Male Infertility
Infertility affects one in every six couples who are trying to conceive. In at least half of all cases of infertility, a male factor is a major or contributing cause. This means that nearly 10% of all men in the United States who are attempting to conceive suffer from infertility. Almost one percent of all men have severe male infertility where sperm production is so limited that few or no sperm are present in the ejaculate. This is a condition where we have developed, and continue to evolve, the most effective treatments for male infertility, even when treatment has failed elsewhere.
Historically, infertility has been considered a woman’s disease. Only more recently has the importance of the male factor contribution to infertility been recognized. The mistaken notion that infertility is associated with impotence or decreased masculinity may contribute to a fear of evaluation or even treatment of male fertility. The good news is that the rapid research advances in the area of male reproduction have brought about dramatic changes in the ability to both diagnose and treat male infertility. Dr. Schlegel has contributed to many of these research advances. The majority of couples suffering from infertility can now be helped to conceive a child on their own.
Optimizing Fertility
Many men are born with inherent limitations in sperm production, but some lifestyle factors can also adversely affect (or benefit) sperm production. Although some exposures are related to lower sperm production, we don’t have great medical evidence that correcting these factors/removing adverse effects will actually enhance fertility. Regardless, medical care often involves making recommendations where imperfect information is available. General comments regarding adverse environmental/lifestyle effects can be made.
Obesity and Dietary Fats
Male obesity and dietary fat has a substantial adverse effect on fertility potential, even with the use of assisted reproduction. Weight loss has been reported to be associated with improved sperm production, although it is not clear whether dietary change, exercise, surgical intervention or medical treatment (e.g., with GLP-1 agonists like Wegovy or Ozempic) have better or worse effects on the weight loss effects on sperm production. Whether improved sperm production with lower weight is better maintained with GLP-1 agent or diet/exercise does not appear to be important ( https://pubmed.ncbi.nlm.nih.gov/29774489/, https://pubmed.ncbi.nlm.nih.gov/35580859/).
Cigarettes, Vaping, Illicit drugs
Cigarette smoking has perhaps the best evidence for its adverse effects on sperm quality and production. Sperm DNA quality is adversely affected by smoking, with decreased damage after stopping cigarette smoking. Less data is available on the effects of e-cigarettes or vaping. However, the most recent analysis of all published studies suggest a substantial adverse effect of vaping and e-cigarettes on sperm production and fertility. Marijuana has also had some substantial adverse effects on sperm production suggested in a variety of studies. The quality of sperm can also be affected without dramatically affecting sperm production.
Counseling
Several online services can provide support to improve dietary and other lifestyle factors to enhance fertility. One of the services with the best data supporting their interventions is Doveras.com.
Exercise
A sedentary lifestyle is associated with impaired sperm production. Moderate physical activity may allow higher sperm production, but excess physical activity (more than 30-45 minutes per day) can limit sperm production. Of note, bicycle riding can cause lower sperm production – a unique adverse effect that doesn’t appear to occur with other forms of exercise.