The addition of vitamin E will increase sperm motility and its ability to penetrate the egg. The recommended dose is 400 IU per day.
Zinc deficiency is common. Zinc is found in the outer layer of sperm cells and is vital for cell division and sperm production. It is also the most important mineral in sexual function. It is essential for testosterone metabolism, testicular growth, sperm motility and sperm count. Zinc also reduces excess estrogen. In each ejaculation, an average of 5 mg of zinc is lost. The recommended dose for improving sperm quality is 30 mg per day in two doses of 15 mg, combined with 1 mg of copper. Recommended food sources: meat, fish, eggs, pumpkin seeds (½ cup per day) and sunflower seeds, oats, rye, whole grains, ginger, parsley, and mushrooms.
CoQ10 is an antioxidant that your body produces naturally. Your cells use CoQ10 for growth and maintenance. It provides energy to the body, which is needed to produce sperm. Healthy men are supposed to produce about 1500 sperm cells per second in each testicle. Over time, the energy in the testicles decreases because the amount of the Q10 decreases. Studies have shown that men who started taking Q10 can see an up to 80% increase in sperm production output, after only four months. Q10 also helps to optimize sperm motility so it can reach the egg in the fallopian tube. 10 mg per day is the recommended dose. .
EFA’s are very important for those trying to get pregnant. These acids play an important role in regulating hormones. They are a vital component in normal cell membranes and the sperm itself contains a high level of omega 3 (recommended use: 1000 mg of omega 3 per day, or about 2000 mg of fish oil per day). Omega 3 sources include: fish oil (herring, mackerel, salmon, tuna, sardines), flax seeds/oil, nuts and seeds, and green leafy vegetables. EFA’s are also found in omega 6; sources include: meat, poultry, eggs, soy, nuts and seeds.
The use of herbs can contribute to improving fertility and sperm quality. Best to work with a professional.
It is time for the medical and public health communities to acknowledge the importance of men’s reproductive health and their contribution to the infertility crisis. It is time for men to step up and take responsibility for their part in the equation. There is urgent work to be done, with an emphasis on fertility awareness and education, about age and the male biological clock, about the connection between healthy sperm and longevity, about modifiable, behavioral risk factors, nutrition and lifestyle. It is time to recognize that men’s health and men’s reproductive health matters, not only for their lives, but for their relationships and plans to build future families.
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