Male Fertility
Did you know that your diet can impact your reproductive health?
Eating a diet that contains the right balance of healthy foods and is rich in the nutrients necessary for hormone balance and sperm production is a powerful way to support male reproductive health, even in the short term. The male reproductive organs are constantly producing new sperm and this process can take between 60 – 80 days. So, making positive dietary changes, eating the right foods and getting the right nutrients in the 2-3 months prior to trying to conceive, can have a real positive impact on the quality and number of sperm produced, potentially boosting your chance of conceiving.
Firstly, some info on male reproductive health.
Male fertility is the second most common cause of fertility issues, coming second only to the advanced age of the female partner. It affects about half of all couples so it is essential to consider when you are trying to conceive. Historically, it was often the female partner who might initiate tests with her GP, but it is strongly recommended that tests are done for the male partner from the start of your fertility journey.
The lowdown on semen
Semen Analysis
A regular semen analysis looks at the external parts of a sperm, how well it can function and get from point A to point B. The World Health Organisation guidelines 2010 define the lowest values of a normal sperm as follows:
• Semen Volume:1.5ml
• Total sperm count: 39million/ejaculate
• Sperm concentration: 15million/ml
• Total motility: 40%. This indicates how well the sperm can swim
• Progressive motility: 32%.
• Normal morphology: 4%. This indicates that the sperm are well-formed and not abnormal-looking which might impede their ability to swim or penetrate the egg. There are usually a high number of abnormal forms in the sample, this is quite normal. Depending on how this is measured, the normal forms should be above 4% or perhaps higher than this depending on the lab.
Anti-sperm antibodies: these are antibodies that bind to the sperm which interferes with their function. It is important to have this below 50%.
Sperm DNA Fragmentation
This test looks at damage to the DNA within the sperm which carries the important paternal genetic information. Men with an abnormal semen analysis may have increased DNA fragmentation also. However, one in four men with a completely normal semen analysis will have increased DNA fragmentation. This might mean that you have proceeded with trying to conceive and only later down the road, it might be identified that there is another issue. This is often later found as a cause of ‘unexplained infertility’ or recurrent miscarriage. It is recommended that this test is done with a semen analysis.
It is normal to have a certain level of DNA fragmentation. Depending on what test is used, this might be up to 15%. Above this, there might be difficulty conceiving and above 30%, the chances are reduced significantly and the risk of miscarriage increases.
The DNA in sperm is vulnerable to conditions of ‘oxidative stress’. Under these conditions, the DNA can be damaged causing the DNA to fragment. Where there is a high degree of DNA fragmentation, there may be an increased risk of infertility, failed assisted reproduction e.g. IUI or IVF, and recurrent miscarriage.
Oxidative stress can be caused by a number of conditions such as;
- Infection – inflammation can cause a significant increase in oxidative stress
- Inflammation elsewhere in the body can also contribute to sperm damage and deplete critical antioxidants
- Varicocele – similar to a varicose vein near the testes, can increase damage to sperm
- Obesity – excess body fat, especially that which accumulates around the middle
- Smoking – markedly increases oxidative stress
- Testicular heat – increased local heat can damage sperm and sperm DNA
- Chemicals – exposure to certain pesticides and other chemicals
- Poor diet – a diet low in protective antioxidants, deficiencies in vitamins or minerals
- Age – DNA fragmentation may increase with age
- Genetics – issues with the folate cycle
- Some conditions such as undiagnosed or poorly managed type II diabetes
- Some medications
Optimising your nutrition to support your reproductive health
How can nutrition support male fertility?
Dietary changes to promote male reproductive health should address both the overall balance of the diet, as well as the specific nutrients that the body needs for hormone balance and sperm production.
The Mediterranean diet is one dietary pattern that we know promotes good male reproductive health, being associated with improved sperm number, sperm quality and improved chances of conceiving. Even if you don’t live in Italy or Greece, the principles of a Mediterranean diet can be followed anywhere in the world. A Mediterranean-style diet focuses on eating an abundance of fresh vegetables and fruit (at least 7 servings daily), whole grains, beans, lentils, quality protein from meat, fish and seafood, and good fats from extra virgin olive oil and nuts.
On the other hand, eating a diet that is dominated by processed foods, processed meats, fast food and refined snacks is associated with lower sperm count. So, making positive dietary changes and moving towards a more Mediterranean eating pattern is a key lifestyle change when preparing the body for conception and trying to boost sperm number and quality.
To make your diet more Mediterranean aim to:
- Fill up half of your plate with vegetables at each main meal
- Eat one serving of beans or lentils daily – keep a tub of hummus in the fridge for snacking
- Drizzle 1 tablespoon of uncooked extra virgin olive oil over vegetables or a salad every day
- Swap refined snacks for fresh fruit and nuts (have a handful of unsalted nuts every day)
Let’s talk ‘Antioxidants’
One reason why the Mediterranean dietary pattern is so positive for male fertility is that it provides an abundance of a form of nutrients called antioxidants. Increasing dietary intake of antioxidants is possibly the single most important dietary change to promote male fertility. Antioxidants occur naturally in all plant foods, and our bodies can also produce antioxidants using certain nutrients, such as selenium and zinc. The reason that antioxidants are so crucially important in male fertility is that they protect the sperm cell from damage, ensuring the quality of the sperm cell and the quality of the DNA within that sperm cell.
The role of sperm is to deliver the genetic material within DNA for conception and reproduction, and sperm cells are often described as DNA with a tail. Sperm cells, and the DNA inside them, are very vulnerable to damage by free radicals (unstable molecules that can damage our body’s cells). Damaged DNA within sperm is linked to reduced chances of conception and increased chances of miscarriage. The more antioxidants in your diet the better protected your cells (including sperm cells) will be from free radical damage.
Ways to increase your antioxidant intake:
- Eat a rainbow of colours of fruit and vegetables, the pigments that give fruit and vegetables their colour are antioxidants. Eating a variety of colours will ensure you consume a wider variety of antioxidants.
- Spice it up: spices and herbs such as turmeric, ginger, cumin, rosemary and oregano are some of the most concentrated sources of dietary antioxidants. Try cooking with spices or herbs at least once a day.
- Swap your usual chocolate bar or biscuit for a few squares of dark chocolate. Cocoa is actually one of the richest dietary sources of antioxidants (it comes from a bean after all) and eating dark chocolate is a great way to get more antioxidants into your diet.
- Dress your vegetables and salads with either butter or extra virgin olive oil. Antioxidants are mostly fat-soluble and we absorb them better when we eat them together with a fat source.
- Include quality protein sources, such as fish and shellfish at least 3 times a week to supply minerals essential for antioxidant production.
Beneficial nutrients to support male fertility
Specific nutrients that the male body uses to produce hormones, sperm, and antioxidants are essential when trying to improve fertility. You want to ensure that you are getting enough of all of these key nutrients.
Zinc
Zinc may be one of the most important minerals for sperm health. It plays a number of critical roles from sperm development, formation, maturation and a role in stabilising the membrane which supports motility. It is also part of the antioxidant compound zinc-copper superoxide dismutase (SOD). This is one of the antioxidants that helps to protect sperm as they mature, decreasing damage and reducing DNA fragmentation.
Zinc deficiency is common worldwide and can be found in meat, chickpeas, nuts and seeds. However, absorption can be difficult and those with poor digestion are at risk. People on long-term proton pump inhibitors (PPI), which are commonly prescribed stomach acid inhibitors, are at risk from malabsorption. In addition, those on a high plant diet can also be at risk unless efforts are made to increase absorption in the diet such as soaking, sprouting and fermenting.
Zinc supplements have been shown in clinical trials to improve count, morphology and motility and can reduce DNA fragmentation. Some supplements are poorly absorbed, such as zinc oxide. Zinc citrate at 23mg per day is recommended for those on a high plant diet. Caution is advised, however, as with all supplements. The antioxidant balance in critical and over-supplementing can have negative effects also. It is important to seek advice from a nutritional therapist like myself or your GP when starting any supplementation.
Selenium
Selenium is found in high concentrations in the testes. Here it forms part of the antioxidant family glutathione peroxidases (GPX). This family of proteins help to protect sperm as they develop and mature. They also help to regulate the antioxidant reactions within sperm – where the balance is important and too much is not helpful.
Brazil nuts are a great source of selenium, but it’s easy to get too many. Just one Brazil nut per day can provide over the recommended daily allowance so eat these as part of your diet, but not too often. Selenium is also found in meat, chicken, fish, shellfish and eggs and deficiency often depends on the selenium content of the soil near where you live or source your animal products. Supplementing with selenium has been shown to be ineffective if you are not actually deficient. Many people we see in clinics have already started consuming Brazil nuts and are high in selenium. It’s best to check your levels before you supplement.
Vitamin C and E
Both of these nutrients are important antioxidants for sperm health. They work together as vitamin C is water-soluble and vitamin E is fat-soluble. Vitamin C may be particularly important if you smoke.
Clinical trials have shown success in reducing DNA fragmentation with both vitamin C and E. A diet rich in fruits, vegetables, nuts, seeds and healthy fats such as avocado, salmon and olives should provide sufficient vitamin C and E for general health. However, it is worth noting that studies often use higher amounts of vitamin C, such as 1g. This would be extremely difficult to reach with diet alone, where fruits high in vitamin C such as kiwi contain approximately 90mg.
Omega-3
Omega-3 fatty acids, eicosapentaenoic acid (EPA) and more specifically docosahexaenoic acid (DHA) are major components of sperm membranes. Good levels of omega-3 can improve sperm count and motility. Omega-3 fatty acids are anti-inflammatory and so can protect indirectly against sperm damage. In a ‘Western Diet’, we do not get enough omega-3 in our diet. Eating at least two portions per week of oily fish is recommended. If you do not eat fish, a supplement containing over 500mg of each of EPA and DHA is useful.
Vitamin D
We know that conception rates increase during the summer which may show a role for vitamin D in fertility and sperm have receptors for vitamin D. Be cautious when supplementing with vitamin D; it is important to tailor your supplement levels to meet your needs. Vitamin D can be toxic at high levels. While it has a beneficial effect on our immune system at optimal levels, this too can have a negative effect if the levels get too high. A dose of 1000IU suits most people, but it can depend on a number of factors.
Factors to consider which may be working against sperm health
Caffeine and Alcohol
Caffeine and alcohol may cause reduced sperm quantity and quality. It is recommended to either avoid or if necessary, reduce your intake, sticking to 5-10 units of alcohol per week and no more than 2 cups of coffee per day.
Your environment
Xenoestrogens are environmental oestrogens, coming from pesticides and the plastic industry. This can cause hormonal imbalances in men leading to reduced sperm quantity and also affecting quality and DNA fragmentation. Aim to reduce your plastic exposure, avoid handling till receipts, use more natural personal hygiene products and try to eat as organic produce where you can.
Other chemicals can also specifically cause an increase in DNA fragmentation. Consider your exposure in the workplace or during your spare time or hobbies. Always use the correct personal protective equipment or avoid chemical exposure altogether if possible.
Local heat can cause damage to sperm and increase levels of DNA fragmentation. Avoid saunas, hot baths, heated car seats, prolonged use of a laptop resting on your lap and try to limit carrying your mobile phone in your pocket.
Exercise
Moderate exercise is excellent for weight management, stress reduction and hormonal balance. Excessive or intensive exercise can be a cause of damage and inflammation in the body and may be an indirect cause of damage to sperm. Specifically cycling is a source of direct damage, friction and heat to the testicular area. It may be that short bouts are fine, but if you are taking to longer cycles at the weekend as recreation, it would be best to reduce this if you are trying to conceive.
Nutrient Testing
If you would like to know more about what vitamins and minerals you need, this can be done via functional tests such as a Nutritional Profile (blood test). This can help find out what you are deficient in so that you can supplement safely. Restoring antioxidants and critical deficiencies can be very effective in improving sperm quantity and quality.
Please contact me for further guidance on functional testing. My 1:1 programmes will include recommendations on what tests are best suited to your needs, interpretation of results and any necessary guidance to support findings. There is an additional charge for all functional testing in addition to any of my programmes.
