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Factors influencing male fertility

ProFecund B: designed to stimulate male fertility

Factors influencing male fertility

There are three important characteristics of sperm quality: sperm count, morphology and motility. For a pregnancy to occur, all three conditions must be fulfilled.

To make sure that a man is able to conceive, he should undergo a seminal fluid analysis called spermogram.

The spermogram describes seminal fluid using the three characteristics above and it sometimes considers other parameters, too. Most often, however, the following are assessed at first:

  • number of sperm cells per unit of volume
  • sperm morphology
  • sperm motility

A major factor of male infertility, found in about 50% of cases, is low sperm count, called oligospermia by physicians. Up to 90% of the cases of failure are due to low sperm count or quality, or both. Low quality can mean sperm malformations, low motility, damaged DNA and more. In the other 10% of cases, other factors are at play, including, for instance, anatomic problems, hormonal imbalance, genetic defects, or, sometimes, undiscovered factors.

If the spermogram does not show normal parameters, another analysis of the seminal fluid is performed, called sperm culture. Sperm culture aims to identify the possible existence of an infection of the testes, which may explain the change in the envisaged parameters.

Now let us talk about other factors that may influence male fertility.

Male age does not have a very important role when it comes to fertility. As opposed to women, who are born with a fixed number of eggs that age with time, men produce new sperm constantly after puberty. Moreover, the decrease in sperm quality in men occurs at a much older age and it is usually not problematic until the age of 60.

Although not as sudden or visible as the changes affecting women, there are, however, a series of changes related to fertility and the sexual function occurring in men as they age, but there is no maximum age limit up to which a man can procreate.

In elderly men, the testes tend to shrink and lose their firmness, and sperm morphology (shape) and motility (movement) tend to decrease, with a slight increase in the risk of genetic defects in their sperm. In addition, elderly men may develop medical conditions that have a negative impact on their sexual and reproductive function.

An elderly man’s sperm has a low potential of fertilising the egg compared to that of a younger man, but, if the egg is fertilised, there is no proof of poor embryo quality correlated with the man’s age.

It is equally important that men should improve their lifestyle before conception, not just women.

The quality and quantity of the available sperm are directly related to environmental factors, nutrition, health and lifestyle, which can be easily changed. An increasing number of studies have begun to show that fertility problems and birth defects are related to the man’s health. Men should do their best to invest in their own health, because it is also an investment in their fertility and their future child’s health.

The sperm formation process, for the sperm to be capable of fertilising an egg, lasts for 3 months. It is, however, recommended to adopt a conception friendly lifestyle at least three months before you decide to have a baby. Men’s awareness of the importance of this period and following pre-conceptive instructions will improve sperm volume and quantity, and the chances of healthy conception and a healthy baby will increase significantly.

The following are the main modes of action.


Research has increasingly shown that fertility is related to the health of both partners in a couple. Choosing a healthy, balanced diet is the first step you should take. There are a few key nutritive elements that directly influence male fertility.

  • LZinc is an important nutrient due to its contribution to sperm and testosterone production in men, thus influencing both the quality and the quantity of sperm produced. Consequently, men (and women, too) should have a daily intake of 15 mg of zinc. This dose can be obtained naturally from vegetables, eggs, whole grain cereals, walnuts, sunflower seeds, watermelon and dried fruit. Zinc can also be found in onions, red beet, peas and beans.
  • Vitamin C helps prevent sperm agglutination and increases sperm count. Vitamin C can be obtained by consuming vegetables and fruits, particularly strawberries, oranges, kiwi, mango and blueberries.
  • La vitamina E fa aumentare la quantità e la qualità di liquido seminale, specialmente se associata al selenio. La vitamina E può essere ottenuta dal consumo di olio di pesce, verdure a foglia verde, noci, tuorlo d’uovo, cereali integrali e oli raffinati.
  • Selenium can be found in eggs, whole wheat, carrots, mushrooms, tuna and broccoli.
  • Omega 3 fatty acids increase sperm quality and viability.
  • All these nutritive elements have been correlated with a healthy sperm production. Men should make sure they consume the daily recommended intake.

  • ProFecund B stimulates male fertility and supports normalisation of the reproductive function in men through a variety of mechanisms


    Overweight may affect male fertility. If you wish to conceive in the future, a healthy diet and regular physical exercise can stimulate fertility. To increase the chances of your partner getting pregnant and having a healthy baby, start a healthy diet plan and a regular physical exercise programme now.

    A common way of assessing whether a person is “overweight” or “obese” is the body mass index (BMI). It is calculated by dividing the person’s weight (in kilograms) to their height, expressed in metres squared. A healthy BMI range is 18.5 to 24.9. A BMI between 25 and 29.9 is “overweight”, and a BMI over 30 makes one “obese”.

    Overweight and obese men have low sperm quality compared to those of normal weight. The “quality” of being overweight or obese may also cause hormonal changes that reduce fertility and libido. Overweight men are much more likely to suffer from erectile dysfunctions. Excess weight on the hips and around the groin of an obese man brings the testes closer to the body temperature and makes them overheat, thus reducing sperm production. Together, these factors reduce the chances of overweight or obese men becoming fathers.

    Underweight may also reduce a man’s sperm quality and, therefore, his fertility. Persons with a BMI under 18.5 are classified as “underweight”.


    Smoking men need more time to conceive than non smokers and are more likely to have fertility problems. As smoking affects the genetic material in the eggs and sperm, miscarriage and congenital birth defect rates in babies are higher among smoking couples.

    Smokers may have low sperm quality, low sperm count, motility and a high number of abnormal sperm cells. Smoking could also reduce the sperm’s ability to fertilise the egg.

    In men, the toxic components in cigarette smoke affect three essential elements: local vascularisation, local innervation and a catalysing factor, an enzyme that acts in the penile vessels, leading to the formation of the main erection mediator – nitric oxide. The risk of infertility among smokers could be twice as high as that among non-smokers.

    The chemicals in tobacco may harm sperm DNA, which nature may reject for fertilisation. If, however, fertilisation occurs, the damaged sperm can increase the risk of miscarriage.


    There is little scientific evidence of the manner in which low to moderate alcohol consumption affects male fertility. People often have difficulty in reporting accurate alcohol consumption and it is difficult to conduct research isolating the impact of alcohol as an influencing factor of fertility.

    Not just women should mind their alcohol consumption when trying to conceive a child. Alcohol consumption also reduces male fertility; it can lead to impotence or low libido and may affect sperm quality. Alcohol may reduce testosterone level in men, which leads to lower libido. In addition, it can also affect sperm quality, structure and motility, by preventing proper hepatic vitamin A metabolism, a necessary vitamin for sperm development. Alcohol reduces zinc levels in the body, another essential element for good reproductive function.

    According to the current recommendation, you should not exceed three or four units of alcohol per day. Consumed within these limits, alcohol is unlikely to affect the quality of your sperm. Keep in mind that an alcohol unit is the equivalent of half a pint of beer, a glass of wine or 25 ml of spirits.

    Many of the effects of alcohol on reproduction are temporary, and the reproductive system will revert to normal when you stop consuming alcoholic drinks. However, regular excess alcohol consumption may lead to serious fertility problems in women and men alike. This includes excess alcohol consumption during the teenage years or in the early youth. In men, excess long term alcohol consumption may lead to testosterone deficit and shrinking testes. This may cause impotence, sterility, breast development, loss of facial and body hair, as well as an increase in fat around the hips.

    Physical exercise

    Moderate or even higher intensity physical exercise will increase erectile function in men and help prevent its decline with age. It can also increase sperm count and, therefore, chances of conceiving.

    New studies prove the existence of a connection between male fertility and physical exercise. Scientists have found that men engaging in moderate workouts (an hour of physical exercise, three times a week) have had better sperm analysis results than those who have chosen high intensity workouts.

    Some of the most recent discoveries in fertility show that regular average-intensity workouts can act as an antioxidant, as they teach the body to improve its antioxidant enzyme production. However, when the effort is extremely intense or when we do not spare enough time for the body to recover, cellular degradation may occur as a consequence of oxidative stress.


    As we were saying, in men and women alike, recent research has proven that stress increases stress hormone levels, such as adrenaline, noradrenaline and cortisol. They may inhibit the secretion of gonadotropin-releasing hormone (GnRH), the main hormone responsible for the release of sex hormones. Subsequently, this may suppress ovulation in women or reduce sperm count in men, decreasing libido in partners of both sexes.

    The effect of stress on male fertility has been assessed in a study whose results were published in 2014. It monitored the relation between experiencing two or more stressful events in the past year and seminal fluid motility, shape and concentration. It was found that stressed men produce lower concentrations, and their sperm often had morphological defects or lower motility. What is interesting is that it was found that such negative effects were amplified by the stressful events in the life of those individuals, while stress at work did not seem to be related to seminal fluid quality. However, stress at work was associated with a decrease in testosterone levels, which may affect the health of the reproductive system.

    A decrease in fertility, generally due to stress, has thus become such a common issue that it even got its own specific name: stress-induced reproductive dysfunction.

    What can you do, whether you’re a man or a woman, to fight against the additional stress caused by the fact that you want a baby and can’t have one? Here are some things you can try (which will definitely work better if pursued by both partners).

    1. Learn. Set up a dialogue with your doctor, trying to understand your real chances of achieving a pregnancy, the treatments they prescribe and their potential effect on the fertility problems you may have. Do it with your partner, work together as a team to fight infertility.
    2. Look for a therapist, a specialist (psychologist or psychiatrist) prepared to help people or couples with fertility problems. This type of therapy, called cognitive behavioural, not just clears the anxiety surrounding the phenomenon of infertility, but it may even increase your chances of getting pregnant.
    3. Stop blaming yourself. Infertility is not your fault. Even if you have experienced one of the factors described above, there are many other unknown ones that also affect the most conscientious and functional of us, in terms of health. There is no magical pill to remove stress, so accept it, understand it and forgive. In the end, if it were a major cause of infertility, no couple in the modern era would be able to conceive.
    4. Meditate and breathe. Every day, spare a few minutes of your life, full of stress at work, at home and in the waiting room of the infertility treatment office. There are even mobile apps for stress management. If English (or Spanish) is not a problem, we recommend you try a specially designed app for people with fertility issues, called FertiCalm.
    5. Try acupuncture. Regular acupuncture sessions increase blood flow, stimulate the immune system and the release of endorphin (hormones that inhibit pain signals) and serotonin (neurotransmitter with an important role in sleep installation, fighting depression and anxiety). These sessions also significantly decrease stress levels.
    6. Sleep. Nothing can replace good sleep, as the body has to recover every night. Be careful, though: quality sleep means sleeping with no lights on, no noise and no interruptions, if possible.
    7. Eat healthy – more often than not. A balanced diet, along with a workout programme, will not just help you keep your BMI within safe limits, but it will also increase your chances of getting pregnant. On the other hand, don’t stress out by strictly adhering to such a plan. Allow yourself to miss a fitness workout or to eat a nice plate of fries covered in parmesan once in a while. But not all the time…
    8. In the end, however, perhaps more importantly than all the items above, if you are going through this process of fighting infertility together with your partner, don’t forget about him/her. You should know they are experiencing almost the same worries you have. Sharing these concerns between the two partners and/or with a therapist may considerably reduce the stress of infertility.

    If you’re a man, you might not know much of what your partner can tell you about the best time of the month to conceive a child. You may not even know there is such a thing! If you start a discussion on this topic, it will definitely be very interesting

    However, as the role of synchronisation in conceiving a child is essential, you should try and learn more about this.

    Even though the most common male problems interfering with fertility are related to semen, it is also important to consider potential problems related to sexual behaviour, such as erectile or ejaculatory dysfunctions, lack of libido due to depression or using certain drugs. 90% of male infertility cases are due to an insufficiency of released sperm, the poor quality of such and only afterwards due to anatomic problems, hormonal imbalance and genetic defects.

    Sperm production

    The most frequent cause of male infertility is related to sperm production in the testes. Either a low number of sperm is produced, or the produced sperm do not function properly, or both. Sperm of an abnormal shape are not able to penetrate and fertilise an egg. Sperm with low motility, which do not move well, cannot reach the egg. Without a sufficient number of healthy sperm, chances of fertilisation are low.

    About two thirds of infertile men have a problem related to sperm production. The causes of sperm production disorders may include a genetic defect, infections, testicular trauma, hormonal imbalance, exposure to radiation and certain drugs, torsion (twisting the testes inside the scrotum), excessive heat, varicocele (varicose veins in the testes), problems related to the prostate, or vasectomy. Sometimes, the cause cannot be detected.

    Testosterone substitution therapy (oral, injectable or topical) significantly reduces or completely stops sperm production.

    At the medical examination, after the anamnesis and the physical exam, the doctor will request a spermogram, i.e. a seminal fluid analysis, in order to assess the sperm. If the test results are normal, they will look for the existence of hormonal imbalance (testosterone, etc.) or genetic defects.

    Sperm transportation

    Blockages or obstacles in the tubes carrying the sperm from the testes to the penis may cause a total lack of sperm in the ejaculated seminal fluid. In terms of frequency, this is the second leading cause of male infertility and it affects about one in five infertile men, including those who have had a vasectomy, but now wish to have other children. Some of the causes of an obstructive problem in the male reproductive system are scar tissue formed after a previous surgery or an infection. The varicose veins developing in the testes may also interfere with sperm transportation. Some structural defects may be congenital (present at birth).

    If a structural problem is diagnosed, surgery may be the solution. If the surgery does not solve the problem, the sperm may be extracted straight from the testes, so as to be used in an assisted human reproductive procedure, like in vitro fertilisation.

    Hormonal imbalance

    In about 1% of infertile men, the problem is caused by the low level of hormones acting on the testes, produced by the pituitary gland. Low production of follicle stimulating hormone (FSH) and luteinising hormone (LH) may affect the level of testosterone in the testes and cause lower sperm production. The most common hormonal problems are pituitary tumours or pituitary gland development issues, leading to low levels of FSH and LH.

    Very low levels of testosterone also affect male fertility, as well as excess prolactin, which inhibits gonadotropic hormones, thus leading to low levels of LH and testosterone.

    Hormonal imbalance that prevents sperm development and maturation may lead to fertility problems. The testes may not be sensitive to hormonal stimuli or receive signals to stimulate sperm production. Hormonal problems may be present at birth or develop later. Even excessive workouts, malnutrition or disease can cause hormonal imbalance, thus affecting fertility.

    Antisperm antibodies

    Antisperm antibodies are produced by some men when their immune system reacts to their own sperm as if it were a foreign tissue. For instance, about four in five men develop antisperm antibodies after a vasectomy.

    In most men, antisperm antibodies do not cause problems and will not affect the ability to conceive. However, in some, antisperm antibodies may reduce fertility by decreasing the sperm count in the seminal fluid, by agglutinating sperm, which reduces sperm motility, preventing them from advancing towards the egg or preventing the sperm from adhering to the egg and penetrating it for fertilisation.

    Antisperm antibodies usually do not affect the man’s general health and do not cause any symptoms that may signal their presence. Antisperm antibodies can be found in about 1 in 16 infertile men.

    Sexually transmitted diseases

    Sexually transmitted infections, especially gonorrhoea and Chlamydia, may affect fertility in women and men alike. There is only one way to avoid sexually transmitted infections. In fact, there are two, but the second one involves total abstinence. So it is best to have safe sex, by using a condom, and when you are both ready to start a family, both parties involved can be tested for sexually transmitted diseases, so as to avoid transmitting the infection to the other partner or to the baby.

    Chlamydia is a very common bacterial infection, which can affect anyone who has had unprotected sex. It is estimated that at least 75% of women and 40% of men have no symptoms. Moreover, as the symptoms of Chlamydia infection may be similar to those of other conditions, such as yeast infection or cystitis, they can be overlooked. If they occur, the symptoms may include unusual penile discharge, burning or pain when urinating, itchiness or rash on the tip of the penis, pain or tenderness in the testes.

    Chlamydia produces the inflammation of the urethra. If left untreated, the infection may extend to the epididymis (the tubes that carry sperm). This may cause pain and scarring. In men, Chlamydia infections may have serious consequences of the reproductive system: conditions of the testes or the urinary tract. If left untreated, the individual may remain sterile. Chlamydia infection is treated with antibiotics.

    Gonorrhoea is a bacterial infection that usually affects the genital area, although the neck or anus may also be affected. Gonorrhoea can affect both men and women and it can be easily transmitted during intercourse, whether vaginal, anal or oral.

    Gonorrhoea usually infects the inside of the penis (urethra). Symptoms may include burning while urinating, discharging white or yellow pus from the penis, swelling and pain in the testes, which may occur if gonorrhoea is left untreated. Some men are asymptomatic.

    Gonorrhoea may damage the epididymis (the tubes that carry sperm), preventing the sperm from being ejaculated from the testes.

    Gonorrhoea is treated with antibiotics. Men who do not treat gonorrhoea run the risk of having the infection spread to the urethra, where it may infect the prostate, the seminal vesicles, the Cowper’s glands and the epididymis, where a painful wound may form, causing fever with chills. If the wound heals with scar tissue, the man may later experience fertility problems.

    Drug treatments

    Some drugs may have a negative impact on male fertility and should be avoided if possible. If you take any kind of drugs, you should talk to your doctor about them and check if they influence fertility. This is particularly so if you take long-term drugs for cholesterol, heart conditions, high blood pressure or any other chronic condition.

    Some drugs may have side effects, leading to nervous tension and causing psychological problems: stress, emotional instability and anxiety.

    This is a list of drugs and medical treatments that are known to have a negative effect on male fertility:

    • Tagamet (cimetidine, a drug used to treat gastric hyperacidity), sulfasalazine (anti inflammatory drug used in autoimmune conditions), nitrofurantoin (antibiotic). These drugs significantly reduce sperm count
    • Anabolic steroids, including prednisone and cortisone: after using them for a long time, they reduce the amount of sperm and sperm motility, and they may even cause the testes to shrink
    • Chemotherapy and radiation: they decrease sperm production and may cause sterility