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. 2025 Jul 1;15:21656. doi: 10.1038/s41598-025-98985-y

The effects of mediterranean and Persian diet on sexual function and semen parameters quality among infertile men: a randomized controlled trial

Ali Ghasemi 1, Amir Mohammad Jaladat 2,✉, Mohammad Hossein Sharifi 3,4, Ali Tavakoli 2, Haleh Ghaem 5, Abdolreza Haghpanah 6,7
PMCID: PMC12215366  PMID: 40593139

Abstract

There is no consensus on which diet best for improving male reproductive health and published studies on the effect of diet on sexual function and semen quality are limited. The aim of this study was to investigate the effect of intervention based diet, namely Persian Medicine Diet (PMD) and Mediterranean Diet (MD), on sexual function and semen quality parameters. In this single blind, randomized controlled clinical trial, 159 male patients with oligoasthenospermia aged between 18 and 45 years were enrolled and divided into three groups of 53 people each. The patients were randomly assigned to either PMD or MD intervention and control groups for two months between July 2022 and February 2023 in Shiraz, Iran. To evaluate the outcomes, we used the International Index of Erectile Function (IIEF-15) questionnaires that included five subscales and semen quality parameters. The mean age of the participants was 30.87 ± 6.55. Our analysis showed that total score of IIEF was higher in the PMD intervention (P ≤ 0.001). In addition, the PMD intervention showed a higher average difference in erectile function and intercourse satisfaction subscales, respectively (P ≤ 0.001, P ≤ 0.003). However, MD intervention showed a higher average difference in orgasm function subscale (P = 0.053). Additionally, in semen analysis, the study showed that MD intervention improved statistically. Also, semen count, sperm motility, and morphology difference improved significantly (all P ≤ 0.001). To improve infertility, PMD and MD interventions could positively impact male sexual function and semen quality parameters in infertile mess. Further studies with larger sample sizes and longer durations are needed for conclusive results.

Keywords: Mediterranean diet, Persian medicine diet, Randomized clinical trial, Sexual function

Subject terms: Health care, Nutrition

Introduction

In recent decades, researchers have paid attention to the role of diet in improving male reproductive health and infertility; however, they are inconsistent in their results1. Scientific evidence shows that diet and lifestyle, including physical activity, high body mass index, anxiety, mental and psychological disorders, and smoking and alcohol consumption, have influenced reproductive performance2. According to our knowledge, there is no ideal diet for improving sexual function and semen quality parameters among males with infertility problem. The aim of this study is to investigate the effect of Persian Medicine Diet (PMD) or Mediterranean Diet (MD) on sexual function and semen quality parameters.

Clinical infertility is defined as the inability of a couple to conceive after one year of effective trying. It is estimated that male factors contribute to 30–50% of infertility cases3. Diagnosis of infertility in men is mainly based on semen analysis4. The main parameters of semen include semen count, sperm motility, and morphology difference. Testicular factors, endocrine factors, lifestyle (such as tobacco use5 and obesity6), congenital anatomical factors, gonadotoxic exposure, and aging are recognized as the main factors of infertility or reduced fertility7,8. Statistics show that nutrition could play a role in couples’ infertility9,10. Scientific evidence shows that omega-3 fatty acids, vitamins, minerals and other phytochemicals might enhance semen qualityand sperm functionality in male infertility10. In addition, some studies on decreased infertility rate have recommended fewer calories with a low glycemic index11,12, increased consumption of protein and unsaturated fatty acids, especially Ω-6 and linoleic acid, fiber, high-fat dairy products, and non-heme iron, especially with vegetarian food, while consuming less trans fatty acids and less animal protein13–18. It appears that published studies in this field have not dealt with the problem completely.

Although observational studies reveal that adherence to MD is positively associated with sperm motility, the clinical trial study of MD on semen quality parameters and infertility rate in couples is limited19. The use of MD with more vegetables, olive oil, fish, and legumes has been reported to be more successful in the pregnancy of couples who are candidates for IVF20,21. Considering the positive effects of legumes, especially peas and beans, on metabolic syndrome, fasting blood sugar, insulin, and blood pressure, it seems that legumes may have a positive effect on the reproductive system22. Previous studies indicated that the consumption of legumes, fruits, and vegetables has a positive effect on the quality of the formation and health of the fetus23, while alcohol consumption24 and smoking25 have shown negative effects. In addition, prior studies showed the use of MD, as well as higher consumption of soy, fruits, vegetables, whole grains, and less processed beans by IVF candidate couples, was associated with increased live birth rates26. Based on the results of the observational studies, which are important for creating new hypotheses regarding the role of MD diet and sperm quality, randomized clinical trials are also needed.

Although in modern medicine the effects of some foods and supplements, including antioxidants27, on fertility have been studied, so far no guideline or specific food plan has been provided for couples. Persian medicine takes a holistic approach in the treatment of diseases28–30 and in the involvement of all parts of the body, especially the some organs (heart, liver, brain, ovaries, and testicles), in performing appropriate activities in different parts of the body such as the reproductive system31. Unlike the MD diet, which has been extensively studied and shown positive effects on male fertility and semen quality parameters, evidence related to the Persian Medicine Diet (PMD) is limited and less investigated. PMD is rooted in centuries of traditional Persian Medicine practices and emphasizes a holistic approach to health, including dietary advice to balance physical and reproductive health. Despite limited clinical evidence, some studies have explored the effects of specific Persian Medicine-based formulations on male reproductive health, demonstrating improvements in libido, erectile function, and overall fertility32. Therefore, investigating PMD alongside MD in this study provides an opportunity to bridge the gap in existing literature and bring scientific attention to an underexplored dietary intervention with a historical basis. Based on some evidence, it is possible that food recommendation based on PMD affects male infertility33. PMD has had several pieces of diet advice on improving male reproductive health and infertility; however, scientific evidence in this field is not adequate.

Many diseases could be improved first by modifying lifestyle and eating healthily34. In the case of infertility, diet intervention could potentially improve the management of infertility35. Male infertility is an issue and regarding infertility management research based on neutral intervention such as diet intervention could have potential opportunities. However, no ideal diet has been provided to be recommended to couples, especially men, and a few clinical trials have been conducted on these patients based on the existing recommendations. Therefore, the aim of this study is to investigate the effect of diet intervention based on PMD or MD on male sexual function and semen quality parameters.

Materials and methods

Study design and sample size determination

The study was designed as a randomized controlled clinical trial and the participants (all male) were selected from clinics affiliated with Shiraz University of Medical Sciences. These men underwent examinations under the supervision of an urologist and a traditional medicine specialist to evaluate eligible candidates for the study and for having medical and demographic history. The sample size was 159 participants who were divided randomly into three groups of 53 each. This sample size was calculated by referring to the article (35) using MedCalc statistical software Version 19.1.0 with 80% power, a 0.05 confidence level, and a 20% dropout probability. (Fig. 1)

Fig. 1.

Fig. 1

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Flow diagram illustrates the progress phases of randomized trials of groups (enrollment, intervention, allocation, follow-up, and data analysis).

The Ethics Committee of Shiraz University of Medical Sciences (Ethical Code IR.SUMS.MED.REC.1400.100) approved the study protocol. This study has also been registered in the Iranian Clinical Trials Center (code number IRCT: IRCT20210228050534N1, Registration date:13/04/2022). We confirming that all experiments were performed in accordance with relevant guidelines and regulations. We confirming that informed consent was obtained from all participants. Also, This study performed in accordance with the Declaration of Helsinki.

Inclusion and exclusion criteria

Inclusion criteria included adult men of Iranian race aged between 18 and 45 who expressed their consent to participate in the study. Participants should not suffer from infertility due to anatomical causes, prostate cancer, cardiovascular disease, diabetes, and should have a BMI between 18.5 and 30. Additionally, they should not use herbal medicines and should suffer from oligostenospermia. Exclusion criteria included the patients’ lack of interest or cooperation during the study or the development of complications due to a change in dietary pattern. All patients completed a written informed consent before the study intervention.

Intervention and control group

Male patients with oligoasthenospermia aged between 18 and 45 years were included in the study and were assigned to two intervention groups and one control group. Routine treatments were given to all three groups. The control group (Group C) received routine drug treatment, while the first intervention group received routine drug treatment and a diet based on PMD (Group A), and the second intervention group received routine drug treatment and MD (Group B).

Participants in both intervention groups were followed up to ensure adherence to the dietary recommendations. Follow-ups were conducted by telephone every two weeks. The extent and manner of following the recommendations or any possible problems regarding the diet or food preparation were assessed.

Intervention groups

Group A

This intervention group received routine drug treatment and a diet recommendation based on PMD. It is noteworthy that PMD recommendation was extracted from a panel of specialists based on the assessment of useful foods and seasonings in the treatment of infertility which were extracted from scientific sources36 The summary of suitable dietary recommendations for infertility from the scientific panel of experts according to numerous scientific sources is given in Table 113,16,37.

Table 1.

Foods recommended for patients with infertility based on Persian medicine diet.

Foods recommendation Detail of recommendation intake
1 Proteins include: mutton, chicken, fish and shrimp, egg 450 g per week three days a week three times a week and a total of 4
2 Almonds, hazelnuts, raw pistachios, or coconuts Half a glass of 50 g per day
3 Carrot, pumpkin, or onion vegetables One unit (each unit is 200 g) per day
4 Sweet pomegranate fruits, apples, melons, watermelons, or grapes Two units per day (80 g per unit)
5 Milk, yogurt, or sweet buttermilk Two units (each unit 200 g) per day
6 Seasonings such as saffron, cinnamon, ginger, garlic, or mint Yes or no
7 Animal butter Two tablespoons (10 g) per day
8 Legumes such as peas, beans, and mung beans One cup (200 g) per day
9 Bread and cereals 350 g per day
10 Halwa or dessert (a combination of flour or eggs with oil and spices and sugar or honey) 5 g per week
11 Syrup drinks (grapes, saffron, rose syrup, a combination of milk and honey or a combination of milk and coconut) 300 cc per day
12 Carrot or baling jam Twice a week, at least two tablespoons each time
Avoid foods for patients with infertility based on Persian Medicine Diet
 1 Avoid consuming very sour and salty foods
 2 Avoid eating salad, yogurt, and iced water with meal
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Group B

This intervention group received routine drug treatment and a modified MD. The modified MD recommendation were extracted from the 14-item of modified MD that had content validity in Iranian population38.

Group C

The control group (Group C) received routine drug treatment.

Blinding and allocation

In this trial, single blinding was used. The participants in this study were unaware of the study group allocation. Research assistants enrolled in one group intervention and consultation based on a special protocol. The participants were recruited using advertisements in local media outlets and clinicians’ invitations. The modified MD, PMD, and control group were allocated to participants at random using a computerized random sequence generator. The researcher assigned to randomization was not involved in either the follow-up assessments or analysis.

Questionnaires and outcomes measurement

  • Persian medicine diet questionnaire: The selected diet of PMD, which is obtained based on the past review and previous data, is measured in the form of a questionnaire. The researchers of this project with the consultation and survey of professors (elite panel) of Iranian Traditional Medicine and Nutrition departments of Shiraz University of Medical Sciences (Table 1) designed PMD diet.

  • Mediterranean diet questionnaires: Modified Mediterranean diet recommendation was used based on validated 14-item questionnaires38. MD questionnaire were validated by Khalighi Sikaroudi and others in Iranian population with CVR ≥ 0.714 and CVI 1. Also, a significant correlation was seen regarding Pearson coefficient for test-retest reliability (r = 0.74, p < 0.001).

  • International index of erectile function (IIEF-15) questionnaire: The 15-question IIEF questionnaire is a multi- dimensional subscale (erectile function, orgasm function, sexual desire, intercourse satisfaction, and general satisfaction), self-administered questionnaire that has been found useful in the clinical assessment of erectile dysfunction, sexual function, and treatment outcomes in clinical trials. In addition, the participants were categorized into five levels of erectile dysfunction severity: severe, moderate, mild to moderate, mild, and no dysfunction. At the beginning of the study, at the end of the first month and at the end of the second month, the IIEF questionnaire was filled out for all patients. IIEF questionnaire was validated by Pakpour and others in Iranian population39.

  • Semen analysis: At the beginning of the study, at the end of the first month and at the end of the second month, semen analysis was performed for all patients. In this study, a semen analysis device was used to evaluate semen parameters. The device used is an advanced and accurate device called CASA (Computer-Aided Sperm Analysis), manufactured by Hamilton Thorne. This device is specifically designed to analyze different characteristics of semen. This system uses computer analysis to evaluate the number, movement and morphology of sperm. Below is the detailed information:

    • Quantitative analysis: The device first measures the semen sample using accurate volumetric systems and evaluates parameters such as volume, sperm count, and sperm concentration.
    • Evaluation of sperm movement: The device uses advanced imaging techniques to record and analyze sperm movement. This includes evaluating the speed of sperm movement, the percentage of motile sperm, and the type of movement.
    • Morphological examination: Using high-resolution digital microscopes, the device can examine the structure and shape of sperms and identify possible abnormalities.
    • Accuracy of the device: Due to the use of advanced technologies and precise analysis algorithms, the CASA device has high accuracy in measuring semen parameters. This device is repeatedly subjected to calibration tests to ensure the accuracy and correctness of the results. According to reliable studies, the accuracy of this device in measuring key parameters of semen such as sperm count and their movement has been reported as 95–98% in the evaluation of different parameters of semen.

Statistical analysis

For quantitative variables, the normality of the data was first checked using the Kolmogorov-Smirnov test and the histogram chart. The mean ± Standard deviation (SD) was used to describe quantitative data if they were normally distributed; otherwise, median and interquartile (Q1, Q3) were reported, and frequency and percentage were used to describe qualitative data. To analyze the data, the groups were first compared in terms of basic variables such as BMI, causes of sexual dysfunction, and food frequency. To compare the effects of the intervention (before and after the intervention) in all three groups, the analysis of variance (ANOVA) test was used if the variable was normally distributed, and the Kruskal-Wallis test was used if the variable was not normally distributed. Additionally, to determine the effectiveness of the intervention, the effect size (Eta-squared) was reported. Data analysis was performed using SPSS statistical software Version 19, and the significance level was set at 0.05.

Results

Demographic information of participants

The mean age of participants was 30.87 ± 6.55 years, with a minimum age of 20 and a maximum age of 42 years. There were no significant differences in age between the groups (P = 0.097), although the PMD group was slightly older (32.45 ± 6.35 years) compared to the MD and control groups. There were no significant statistical differences between the three studied groups, PMD, MD, and control groups, in terms of education status (P = 0.961). However, significant differences were observed in economic status and daily physical activity between the groups. Body mass index (BMI) did not show a statistically significant difference between the groups (P = 0.562). Detailed demographic characteristics are presented in Table 2.

Table 2.

Demographic information of participants among Persian medicine diet, mediterranean diet, and control group.

Variable Control group Mediterranean Diet Persian medicine diet P. value
Education status, n (%)
 Primary 1 (33.3) 1 (33.3) 1 (33.3) 0.961a
 Secondary 28 (35.9) 26 (33.3) 24 (30.8)
 High 24 (30.8) 26 (33.3) 28 (35.9)
Economic status
 Low 13 (44.8) 16 (55.2) 0 (0.0) ≤ 0.001 a
 Moderate 22 (31.0) 22 (31.0) 27 (38.0)
 High 18 (30.5) 15 (25.4) 26 (44.1)
Daily physical activity
 < 30 min 16 (59.3) 3 (11.1) 8 (29.6) 0.005 a
 30 min 15 (35.7) 30 (42.9) 25 (35.7)
 > 30 min 22 (35.5) 20 (32.3) 20 (32.3)
Smoking
 Yes 6 (30.0) 6 (30.0) 8 (40.0) 0.796a
 No 47 (33.8) 47 (33.8) 45 (32.4)
Alcohol
 Yes 4 (19.0) 9 (42.9) 8 (38.1) 0.316a
 No 49 (35.5) 44 (31.9) 45 (32.6)
Opium
 Yes 1 (100.0) 0 (0.0) 0 (0.0) 0.366a
 No 52 (32.9) 53 (33.5) 53 (33.5)
Duration of disease, mean ± SD 2.26 ± 1.37 2.83 ± 1.46 2.25 ± 1.27 0.047b
Age, mean ± SD 30.23 ± 6.77 29.94 ± 6.35 32.45 ± 6.35 0.097b
Height, mean ± SD 173.67 ± 4.07 173.84 ± 4.08 174.56 ± 3.51 0.464b
Weight, mean ± SD 75.83 ± 10.02 73.94 ± 9.82 76.32 ± 10.47 0.444b
Body mass index, mean ± SD 25.15 ± 3.13 24.56 ± 3.27 25.15 ± 3.28 0.562b
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Significant values are in bold.

aChi square.

bANOVA.

Table 3 shows the effect of PMD and MD intervention compared to that of the control group on five indexes of erectile function subscales between pre- and post-intervention. The median difference in erectile function showed a statistically significant difference between the groups (P ≤ 0.001); however, in the PMD intervention, erectile function was higher than in the MD intervention and control groups. The median difference in orgasm function showed a statistically significant difference between the groups (P = 0.053); however, it was higher in the MD intervention than in the other two groups. There was no statistically significant difference in sexual desire between the groups (P = 0.680). The median difference in intercourse satisfaction showed a statistically significant difference between the groups (P = 0.003); however, it showed a higher average difference in the PMD group. There was no statistically significant difference in general satisfaction between the groups (P = 0.149), but the PMD group showed higher values (0.75 ± 2.04). Total score of IIEF was higher in PMD group (P ≤ 0.001).

Table 3.

The effect of Persian medicine diet and mediterranean diet on international index of erectile function (mean difference before and after).

Variable Control group Mediterranean Diet Persian medicine diet P. value* Effect size (Eta-squared)
Erectile function, Median (IQR) 0.00 (− 4.00, 3.50) 1.00 (− 2.00, 5.00) 4.00 (0.0, 9.00) ≤ 0.001 0.117
Orgasm function, Median IQR) 1.00 (− 1.00, 2.00) 1.00 (0.00, 3.00) 0.00 (− 1.00, 2.00) 0.053 0.024
Sexual desire, Median (IQR) 1.00 (− 1.00, 2.00) 1.00 (− 2.00, 2.00) 1.00 (− 1.00, 2.00) 0.360 0.011
Intercourse satisfaction, Median (IQR) 1.00 (− 1.00, 4.00) 0.00 (− 1.75, 3.00) 3.00 (1.00, 4.00) 0.003 0.085
General satisfaction, Median (IQR) 0.00 (− 1.00, 1.00) 0.00 (− 1.50, 1.00) 1.00 (− 1.00, 2.00) 0.149 0.029
Total 4.00 (− 3.50, 8.00) 2.50 (− 1.00, 8.00) 11.00 (1.00, 16.50) ≤ 0.001 0.089
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Significant values are in bold.

*Kruskal–Wallis test.

Before the intervention, six (3.8%) participants were classified as having severe erectile dysfunction, 14 (8.8%) of the participants had moderate erectile dysfunction, 50 (31.4%) participants had mild to moderate erectile dysfunction, 53 (33.3%) of the participants had mild erectile dysfunction, and 36 (22.6%) of the participants had no erectile dysfunction. Following the intervention, the number of participants with mild to moderate erectile dysfunction decreased to 40 (25.2%), and the number of those with mild erectile dysfunction remained at 50 (31.4%). Significantly, the number of participants with no erectile dysfunction increased to 69 (43.4%) (P ≤ 0.001).

Table 4 shows the assessment of mean difference between the PMD and MD intervention in semen parameters quality before and after the intervention. There was a statistically significant difference in semen volume between the three groups (P = 0.003). In the PMD and MD interventions, the mean difference in semen volume decreased, while in the control group, the volume increased. Semen count showed a statistically significant difference in all three groups (P ≤ 0.001). The mean difference in semen count was highest in the MD intervention (16.56 ± 9.80). Sperm motility also showed a statistically significant difference among the three groups (P ≤ 0.001), with the MD intervention having the highest motility (23.49 ± 13.10). Sperm morphology showed a statistically significant difference among the three groups (P ≤ 0.001 with the MD intervention having the highest motility. In addition, the effect size (Eta-squared) for this variable was 0.400, which indicates a significant effect of the studied diets on sperm morphology.

Table 4.

The effect of Persian medicine diet and mediterranean diet on the semen parameters (mean difference before and after intervention).

Traditional medicine diet Control group Mediterranean Diet Persian Medicine Diet P. value Effect size (Eta-squared)
Semen volume, mean ± standard deviation 0.17 ± 0.79 − 0.28 ± 1.52 − 0.66 ± 1.29 0.003 * 0.074
Semen count, mean ± standard deviation 3.86 ± 5.00 16.56 ± 9.80 11.98 ± 8.66 ≤ 0.001 * 0.300
Sperm motility, mean ± standard deviation 7.35 ± 9.68 23.49 ± 13.10 18.49 ± 10.94 ≤ 0.001 * 0.265
Morphology, median (IQR) 0.00 (0.00, 1.00) 1.00 (1.00, 2.00) 0.00 (0.00, 1.00) ≤ 0.001 ** 0.400
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Significant values are in bold.

*ANOVA.

**Kruskal–Wallis Test.

Discussion

This study aimed to investigate the effect of PMD on sexual function and semen analysis parameters of infertile men in comparison with MD. The results of this study showed that total score of IIEF was higher in the PMD intervention. In addition, the PMD intervention showed a higher average difference in erectile function and intercourse satisfaction subscales, respectively. However, the MD intervention showed a higher average difference in orgasm function subscale. Additionally, in semen analysis, the study showed that the MD intervention improved statistically significant in semen count, sperm motility, and morphology difference, while in PMD group the semen parametric improvement was not statistically significant.

Prior to our study the relationship between diet and sexual erectile function have been investigated severally, and adherence to the MD has shown a positive effect on erectile function and cardiovascular hemodynamics in male patients with chronic heart failure40. One study stated that an MD rich in whole grains, fruits, vegetables, legumes, walnuts, and olive oil might be effective in reducing the prevalence of erectile dysfunction in men with metabolic syndrome41. Published studies have shown that adherence to the diet helps prevent erectile dysfunction by improving lipid and glucose metabolism, increasing antioxidant defenses, and increasing arginine levels, which can increase nitric oxide activity as well42. It has been stated that higher diet quality based on following an MD or an alternative with a healthy eating index that emphasizes the consumption of vegetables, fruits, nuts, legumes, and fish or other sources of long-chain fats, as well as avoiding red and processed meats, are associated with a lower risk of erectile dysfunction43 (40). MD has been shown to improve endothelial function, inflammatory markers, and glucose metabolism, which can help prevent erectile dysfunction41–43.

The results of our study showed that PMD could also improve sexual erectile function. In this study, a better sexual desire and overall satisfaction was reported following PMD compared to the other two groups. Better erectile indexes resulted in the PMD group can be related to the presence of more micronutrients such as zinc, iron, selenium, magnesium, manganese, and group B vitamins in the recommended protein resources like mutton and shrimp compared to the fish meat in MD. Also, advised sweet fruits such as grapes and watermelon are rich in L-Arginine and L-citrulline with induction potential of sexual ability, and recommended spices like saffron, cinnamon, and ginger in PMD with multi beneficial advantages like anti-inflammatory and anti-oxidant effects can be another factor in enhancing sexual power among the consumers of this diet44,45. It has been demonstrated that targeting multiple signaling pathways, including pathways involved in oxidation, apoptosis, atherosclerosis, and endothelial function by traditional Chinese medicine can be more effective than chemical drugs in treating diabetic erectile dysfunction46.

Another goal of this study was to investigate the effect of recommended diets on semen parameters. The results of this study showed that MD is associated with improved semen parameters including semen count, sperm motility and morphology difference. The relationship between MD and the Western diet with semen quality parameters has been investigated in a previous study and the scientific evidence revealed a correlation between semen parameters and increased chances of conceiving47,48. The biological mechanisms related to diet, sperm function, and fertility are not yet fully understood. Naturally, rich nutrient foods included in MD with anti-inflammatory effects are proposed potential mechanisms49. Low-grade chronic inflammation may affect reproduction through anatomical or functional changes in the male accessory gland or through direct negative effects on sperm49. Furthermore, it is believed that the benefits of MD on semen characteristics are due to the high consumption of fruits and vegetables rich in antioxidant vitamins (such as beta-carotene and vitamins A, C, and E), minerals (such as magnesium), and polyphenols50. Since sperm membranes are very sensitive to oxidative damage caused by reactive oxygen species (ROS), the benefits of this diet on semen quality may be due to higher consumption of natural foods rich in antioxidants and carotenoids50. Additionally, MD characterized by high consumption of vegetables, fruits, seafood, whole grains, and low meat consumption, has been associated with improved parameters of semen quality. A cross-sectional study showed that adherence to an MD has a positive relationship with total sperm count48. Another cross-sectional study on couples attending a fertility clinic found that greater adherence to MD was significantly associated with higher sperm concentration, total sperm count, and sperm motility51. A systematic review and meta-analysis of six studies reported significantly higher sperm concentration, a significant increase in total sperm count, and a significant increase in progressive sperm motility in men with higher consumption of healthy dietary patterns, including MD52. In fact, the results suggest that greater adherence to MD may help improve semen quality, and our study also confirms these findings.

Despite the evidences that show the efficacy of MD on male fertility there are very few studies examining other diets including PMD in this area, albeite the efficacy of some herbs and traditional formulations like Majoon Labob on male fertility, libido, and erectile function has been investigated53, and the impact of Persian Medicine-based diet on infertile women undergoing assisted reproduction has been studied ( …), but there is no specific evidence that directly links a diet based on PMD with men’s sexual function and sperm parameter quality, and as far as we know this is the first clinical work in this subject.

Due to the limitations of this study, including the small sample size and short duration, further research with larger sample sizes and longer study durations is necessary to draw definitive conclusions. More targeted research with large-scale, multicenter, randomized, and controlled clinical trials is needed to establish a clear link, and to recognize the underlying medicinal mechanisms. In addition, future studies should also investigate the effects of PMD on other semen parameters, such as sperm shape and morphology, to provide a more comprehensive understanding of its impact. Furthermore, longitudinal follow-up studies are highly recommended to assess the long-term effects of dietary interventions, such as PMD, on fertility outcomes, which may help to further explore and solidify its potential benefits.

Conclusions

The present study demonstrated that PMD could positively affect sexual function and semen parameters in infertile men. Specifically, PMD could improve erectile function, sexual desire, unwanted satisfaction from sexual relations, and overall satisfaction compared to the MD and control group. However, the MD group showed better results in terms of count, sperm motility, and morphology difference. These findings indicate that while PMD can enhance sexual performance in infertile men, using an MD appears to bring better results in semen quality, particularly sperm count and motility.

Acknowledgements

This article was a part of Ali Ghasemi’s thesis, approved and financially supported by the Research Vice-chancellor of Shiraz University of Medical Sciences (Grant no. 1400-2-22-20460). The Ethics Committee approved this study at Shiraz University of Medical Sciences (IR.SUMS.MED.REC.1400.100).

Author contributions

AM.J. is the lead author and guarantor and contributed to interpreting the data and revising the manuscript. A.GH and MH.Sh planned the study and led the drafting and revising of the manuscript. A.GH, A.T., H.Gh, and A.H contributed to interpreting the data and drafting and revising the manuscript. All authors approved the submitted version of the manuscript. All authors have contributed to the preparation of the manuscript, have read, and approved the submitted manuscript. All authors listed meet the authorship criteria according to the latest guidelines of the International Committee of Medical Journal Editors and agree with the manuscript. The work is original and not under consideration by any other journal.

Data availability

The data that support the findings of this study are available from the corresponding author, [AM.J.], upon reasonable request.

Declarations

Competing interests

The authors declare no competing interests.

Footnotes

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author, [AM.J.], upon reasonable request.

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