Medical Contribution by Paul Shin, M.D.

Although many people still think of infertility as mostly a female problem, the male partner’s role is just as important. We interviewed Dr. Paul Shin, SGF’s board certified reproductive urologist, to find out more about male factor infertility and how diet and lifestyle choices play a role.

According to Dr. Shin, “One of the big things that we as male fertility specialists are trying to overcome is the notion that fertility problems are solely the domain of female health. This popular sentiment is shifting a bit, and more men are now aware that it is not just a female problem.”

In fact, about 40 percent of infertility cases are due to the female partner and about 40 percent are due to the male partner. An additional 10 percent are due to a combination of both partners, and for the remaining 10 percent, the cause of infertility is unknown.

“It makes sense. It takes two to make a baby, and there can be problems with one or both partners,” says Dr. Shin.

Diagnosing Male Factor Infertility

A semen analysis is a simple, quick test that should be conducted early to help identify any issues with male infertility. The results of a semen analysis can provide insight to the overall quality and quantity of your sperm. The semen analysis focuses on four parameters:

Semen volume is the amount of ejaculated semen. According to the 2010 World Health Organization (WHO) standards1, normal semen volume should be at least 1.5 ml.

Sperm count is the concentration, or number of sperm in the semen. Ideally, the semen should contain at least 15 million sperm per milliliter of semen. Generally, the more sperm, the more likely one will meet and fertilize an egg. When sperm count drops, so does the chance of conception.

Sperm motility is the movement of the sperm, or the ability of the sperm to swim. In a healthy sample, at least 32 percent of the sperm are moving normally. When sperm motility falls below this, it is difficult for the sperm to travel through the woman’s reproductive tract and fertilize an egg.

Sperm morphology refers to the percentage of sperm that are normal shape and size. It is important to put this number into context – the morphology is not a commentary on genetic integrity, propensity for miscarriage, or potential problems with the embryo. The “strict” criteria for morphology assessment looks at sperm through the lens of selecting that sperm individually for in vitro fertilization through ICSI. From a timed intercourse or IUI perspective, the total number of motile sperm is a more important number to determine a man’s fertility potential.

If male factor infertility is a known issue, we recommend seeing a fertility specialist as soon as you start trying to conceive. 

Diet and Lifestyle to Promote Male Fertility

Various lifestyle factors can have an impact on sperm. Semen is continuously being made in the male body, and takes approximately 74 days to mature. This means that it takes about 3 months to see results from healthy lifestyle changes.

According to Dr. Shin, the best advice for male fertility is the same as for any male who is seeking to live a healthier lifestyle. He advises patients, “Avoid smoking, drink alcohol only in moderation, get some exercise, decrease the stress in your life, eat a reasonable diet, and maintain a healthy weight.”

Dr. Shin encourages his patients, “Use common sense, try not to go overboard, and stick to the things you know you should do to maintain a healthy lifestyle.” Moderation is key when it comes to a healthy lifestyle to promote male fertility. “If you play golf with friends on the weekend and have a cigar, or if you have a glass of wine with dinner at night, that is not going to wreck your fertility,” he adds.

Watch: SGF’s On-Demand Male Fertility Webinar

Maintain a Healthy Weight for Optimal Sperm Production

Most of us are aware that carrying around excess body weight can have a negative effect on overall health. Obese men typically have higher levels of inflammation and an increased risk of diabetes, heart disease, and other health conditions. What many people don’t realize is that obesity (defined as body mass index >30) negatively impacts male fertility.2  There are two main ways in which obesity decreases sperm production.

1) Testicular warming: The testicles should be cooler than the rest of the body for optimal sperm production.3 “When men come in with a low sperm count, we look for any sources of heat exposure to the testicles, including obesity. Excess body fat serves as a layer of insulation on the testicles, which can decrease sperm production,” says Dr. Shin.

It is also important to avoid other sources of heat exposure to the testicles, such as hot tubs, laptop computers, or high-temperature work areas.

2) Hormone changes: A balance of androgens (testosterone) and estrogens is essential for normal fertility and reproductive function in men.4 “Fat cells take testosterone and convert it to a form of estrogen. This process is called aromatization. When testosterone drops lower, and estrogen gets higher, it can be detrimental for sperm production,” explains Dr. Shin. Low testosterone also contributes to lower energy levels, decreased libido and feelings of vitality, and mild erectile dysfunction.

Dr. Shin encourages patients to seek help from a registered dietitian/nutritionist, a personal trainer, or other health professional when needed. “Physicians are great at telling people to lose weight, but we are not good at coaching them along the way. It is super important to understand patients’ lifestyles and help them figure out how they can make positive changes within the confines of their day to day life,” says Dr. Shin.

Choose Nutritional Supplements Wisely

Research has shown that certain antioxidants and other nutrients may improve male fertility. If you have had an abnormal semen analysis, a nutritional supplement may be recommended. There are many over-the-counter supplements marketed for male fertility, many of which make claims that are not backed by scientific evidence.

Determining which product is best can be difficult. Dr. Shin advises men to “choose reasonably-priced supplements from a reputable source that has vetted their production process.” Dr. Shin also reminds his patients, “There is a lot of benefit to supplementing, but it is not a substitute for healthy living.”

Shady Grove Fertility recommends Theralogix, a line of evidence-based, independently tested and certified fertility products for men and women. All Theralogix products are NSF tested for content accuracy, purity, freedom from contaminants, and proper disintegration.

Oxidative Stress, Antioxidants, and Sperm Quality

It is thought that 30 to 80 percent of male infertility cases are due to the damaging effects of oxidative stress on sperm.5 Oxidative stress is a condition in which harmful molecules called free radicals damage the sperm. Oxidants are normally kept under control by the presence of antioxidants in the semen.  When the amount of oxidants in semen is greater than the amount of antioxidants, oxidative stress is present.

Antioxidants such as vitamins C and E, selenium, and lycopene have shown benefit in protecting sperm. Antioxidants have been shown to enhance fertilization and pregnancy rates during in vitro fertilization (IVF).6 A recent Cochrane Review found that antioxidants increased pregnancy and birth rates and improved sperm motility.5

Other nutrients such as folic acid and zinc may improve sperm count,7 and coenzyme Q10 (CoQ10)8-9 and L-carnitine10 have been shown to improve sperm motility. Maintaining a normal vitamin D level has also been linked to better sperm motility.11

To schedule a virtual consultation with an SGF physician, please call our New Patient Center at 1-888-761-1967 or submit this brief form.

Editor’s Note: This blog post was originally published in September 2017, and has been updated for accuracy and comprehensiveness as of November 2020.

  1. Cooper et al. World Health Organization reference values for human semen characteristics. Hum Reprod Update. 2010; 16(3):231-45.
  2. Campbell et al. Paternal obesity negatively affects male fertility and assisted reproduction outcomes: a systematic review and meta-analysis. Reprod Biomed Online. 2015; 31(5):593-604.
  3. Garolla et al. Twenty-four-hour monitoring of scrotal temperature in obese men and men with a varicocele as a mirror of spermatogenic function. Hum Reprod. 2015; 30(5):1006-13.
  4. Xu et al. The Effect of Aromatase on the Reproductive Function of Obese Males. Horm Metab Res. 2017; 49(8):572-9.
  5. Showell et al. Antioxidants for male subfertility. Cochrane Database Syst Rev. 2014; 12:CD007411.
  6. Tremellen et al. A randomised control trial examining the effect of an antioxidant (Menevit) on pregnancy outcome during IVF-ICSI treatment. Aust NZ Journal Obstet Gynaecol. 2007; 47(3): 349-54.
  7. Wong et al. Effects of folic acid and zinc sulfate on male factor subfertility: a double-blind, randomized, placebo-controlled trial. Fertil Steril. 2002; 77(3):491-8.
  8. Balercia et al. Coenzyme Q10 treatment in infertile men with idiopathic asthenozoospermia: a placebo-controlled, double-blind randomized trial. Fertil Steril. 2009; 91(5):1785-92.
  9. Nadjarzadeh et al. Effect of Coenzyme Q10 supplementation on antioxidant enzymes activity and oxidative stress of seminal plasma: a double-blind randomised clinical trial. 2014; 46(2):177-83.
  10. Lenzi et al. Use of carnitine therapy in selected cases of male factor infertility: a double-blind crossover trial. Fertil Steril. 2003; 79(2):292-300.
  11. Blomberg, Jensen et al. Vitamin D is positively associated with sperm motility and increases intracellular calcium in human spermatozoa. Hum Reprod. 2011; 26(6):1307-17.