How to improve fertility and semen quality in men?

From the Guidelines

To improve fertility and sperm quality in men, focus on lifestyle modifications and targeted interventions, as recommended by the most recent guidelines from the American Urological Association (AUA) and the American Society for Reproductive Medicine (ASRM) 1.

Key Lifestyle Modifications

• Maintain a healthy weight through regular exercise (at least 150 minutes of moderate activity weekly) and follow a balanced diet rich in antioxidants from fruits, vegetables, nuts, and fish.
• Limit alcohol to no more than 2 drinks per day, quit smoking completely, and avoid recreational drugs.
• Reduce stress through mindfulness practices and ensure 7-8 hours of quality sleep nightly.
• Keep testicles cool by avoiding hot tubs, saunas, and tight underwear.

Targeted Interventions

• Consider supplements like CoQ10 (200-300mg daily), zinc (15-30mg daily), folic acid (400-800mcg daily), and vitamin D (1000-2000 IU daily) after consulting a healthcare provider.
• Limit exposure to environmental toxins by avoiding plastics containing BPA and reducing pesticide exposure.
• If trying to conceive, have intercourse every 2-3 days throughout the month, particularly during the fertile window.

Medical Interventions

• For men with hypogonadotropic hypogonadism (HH), treatment with exogenous gonadotropins or pulsatile GnRH may be effective in initiating spermatogenesis and achieving pregnancies 1.
• For men with low total motile sperm count, assisted reproductive techniques (ART) such as in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) may be considered 1.

Importance of Consultation

• If no improvement occurs after 3-6 months, consult a fertility specialist for further evaluation and potential medical interventions.
• Clinicians should inform patients that the benefits of supplements are of questionable clinical utility in treating male infertility, and that existing data are inadequate to provide recommendations for specific agents to use for this purpose 1.

From the Research

Improving Fertility and Semen Quality in Men

To improve fertility and semen quality in men, several factors can be considered:

• Lifestyle modifications:
  • A healthy diet rich in fruits, vegetables, whole grains, and lean proteins 2
  • Smoking cessation and moderate alcohol consumption 3
  • Regular exercise 3
• Medical treatments:
  • Selective estrogen receptor modulators and gonadotropins to enhance sperm parameters 3
  • Aromatase inhibitors and phosphodiesterase-5 inhibitors to improve sperm motility and increase pregnancy rates 3
  • Antioxidants, such as vitamins E and C, and coenzyme Q10, to reduce oxidative stress and enhance sperm counts, motility, and morphology 3, 4, 5
• Nutrient supplementation:
  • Antioxidant supplements, such as carnitine, vitamin C, vitamin E, selenium, carotenoids, glutathione, N-acetylcysteine, zinc, folic acid, and coenzyme Q10, to improve semen parameters and pregnancy rates 5
  • Mixed fruit and vegetable juice concentrates to increase serum antioxidants and folate 6
• Combination therapy:
  • Combining antioxidant and anti-estrogen therapy, such as vitamin E and clomiphene citrate, to improve sperm concentration and motility in patients with idiopathic oligoasthenozoospermia 4