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Semen analysis not only provides information on fertility but also offers insights into the overall health. A recent study published in Nature reported that sperm quality can significantly improve with basic lifestyle and dietary changes.

Global Decline

Sperm quality has steadily declined over the past 50 years. Between 1973 and 2011, the global sperm concentration and total sperm count decreased significantly.

This decline was most pronounced in Western countries, with a reduction in the total sperm count of almost 60%.

The study, led by Hannah Lyons, a researcher at the Robinson Research Institute and School of Biomedicine at the University of Adelaide, Adelaide, Australia, attributed this decline to multiple factors.

These include chronic conditions such as diabetes and metabolic syndrome, exposure to endocrine-disrupting chemicals such as phthalates, bisphenol A, cadmium, dioxins, and lead, and heat exposure.

Lifestyle factors, including certain medications, substance use, poor diet, and physical inactivity, can impair sperm production by disrupting hormonal regulation, damaging testicular cells, and increasing oxidative stress due to elevated levels of reactive oxygen species (ROS).

High ROS levels can damage sperm DNA, compromise the membrane integrity, and reduce sperm motility. Established risk factors include smoking, heavy alcohol consumption, drug abuse, and excessive exercise.

Nutrient Impact

Sperm quality can recover more rapidly than previously believed. In a study of 132 men with fertility issues, a 3-month micronutrient regimen, including L-carnitine (440 mg), L-arginine (250 mg), zinc (40 mg), vitamin E (120 mg), glutathione (80 mg), selenium (60 µg), coenzyme Q10 (15 mg), and folic acid (800 µg), significantly improved semen parameters. Volume, sperm concentration, progressive motility, total motility, and morphology increased by 33.3%, 215.5%, 93.1%, 36.4%, and 23.0%, respectively (all P < .001). No improvements were observed in healthy individuals (n = 73).

In the 6 months following the intervention, the pregnancy rate among the partners of the participating men was also recorded. More pregnancies occurred in the intervention group (25.8%) than in the healthy group (15%). Although this study had some limitations, including age differences and limited risk factor data, two additional trials supported these findings. The researchers concluded that micronutrients may restore sperm production within 3 months.

Combined Approach

A 2021 study by Markus Lipovac, PhD, at the Robinson Research Institute at the University of Adelaide, and colleagues evaluated 339 men who received micronutrient supplements along with lifestyle changes. These include a healthy diet, regular exercise, and reduced smoking and alcohol consumption.

Of these, 162 men received supplements and lifestyle guidance, whereas 177 followed lifestyle and dietary modifications. After 6 months, sperm DNA fragmentation index (DFI) and pregnancy rates were assessed. In the supplement group, DFI decreased from 10.48 to 6.51 overall and from 20.39 to 9.93 in men with DFI > 15% (P < .001). Pregnancy rates were higher with supplements: 27.78% vs 15.25% overall and 41.30% vs 22.86% in men with DFI > 15%.

The limitations of this study include missing demographic data, lack of randomization, and lack of information on the extent of lifestyle changes.

The researchers emphasized that while the study could not separate the effects of micronutrient supplementation from lifestyle interventions, both appeared to benefit reproductive function, with spermatogenesis being relatively responsive.

However, only active micronutrient treatment significantly reduced sperm DNA fragmentation and improved pregnancy rates, highlighting the need for randomized trials and further investigations.

DFI Interpretation

• < 15% — very good sperm quality
• 15%-25% — good sperm quality
• 25% — impaired sperm quality (increased DNA damage)

A higher DFI is associated with lower fertility and an increased risk for miscarriage.

Short-Term Gains

Sperm quality may improve within 1 month of treatment. In a study of 402 men with abnormal semen, a 1-month personalized program including reduced or no smoking and alcohol, wearing loose underwear, avoiding baths over 15 minutes, limiting radiation exposure, stopping finasteride or dutasteride, and avoiding laptop use on the lap produced positive effects such as motility increased by 7.6%, sperm concentration by 6.9 million/mL, and total sperm count by 15.7 million (all P < .001).

These findings challenge the belief that treatment must last at least 3 months, based on the 42- to 74-day sperm production cycle. The authors noted that this has major implications for the treatment and management of environmental- or lifestyle-related causes of male infertility.

Broader Implications

Semen analysis may reflect the overall health of men, not just their fertility. Men with infertility or abnormal semen are at a higher risk for hospitalization and early death.

Men with infertility had a 26% higher risk for death (95% CI, 1.01-1.59), and men with oligo- or azoospermia had a 67% higher risk (risk ratio, 1.67; 95% CI, 1.26-2.21) than those with normal sperm counts.

Sperm Analysis

A study of 11,935 men at two health centers in the US from 1994 to 2011 found that low ejaculate volume, low sperm concentration, low total sperm count, poor motility, and low total motility were associated with increased mortality rates. Mortality was assessed using data from the Social Security Death Index and the National Death Index. The authors concluded that men with two or more abnormal sperm parameters had a 2.3-fold higher mortality risk.

Abnormal sperm parameters often reflect poor health or disease and are linked to a higher risk for cancer. Studies have shown that men with infertility have an increased risk for prostate and testicular cancer. The exact reasons for this association are unclear but could point to genetic causes, which the research team has emphasized in their study.

The researchers concluded that semen analysis could be a useful health tool for diagnosing infertility. Male fertility is closely linked to overall health, long-term illnesses, and risk for death. Routine semen testing could help detect health risks early and allow for immediate lifestyle changes. Abnormal results may prompt further health checkups. The link between poor sperm quality and self-image may motivate men to take better care of their health.

Sensitive Communication

Colloquial language and humor can sometimes help in medical conversations, but not in men’s reproductive health. In a survey of men, participants reported a lack of sensitive communication from healthcare professionals, with insensitive language frequently used to communicate the diagnosis of infertility in men. Humor was frequently employed, with comments such as, “Your nuts are stuffed,” or, “…your sperm […] they’re all kind of knackered.” These remarks caused distress, and participants said that the same information could have been conveyed more sensitively.

This story was translated from Coliquio.