What are the recommendations for improving male fertility health?

Recommendations for Male Fertility Health

Lifestyle changes including weight loss, physical exercise, and smoking cessation are strongly recommended as they enhance sperm parameters and improve overall health of men seeking fertility. 1

Diagnostic Evaluation

A proper fertility evaluation should be performed in couples who have not conceived after 12 consecutive months of regular, unprotected intercourse 1. This evaluation should include:

• Reproductive history
• Physical examination
• Semen analysis (at least two tests, one month apart if first is abnormal)
• Hormonal evaluation (FSH, LH, testosterone)

Semen Analysis Parameters

Clinicians should understand that WHO lower limits of semen parameters are based on the lowest fifth centile of values for fertile males 1:

• Volume: 1.5-5.0 ml
• pH: >7.2
• Sperm concentration: >20 million/ml
• Total motile sperm count: >5 million

Evidence-Based Interventions

1. Lifestyle Modifications

Lifestyle modifications are the cornerstone of improving male fertility and should be implemented first:

• Weight management: Obesity is associated with hormonal imbalances and decreased sperm quality 1, 2
• Smoking cessation: Tobacco use damages sperm DNA and reduces sperm count 1, 3
• Moderate alcohol consumption: Excessive alcohol impairs spermatogenesis 3
• Regular physical activity: Improves sperm parameters but avoid excessive exercise 1, 2
• Avoid excessive testicular heat: Limit hot baths, saunas, tight underwear, and prolonged sitting 3, 4

2. Dietary Recommendations

Strong evidence supports specific dietary patterns for male fertility:

• Follow a Mediterranean-style diet: Rich in fruits, vegetables, whole grains, fish, poultry, and nuts 5, 6

• Increase consumption of:

  • Seafood and fish (rich in omega-3 fatty acids)
  • Poultry
  • Nuts and seeds
  • Whole grains
  • Fruits and vegetables
  • Low-fat dairy products 5, 6, 7

• Reduce consumption of:

  • Processed meats
  • Full-fat dairy products
  • Sugar-sweetened beverages
  • Excessive caffeine
  • Red meat 7

3. Antioxidant Therapy

Oxidative stress is a significant contributing factor to male infertility:

• Evidence for antioxidant therapy is mixed but may be beneficial 1, 2
• A Cochrane review showed antioxidant therapy may improve live birth rates, though evidence quality was low 1
• Consider antioxidants such as:
  • Vitamin E
  • Vitamin C
  • Selenium
  • Zinc
  • Lycopene 6, 7

4. Prebiotic and Probiotic Supplements

Recent evidence shows promise for gut health interventions:

• An RCT demonstrated significant increases in sperm concentration, motility, normal morphology, and DNA integrity with prebiotic/probiotic supplementation 1, 2
• However, more high-powered studies are needed to confirm these findings 1

5. Hormonal Treatments

For specific hormonal issues:

• Secondary hypogonadism: hCG therapy with or without FSH is well-established and results in sperm production in 75% of cases 1, 2
• Selective estrogen receptor modulators (SERMs): May increase pregnancy rates and improve sperm parameters, but evidence quality is low 1, 2
• Aromatase inhibitors: May increase endogenous testosterone production and improve spermatogenesis 2

Special Considerations

Infections and Antibiotics

• Treatment of asymptomatic Chlamydia infection may improve sperm parameters 1
• Antibiotic therapy is recommended only for chronic bacterial prostatitis (type II) 1
• Refer sexual partners of patients with sexually transmitted infections for evaluation and treatment 1

Cardiovascular Health

Infertile men are at higher risk of developing cardiometabolic disorders and have higher cardiovascular mortality compared to fertile men 1, 2. Therefore:

• Screen all infertile men for modifiable cardiovascular risk factors
• Use fertility evaluation as an opportunity to address overall health

Common Pitfalls to Avoid

1. Relying on a single semen analysis: Parameters fluctuate substantially; at least two analyses are recommended 1

2. Trusting point-of-care or mail-in semen tests: These may provide some information but cannot substitute for comprehensive laboratory analysis 1

3. Overlooking the connection between fertility and overall health: Male infertility may be an early warning sign of other health issues 1, 2

4. Delaying evaluation: Begin fertility assessment after 12 months of unsuccessful attempts (or sooner if risk factors are present) 1

5. Focusing only on the female partner: Male factors contribute to approximately 50% of infertility cases 1