Male fertility and lifestyle: what the evidence says

Start with what matters most

There is a lot of advice online about sperm health, and much of it is not backed by good evidence. This guide focuses on the things that have reasonable evidence behind them. None of this is about blame. Many men with excellent habits have sperm problems, and many with less healthy habits do not. Changes are worth making because they can help, and because they are good for general health.

Good to know. Sperm take about two to three months to develop. A change you make today will usually take around three months to show up in a semen analysis, so give it time before repeating a test.

Factors with good evidence

Smoking

Smoking is linked to lower semen quality. Stopping is one of the most useful things you can do, for fertility and for your partner's health during pregnancy. Chewing tobacco and other tobacco products should also be avoided. Free help is available: India's national quitline is 1800-11-2356.

Alcohol

Heavy or regular drinking can lower testosterone and affect sperm. Keeping alcohol low, and avoiding binge drinking, is sensible.

Body weight

A high body weight is linked to lower sperm quality and to hormone changes. Gradual weight loss through food and activity may help. Very intense exercise or crash diets are not needed.

Anabolic steroids and testosterone

These are among the most important avoidable causes of a very low sperm count. Steroids used for bodybuilding, and testosterone taken for energy or muscle, switch off the signal that tells the testes to make sperm. Recovery after stopping can take many months, and is not always complete. If you have used them, tell your doctor; it is common and they need to know, not to judge.

Recreational drugs

Cannabis, cocaine and other recreational drugs have been linked to poorer sperm quality. Stopping is advised while trying to conceive.

Heat

Sperm develop most effectively at a temperature slightly below body temperature, which is why the testes sit outside the body. Regular saunas, hot tubs and long hot baths, and a laptop resting on the lap, can raise their temperature. Sitting for long hours, for example as a driver, may also play a part. Loose underwear is a simple, harmless change, although the evidence for it is not strong.

Medicines

Some prescription medicines can affect sperm production or ejaculation. Examples include some medicines for bowel and joint conditions, some used for the prostate or hair loss, long-term opioid painkillers and chemotherapy.

Caution. Don't stop a prescribed medicine on your own. Ask the doctor who prescribed it whether it could affect fertility, and whether there is an alternative. If you need cancer treatment, ask about freezing sperm before it starts.

Work and the environment

Some jobs involve exposures that may affect sperm, such as:

• pesticides and other farm chemicals
• solvents, paints and some industrial chemicals
• heavy metals such as lead
• radiation
• high heat, for example in kitchens, bakeries, furnaces or welding

If your work involves any of these, use the protective equipment provided and mention it to your doctor.

What about supplements?

Many supplements are sold for male fertility, often containing antioxidants, vitamins or minerals. The evidence that they improve the chance of a pregnancy is limited and mixed, and some well-designed studies have found no benefit.

• Be cautious about products that promise to "boost" sperm or testosterone. Some testosterone boosters can actually lower sperm production.
• Supplements are not regulated in the same way as medicines, and doses and ingredients vary.
• Herbal and other remedies sold for fertility have not been shown to help, and some may interact with medicines.
• If you are considering a supplement, ask your doctor first, and tell them about anything you already take.

The bigger picture

• Keep having regular sex, every two to three days, rather than saving it for certain days. Long gaps without ejaculation do not improve fertility.
• Avoid lubricants unless they are labelled as sperm-friendly, as some can affect sperm movement.
• Look after sleep, stress and general health. These help how you feel, even where direct evidence on sperm is limited.

When to see a doctor

• If you have been trying for a year (or six months if the female partner is 35 or older), both partners should be checked, whatever your lifestyle.
• Sooner if you have used anabolic steroids or testosterone, have had cancer treatment, surgery on the testes or groin, or have difficulty with erections or ejaculation.
• If a semen analysis is unusual, a doctor may suggest a urologist or andrologist. Our specialist checker can help you decide who to see.
• See a doctor promptly for a lump or swelling in a testis. For sudden, severe pain in a testis, call 112 or go to the nearest hospital.