Male infertility is a predictor of overall health of men by Phyllis Leppert, CNM, MD, PhD
Male infertility occurs in 7% of men world-wide (1). Defined as difficulty in conceiving after one year of unprotected sexual intercourse, about 15% of couples are infertile (2). Around 30-50% of infertile couples have difficulty conceiving due to male infertility factors (3). Therefore. current clinical practice means that both partners need to be evaluated at the start of treatment. It is no longer appropriate to study a woman first and then evaluate her male partner. A recent study shows that suboptimal semen parameters, particularly low sperm count, low sperm concentration, and poor sperm mobility is associated with reduced fecundity. defined as per-menstrual cycle probability of conception (4). There are a number of reports in the literature discussing the fact that sperm counts are decreasing world-wide over the past decades (5,6). Other studies refute these findings (7). It is hard to determine the earlier base-line data, collection of semen and evaluations are often conducted differently in the individual studies. Most studies showing low sperm count or low sperm concentration did not find that these parameters were necessary below sperm counts shown to be necessary for conception. Study methodology is improving. For instance, at home sperm testing method has been developed and validated from epidemiological studies (8). However, recent reports indicated that male infertility is an overall indicator of general male health and a predictor of future health (9,10). Testicular and prostate cancer is linked to a history of infertility. Infertility is also a predictor of cardiometabolic disease. Diabetes mellitus has long been associated with infertility as well. Metabolic syndrome is linked to infertility. Metabolic syndrome which is fairly common in the US and affects roughly one-third of the US adults. It increases the risk of heart disease, stroke and type 2 diabetes. Individuals with metabolic syndrome have high blood pressure, high blood sugar, too much fat around the waist, and high cholesterol or triglyceride levels. There is an increased association of male infertility with autoimmune diseases such as multiple sclerosis, systemic lupus erythematosus, Grave’s disease ( hyperthyroidism caused by antibodies that increases the production of thyroid hormone), thyroiditis, and psoriasis. Male infertility is associated as well with higher morality later in life and is associated with a higher risk of hospitalization. This latter risk is a higher predictive factor of future hospitalization that education, obesity of smoking (12). Poor quality of sperm and semen can be due to many factors of course. Among them are genetic epigenetic and environmental factors. Poor nutrition is implicated as are medications and recreational substances. For instance, 5α-reductase inhibitors which are often prescribed for male pattern baldness can impair sperm quality. Testosterone supplements, which are used by many men now because of “low T” can lead to azoospermia and severe oligospermia. This condition is reversed when testosterone supplementation is stopped. Environmental pollutions such as BPA (bisphenol A), an endocrine disruptor is widespread in many products and PFAS (per- and polyfluoroalkyl substances) are common and long- lasting compounds that pollute the environment in suppress sperm quality. Increased environmental heat such as long exposure to sauna heat has long been known to suppress sperm counts. Poor diet leads to suppressed sperm counts as well. Mediterranean-like diet is known to reverse this problem and increases sperm count. Recently. one study reports that poor sleep quality may affect semen quality and sperm count (13). In other words, the overall health of the male is important to his reproductive potential. Men who wish to have children should be advised to maintain healthy habits and forgo detrimental drugs and substances and avoid pollution as much as possible duking spermatogenesis. This complex process occurs over a 42 t0 76 days in humans (14,15).
References:
(1) Huang B, Wang Z, Kong Y, Jin M, Ma L. Global, regional and national burden of male infertility in 204 countries and territories between 1990 and 2019: an analysis of global burden of disease study. BMC Public Health. 2023 Nov 8;23(1):2195. doi: 10.1186/s12889-023-16793-3. PMID: 37940907; PMCID: PMC10631182.
(2) https://healthcare.utah.edu/healthfeed/2020/12/male-infertility-its-more-common-you-think#:~:text=And%20it's%20not%20just%20a,at%20University%20of%20Utah%20Health.
(3) Leslie S, Soon-Sutton TL, Khan, MAB Male Infertility. Last Update: February 25, 2024. NIH Library of Medicine Stat Pearls Internet
(4) Lovett SM, Sommer GJ, Krivorotko D, Wesselink AK, Rothman KJ, Hatch EE, Eisenberg ML, Wise LA. A prospective study of semen quality and fecundability among North American couples planning pregnancy. Andrology. 2026 Jan;14(1):184-195. doi: 10.1111/andr.70084. Epub 2025 Jul 11. PMID: 40646671; PMCID: PMC12380184.
(5) Levine H., Jorgensen N., Martino-Andrade A., Mendiola J., Weksler-Derri D., Mindlis I., Pinotti R., Swan S.H. Temporal trends in sperm count: A systematic review and meta-regression analysis of samples collected globally in the 20th and 21st centuries. Hum. Reprod. Update. 2023;29:157–176. doi: 10.1093/humupd/dmac035
(6) Huang C., Li B., Xu K., Liu D., Hu J., Yang Y., Nie H., Fan L., Zhu W. Decline in semen quality among 30,636 young Chinese men from 2001 to 2015. Fertil. Steril. 2017;107:83–88.e2. doi: 10.1016/j.fertnstert.2016.09.035
(7) Lewis K, Cannarella R, Liu F, Roth B, Bushweller L, Millot J, Kuribayashi S, Kuroda S, Aguilar Palacios D, Vij SC, Cullen J, Lundy SD. Sperm concentration remains stable among fertile American men: a systematic review and meta-analysis. Fertil Steril. 2025 Jan;123(1):77-87. doi: 10.1016/j.fertnstert.2024.08.322. Epub 2024 Aug 14. PMID: 39128669.\
(8) Sommer GJ, Wang TR, Epperson JG, Hatch EE, Wesselink AK, Rothman KJ, Fredriksen LL, Schaff UY, Behr B, Eisenberg ML, Wise LA. At-home sperm testing for epidemiologic studies: Evaluation of the Trak male fertility testing system in an internet-based preconception cohort. Paediatr Perinat Epidemiol. 2020 Sep;34(5):504-512. doi: 10.1111/ppe.12612. Epub 2019 Dec 15. PMID: 31838751; PMCID: PMC8052852.
(9) Zhao CC, Scott M, Eisenberg ML. Male Fertility as a Proxy for Health. J Clin Med. 2024 Sep 19;13(18):5559. doi: 10.3390/jcm13185559. PMID: 39337044; PMCID: PMC11432267.
(10) Capogrosso P., Ventimiglia E., Boeri L., Cazzaniga W., Chierigo F., Montorsi F., Salonia A. Male Infertility as a Proxy of the Overall Male Health Status. Minerva Urol. Nefrol. 2018;70:286–299. doi: 10.23736/S0393-2249.18.03063-1
(11) Eisenberg ML, Li S, Behr B, Cullen MR, Galusha D, Lamb DJ, Lipshultz LI. Semen quality, infertility and mortality in the USA. Hum Reprod. 2014 Jul;29(7):1567-74. doi: 10.1093/humrep/deu106. Epub 2014 May 15. PMID: 24838701; PMCID: PMC4059337.
(12) Choy JT, Eisenberg ML. Male infertility as a window to health. Fertil Steril. 2018 Oct;110(5):810-814. doi: 10.1016/j.fertnstert.2018.08.015. PMID: 30316415.
(13) Coleman CM, Wesselink AK, Yland JJ, Sommer GJ, Eisenberg ML, Bertisch SM, Rothman KJ, Hatch EE, Wise LA. A North American preconception study of sleep health and semen quality. Hum Reprod. 2026 Feb 1;41(2):275-284. doi: 10.1093/humrep/deaf228. PMID: 41330355.
(14) Neto FTL, Flannigan R, Goldstein M. Regulation of Human Spermatogenesis. Adv Exp Med Biol. 2021;1288:255-286. doi: 10.1007/978-3-030-77779-1_13. PMID: 34453741.
(15) Neto FT, Bach PV, Najari BB, Li PS, Goldstein M. Spermatogenesis in humans and its affecting factors. Semin Cell Dev Biol. 2016 Nov;59:10-26. doi: 10.1016/j.semcdb.2016.04.009. Epub 2016 Apr 30. PMID: 27143445.