Updated on October 11, 2022.
About 1 of every 8 couples has trouble conceiving, according the United States Department of Health and Human Services. While difficulty getting pregnant is often pegged to women, about a third of the time it’s an issue with male fertility. In another third of cases, it involves reproductive troubles with both partners or the cause is unknown.
In many situations, underlying medical conditions, blocked reproductive organs, or other factors cause male infertility. These can lead to damaged sperm or impair sperm’s ability to move, called motility. They may even slow or stop men from producing sperm altogether.
You can’t control everything that influences fertility—it starts declining naturally with age, for example. But there are certain lifestyle factors men can get a handle on. Addressing the following issues may improve your chances of starting a family.
An unhealthy diet
Some research suggests that diminished male fertility may be linked to a higher consumption of certain foods. In one February 2020 study of 2,935 Danish men published in JAMA Network Open, scientists found that eating a typical Western diet filled with red and processed meats, refined grains, and added sugars was associated with a much lower sperm quality than eating a “prudent” diet characterized by lean proteins and produce. Though the median sperm count among men who stuck closest to the prudent diet was 167 million, it was just 122 million among those who adhered to the Western diet.
Consuming unhealthy foods may hurt fertility, but serving up a healthy diet full of produce, whole grains, legumes, and lean proteins could help it along. Fruits and vegetables may be especially important for their antioxidants, which are thought to improve sperm quality.
Obesity
Compared to men of a normal weight, obese men are more likely to have fertility problems. That’s because carrying a lot of extra pounds can both damage the sperm and interfere with its production. “People with more fat can have a lower testosterone level, which can affect the body’s ability to make sperm,” says Wolf.
To help optimize fertility, healthcare providers (HCPs) often recommend that men try to achieve and maintain a healthy weight, especially if they’re actively trying to conceive. Exercising regularly and eating a balanced, nutritious diet can help reach those goals. For some, medication or bariatric surgery may be good options, as well.
Tobacco, alcohol, and recreational drug use
There are a ton of good reasons to kick tobacco, and you can add fertility to that list. The connection is still a matter of some debate, but smoking may affect sperm quality and motility. Men who smoke also tend to have lower sperm counts; it’s a risk factor for erectile dysfunction (ED), as well. It’s not yet known how vaping affects fertility.
There’s some question about alcohol use, too. “For most people, I think the amount of alcohol they consume probably doesn’t affect fertility a great deal,” says Jason Wolf, MD, a urologist affiliated with Kendall Regional Medical Center in Miami, Florida. But, he adds, heavy drinkers may have problems. Too much booze may influence testosterone and sperm production, and also contributes to ED.
Also known to diminish fertility, at least temporarily: anabolic steroids and certain recreational drugs, including cocaine, opioids, and cannabis. “Marijuana can affect the sperm as well as affect the hormone testosterone,” explains Dr. Wolf.
If you’re trying to conceive and you use tobacco or illicit substances, it’s best to quit altogether. Talk to your HCP about accessing resources or, if needed, getting professional help. They can also advise you about your alcohol use. The American Society of Reproductive Medicine recommends men limit themselves to two drinks per day if they’re trying to start a family.
High stress levels
Constant or severe stress may mess with the hormones required to create sperm. It can contribute to poor sleep, too, which may, in turn, negatively affect fertility. What’s more, adds Wolf, “stress can also greatly affect erectile dysfunction, and the body’s ability—as well as the desire—to have sexual activity, and procreate.”
In order to combat high stress levels, Wolf advises patients to find a relaxation activity that works for them. Meditation, deep breathing, tai chi, yoga, or other exercises are often recommended by experts to relieve anxiety.
Genital heat stress
“Sperm production is better a few degrees lower than the normal 98.6 F body temperature,” says Wolf. “That’s why the testicles are kept in a separate compartment at a lower temperature.”
Some research suggests that when your scrotum becomes too warm, it can hinder sperm production. Though studies are inconclusive, avoiding tight underwear or not working with a computer on your lap could help keep the testicles cool. Jacuzzis may be off-limits, too. “We tell people not to use hot tubs or spas if they’re having fertility issues,” Wolf adds.
Heavy metals and other toxins
Extended contact with industrial chemicals or heavy metals such as lead, mercury, and cadmium can lead to reduced sperm count and quality. Welders or men who work in agriculture may be among those at particularly high risk.
While it may be difficult to limit your exposure to these substances—especially if it’s in your job description—following standard safety procedures can help. Wear the correct protective gear and try to avoid contact with the chemicals, if possible.
Your other health problems
Troubles with fertility can be caused by a variety of existing medical conditions. “When these things start to fail—the erections or sperm—it may be a sign that something bigger is going on,” Wolf says. “It’s like the canary in the coal mine in a lot of guys in their 30s, 40s, and even 20s.”
Among the many health issues that can affect male fertility are:
- Varicocele, or enlarged veins in the scrotum
- Infections, including sexually transmitted infections (STIs)
- Diabetes
- Hormonal imbalances or disorders
- Genetic disorders such as cystic fibrosis and Klinefelter’s syndrome
- Kidney disease
- Celiac disease
- Testicular cancer and lymphomas
- Cardiovascular problems
“Tumors in the brain can sometimes affect the body’s ability to make sperm,” Wolf adds. Some medications may affect sperm production, as well, including certain chemotherapy drugs and antidepressants.
Some of these issues, such as STIs, can often be treated relatively quickly, while others require longer-term intervention. But even if you don’t have a complicating health issue, make sure to see your HCP for regular well visits. They can help find medical problems early and keep your overall wellbeing on the right track.
When should you start thinking about fertility?
“I don’t think there’s really an age,” says Wolf. But once you begin trying for children, he explains, it’s best to make changes at least a few months in advance.
“The sperm being made today in the testicles typically take about three months until they come out through the penis,” Wolf notes. “We give people about a three-month window for any kind of adjustments we make or lifestyle modifications to actually affect their sperm count.”
If you and your partner have been trying to conceive for a year with no luck, it’s time to see an HCP. “But there are some caveats in that,” says Wolf. “It’s typically one year unless they’re older, their partner’s older, or they have some other kind of risk factor as far as previous health concerns.” Then, you should speak with an HCP earlier.
