Can lifestyle changes significantly improve male fertility: A narrative review?

ABSTRACT

Male infertility is increasingly recognized as a significant global health concern, with lifestyle factors being critical contributors to declining male fertility rates. This narrative review comprehensively analyzes the impact of various lifestyle choices, including diet, physical activity, substance use, stress, sleep, weight management, sexual habits, and environmental and occupational exposures on male reproductive health. The review examines the biological and ecological mechanisms through which these lifestyle factors affect spermatogenesis and sperm quality. Furthermore, it discusses potential interventions, such as dietary modifications, weight management strategies, substance cessation programs, stress reduction techniques, and workplace policy changes to improve male fertility outcomes. Emphasis is placed on the role of oxidative stress, hormonal regulation, and DNA integrity in mediating the effects of these lifestyle factors. While lifestyle modifications can significantly enhance male reproductive health, the available evidence highlights the need for more rigorous research to establish solid guidelines and interventions for mitigating male infertility.

Introduction

Infertility is a global health problem with an increasing research trend over the last decades [1,2]. Approximately 8–12% of couples are affected by this problem, with the male factor being solely responsible for almost half of them [3]. The global prevalence of male infertility varies from 9%-15.8% among different countries in North/Western Europe, America, and Western Africa [4]. The decline in global sperm count is an indisputable fact, and it continues at an alarming rate in the 21st century [5]. Among the possible reasons or risk factors for the progressive decline in semen quality are the inheritance of genetic and epigenetic patterns affecting spermatogenesis, intrauterine exposures, and lifestyle and environmental factors [6,7]. Lifestyle factors, such as advanced paternal age, diet, psychological stress, smoking, caffeine intake, and alcohol use, have been suggested to affect semen quality and/or sperm DNA integrity [6,8–10]. Considering that reproduction is a dynamic biological process influenced by social and psychological factors, it is reasonable to expect that these elements can have a detrimental impact on reproductive outcomes. Despite this, discrepancies persist within scientific findings [11,12]. It is possible to trace changes in lifestyle in various reproductive parameters, including but not limited to terminating detrimental habits, reducing weight, and adhering to a balanced diet; these modifications can collectively lead to enhanced reproductive results [13]. This review comprehensively examines the influence of lifestyle choices on male fertility, emphasizing the significance of managing these factors for optimal male reproductive health.

Factors influencing male fertility

Biological factors

Spermatogenesis is a complex and meticulously organized process that maintains spermatogonial stem cells and their differentiation into mature spermatozoa. This process requires hormones, growth factors, different cell types, proper interactions between somatic and germ cells, genetic and epigenetic factors, and an intact blood testis barrier, which enable successful spermatogenesis [14]. Endocrine and paracrine signals control spermatogenesis by determining germ cell fate as life or death, including stem cell factors and gonadotropins (e.g. follicle-stimulating and luteinizing hormones). The deterioration in the hormonal regulation of spermatogenesis results in germ cell apoptosis and, ultimately, spermatogenesis impairments [15]. Besides endocrine and paracrine factors, specific cellular and molecular mechanisms ensuring the genomic integrity of sperm via various checkpoints in cell division play a crucial role in the quantity and quality of sperm production, which have sensitivity against environmental factors [16].

Environmental factors

Environmental factors have a growing research interest in male infertility owing to their presence globally. Outdoor pollution, dangerous chemicals, pesticides, herbicides, phthalates, heavy metals, and heat exposure are involved in these factors [17]. Air pollutants, such as ozone, sulfur dioxide, polycyclic aromatic hydrocarbons (PAH), and heavy metals, can be inhaled and enter the bloodstream. These pollutants can harm human semen quality and sperm DNA integrity by disrupting hormones and causing oxidative stress (OS) [18]. Bisphenol A (BPA), phthalates, and pesticides also act as endocrine disruptors [17]. Pesticide residues in fruits and vegetables decrease sperm count in a quantity-dependent manner in young, healthy men [19]. Occupational hazards also contribute to male reproductive impairments. Heat exposure derived from high temperatures in the workplace may cause genital heat stress. Since spermatogenesis is sensitive to temperature changes, 2–4°C lower than the body core is suitable for proper spermatogenesis. Genital heat stress has been associated with testicular atrophy, spermatogenic arrest, and a decrease in the level of inhibin B hormone, resulting in oligozoospermia [20]. Physiological stress and ionizing and non-ionizing radiation are other occupational factors with harmful effects on male fertility. Non-ionizing radiation is derived from radiofrequency emitted by technological devices such as cell phones and Wi-Fi. Radiofrequency adversely impacts sperm quality and quantity through OS, DNA breaks, and epigenetic changes [7].

Impact of lifestyle on male fertility

Men’s lifestyle choices can profoundly affect fertility, and diet and nutrition hold pivotal positions. Understanding the impact of nutrition on male reproductive function is critical for guiding lifestyle modifications that could enhance fertility (Figure 1) [21].

Figure 1.

Impact of lifestyle on male fertility and importance of lifestyle regulation in improving male reproductive health.

Diet and nutrition

Dietary habits are crucial for maintaining overall health and are closely linked to reproductive success. The intimate relationship between nutrition and fertility stems from the body’s need for specific nutrients that contribute to spermatogenesis and hormonal balance [22].

Effects of specific nutrients on sperm health

Nutrients have been shown to play significant roles at various stages of sperm development. For instance, omega-3 fatty acids are essential for the fluidity of sperm cell membranes, and their deficiency has been correlated with decreased sperm quality [23]. Additionally, arginine, which is abundant in nuts and meat, is a precursor for nitric oxide that aids in sperm motility and quality [24].

Fatty acids and hormonal balance

Polyunsaturated fatty acids, like omega-3 and omega-6, are reported to play a role in testosterone synthesis. Research suggests that an optimal balance between these fatty acids is crucial, as an imbalance can disrupt hormonal homeostasis and negatively affect sperm production [25].

The role of antioxidants

Oxidative stress is known to harm sperm DNA integrity, and antioxidants serve as a protective shield against such damage. Vitamin C and E, selenium, and Coenzyme Q10 are potent antioxidants that have been reported to improve sperm quality by reducing the oxidative stress [26].

The role of micronutrients

Micronutrients like zinc and folate are vital for normal spermatogenesis. Zinc acts directly on the testicular cells and is essential for forming the spermatic membrane and tail [27]. Folate’s role in DNA synthesis and repair is equally important to ensure the genetic health of sperm [28].

Physical activity

Physical activity has long been linked to various health benefits, including improvements in cardiovascular health, weight management, mood, and even overall mortality rates. However, its connection with male fertility is complex and multifaceted. Research suggests that both insufficient and excessive physical activity can adversely affect male reproductive health [29].

Impact on sperm quality

Low physical activity levels have been associated with poorer sperm quality, while moderate physical activity has improved up to a certain point [30]. However, excessive exercise, such as intense training for marathons or Olympic events, can potentially lower testosterone levels, reduce sperm quality, and lead to infertility [31].

Optimal levels of physical activity

Moderate exercise can positively impact male fertility by enhancing hormone levels, regulating sperm production, and improving overall health. However, the available studies have limitations, and more research is needed to fully understand the specific effects of different exercises and their impact on fertility outcomes [29].

Substance use

Substance uses, such as tobacco and nicotine, alcohol consumption, and illicit or recreational drug use, have been found to have detrimental effects on male fertility. Research suggests that lifestyle changes in these areas can improve male fertility [12].

Tobacco and nicotine

Smoking adversely affects male fertility, leading to reduced sperm count, motility, and morphology. Heavy smoking exacerbates these effects and can impact in vitro fertilization success rates. However, quitting smoking can be beneficial, as it typically takes almost three months for sperm health to improve [32]. Prenatal exposure to tobacco also has long-term consequences on male offspring fertility [33]. E-cigarette smoking has gained popularity as an alternative to traditional smoking, but growing research suggests it may have adverse effects on male fertility and semen parameters [34–36]. Studies indicate that the chemical components in e-cigarette vapor, including nicotine and various flavoring agents, can negatively impact sperm motility, concentration, and overall sperm quality. These alterations can lead to decreased fertility potential. Additionally, oxidative stress and inflammation caused by e-cigarette use are thought to damage the testes and impair spermatogenesis [37,38]. While more research is needed to understand the long-term effects fully, current evidence suggests that e-cigarette smoking could pose significant risks to male reproductive health [39].

Alcohol consumption

Chronic heavy drinking has been linked to lower testosterone levels and impaired semen quality. It’s advisable to reduce alcohol intake to enhance reproductive outcomes. Moderate alcohol consumption may not have significant adverse effects, but excessive drinking should be avoided [12].

Illicit or recreational drug use

Drugs like cannabis, cocaine, 3,4-methylenedioxymethamphetamine (MDMA), and opioids have shown negative effects on male fertility through various mechanisms, including hormonal changes, DNA damage, and impacts on sperm quality. Avoiding drug addiction and substance abuse is recommended [40,41].

Stress and mental health

The impact of chronic stress on fertility

Chronic stress is a significant factor that can adversely affect male fertility. Stress can trigger a series of physiological responses that may disrupt the normal functioning of the reproductive system. Prolonged exposure to stress can lead to hormonal imbalances, particularly in the hypothalamic-pituitary-gonadal (HPG) axis, which is crucial for regulating reproductive hormones [42]. Studies have shown that chronic stress can reduce testosterone levels, impair sperm production, and decrease libido, thereby reducing the chances of successful conception. Additionally, stress can lead to unhealthy behaviors such as poor diet, lack of exercise, smoking, and excessive alcohol consumption, further exacerbating fertility issues [43].

Stress hormones and spermatogenesis

Stress hormones, particularly cortisol, play a pivotal role in spermatogenesis. Elevated levels of cortisol can interfere with the secretion of gonadotropin-releasing hormone (GnRH) from the hypothalamus, which in turn affects the release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) from the pituitary gland [44,45]. These hormones are essential for stimulating the testes to produce testosterone and facilitate spermatogenesis. High cortisol levels can also induce oxidative stress, damaging sperm DNA and reducing sperm motility and viability. Thus, managing stress is crucial for maintaining optimal spermatogenic function and male fertility [46].

Impact of mental health on fertility

Mental health conditions such as depression and anxiety are closely linked to male fertility issues. These conditions can reduce libido, contribute to erectile dysfunction, and lower overall sperm quality. The psychological stress associated with infertility can exacerbate these issues, creating a cycle of stress and reduced fertility. Effective management of mental health through therapies like cognitive-behavioral therapy (CBT), mindfulness practices, and stress-reduction techniques such as regular exercise and meditation has been shown to improve sperm quality and enhance fertility outcomes [47].

Sleep and circadian rhythms

The importance of sleep in male fertility cannot be overstated. Adequate sleep is essential for the proper functioning of the endocrine system, which plays a crucial role in regulating reproductive hormones. Disruptions to sleep patterns and circadian rhythms can significantly impact male fertility [48].

Numerous studies have demonstrated the link between sleep deprivation and reduced sperm quality, motility, and concentration. Sleep is a crucial component of the body’s natural cycle, and disruptions to this cycle can lead to hormonal imbalances, which can impact various aspects of male reproductive health [49–51].

Circadian rhythms, the internal biological clocks that regulate our sleep-wake cycles, are closely intertwined with fertility. Disruptions to these rhythms, such as those caused by shift work, jet lag, or exposure to artificial light at night, can lead to hormonal imbalances and impaired testicular function. This can result in decreased sperm production, reduced sperm motility, and an increased risk of sperm DNA fragmentation [52]. Moreover, chronic sleep deprivation has been associated with increased oxidative stress, which can damage sperm cells and contribute to male infertility [53]. Conversely, adequate sleep has been shown to improve sperm quality, motility, and overall reproductive health [54].

Weight and body mass index (BMI)

The link between obesity and male infertility

Research indicates that obesity negatively affects male fertility by reducing sperm count, movement, and quality. For example, men being just 20 pounds over their ideal weight increases their chances of infertility by 10% [55,56]. The presence of excess body weight leads to hormonal imbalances, turning testosterone into estrogen and decreasing sperm production [57].

Obesity and reproductive hormone levels

The detrimental impacts of obesity extend to sperm DNA integrity and hormonal profiles. Increased body weight is associated with diminished sperm concentration and alterations in reproductive hormones [58]. These hormonal imbalances, particularly the conversion of testosterone into estrogen and functional hypogonadism, can severely hamper the ability to produce sperm. [59]

Low BMI and its effects on fertility

While much focus is given to obesity, being underweight also poses risks to male fertility. Underweight individuals may experience hormonal imbalances and energy deficiencies that can disrupt the hypothalamic-pituitary-gonadal axis, impacting fertility. These disruptions can lead to extended time to conception, underlining the necessity of maintaining a balanced weight [60].

Sexual habits

Frequency and timing of sexual activity

The frequency of sexual activity plays a crucial role in enhancing male fertility. Studies suggest that ejaculating daily or even twice daily around the time of ovulation may increase the chances of conception for infertile men [61]. This practice helps maintain optimal sperm motility and concentration, especially in normozoospermic and asthenospermic men [62]. Maintaining a balance in sexual activity and timing intercourse around ovulation are essential strategies for couples trying to conceive [63].

Impact of lubricants and sexual practices on fertility

While lubricants can increase comfort during intercourse, many couples are unaware of their potential adverse effects on sperm motility. Most commercial lubricants, mainly water-based and some fertility-specific ones, can significantly reduce sperm’s ability to move and reach the egg [64]. Couples trying to conceive are advised to select lubricants that are hydroxyethylcellulose-based, as these have shown minimal impact on sperm motility and are most akin to natural vaginal mucus. Oil-based and silicone-based lubricants have also performed relatively well in maintaining sperm vitality but should be chosen with care to avoid any potential fertility issues [65].

Environmental and occupational exposures

Heat exposure

Excessive heat can significantly impact male fertility by affecting sperm production and quality. High temperatures can increase scrotal temperature, which may impair spermatogenesis, the process of sperm production [66]. Men should avoid prolonged exposure to heat sources such as hot tubs, saunas, and tight clothing, which can elevate scrotal temperature. Occupational exposure to heat, such as working in hot environments, can also decrease sperm quality and should be managed through protective measures and work breaks [67].

Toxins and pollutants

Exposure to toxins and pollutants is another critical factor that can adversely affect male fertility. Chemicals such as pesticides, heavy metals, and industrial pollutants can lead to oxidative stress, which damages sperm DNA and reduces sperm motility and viability [68]. Men working in environments with high levels of such toxins should use protective equipment and minimize exposure. Also, lifestyle changes like reducing the usage of plastic containers and avoiding areas with high pollution can mitigate these risks. Avoiding exposure to cigarette smoke and limiting alcohol intake are additional steps to protect against reproductive toxins. Understanding and mitigating these environmental and occupational exposures are vital to improving male fertility [69].

Importance of lifestyle regulation in improving male reproductive health

Nutritional interventions

The Mediterranean diet and its association with male fertility

Nutrition affects fertility in both men and women, with the impact being determined by the diet’s quantity and quality, including the caloric content and specific profiles of macronutrients [70]. The Mediterranean diet (MD) is well-studied for its contributions to overall health. It involves eating lots of fresh fruits, vegetables, grains, nuts, and legumes, moderate fish and wine, and minimal dairy and meat. The main source of fat in this diet is olive oil. Therefore, the Mediterranean diet is high in fiber, monounsaturated fats, antioxidants, and anti-inflammatory nutrients while low in saturated fat [71].

Previous studies show that sticking to the MD can lower the risk of various health conditions like cardiovascular disease, Alzheimer’s disease, diabetes, hypertension, certain cancers, and overall mortality [72]. Additionally, the MD, known for its antioxidant and anti-inflammatory properties, has been linked to improved semen quality [73]. For example, one study found a positive relationship between MD adherence and sperm motility in a group of healthy men [74]. Another study discovered that low adherence to the MD increased the risk of low sperm concentration [75]. Recent research further supports these findings, demonstrating that higher adherence to the MD is associated with better sperm count, concentration, morphology, and progressive motility in infertile men. Several published reviews have also highlighted the positive impact of the MD on male fertility, emphasizing the benefits of consuming foods rich in polyunsaturated fatty acids, antioxidants, and anti-inflammatory substances [21,73]. These components help reduce oxidative stress and protect sperm from its negative effects. Similar associations between the MD and improved semen quality have also been observed in women [76]. However, more research is needed to determine the impact of a healthy diet on pregnancy outcomes and assisted reproductive techniques (ART) outcomes.

Studies on diet modification

Two studies found that a MD improves sperm quality in young men compared to a low-fat diet or no changes [77]. Another study supported the positive effect of combining MD with exercise on sperm health [78]. Research on the Prudent diet, which is rich in fruits, vegetables, and fish, also shows better sperm quality than a Western diet [79]. However, studies are mixed about plant-based diets some showing benefits for sperm health and others finding no impact [80]. A Western diet, full of processed foods and sugars, is linked to poor sperm quality due to increased oxidative stress and weight gain. Overall, eating healthily and maintaining proper weight is key for reproductive health in men [81,82].

Supplements and fertility: Impact of antioxidants, micronutrients, and fatty acids on male reproductive health

Antioxidants protect cells from oxidation and free radicals. Enzymatic antioxidants include superoxide dismutase (SOD), catalase, glutathione peroxidase, and glutathione reductase. Non-enzymatic antioxidants include glutathione, cysteine, N-acetyl cysteine (NAC), carotenoids, vitamins C and E, carnitine, ferritin, L-arginine, transferrin, Coenzyme Q10 (CoQ10), myoinositol, lycopene, selenium, zinc, and folate [83]. They help by scavenging free radicals, preserving sperm DNA, and improving mitochondrial transport. Studies show antioxidants positively affect male infertility and semen parameters like sperm motility and vitality, especially with NAC and L-carnitine. Vitamins E and C, carnitines, CoQ10, lycopene, selenium, and zinc improve sperm concentration, motility, and morphology [84]. Despite study differences, antioxidants, including carnitines and zinc, improve semen quality [85].

Omega-3 fatty acids, with anti-inflammatory and antioxidant properties, reduce heart disease risk and benefit semen parameters. They improve sperm count, concentration, and motility by altering cell membrane composition [22]. However, their impact on pregnancy outcomes is unclear. Studies have indicated positive effects of NAC, vitamins C and E, and CoQ10 on sperm DNA fragmentation, though more research is needed. Higher pregnancy rates with antioxidant treatment suggest benefits, but further studies on live birth and miscarriage rates are required [74].

Weight management and physical activity

Weight loss studies

Weight loss is crucial for improving semen quality. Studies show that diet and weight loss medications can enhance reproductive health. The S-LITE trial found that men who lost an average of 16.5 kg had increased sperm concentration and count, which were benefits that would last if the weight loss was maintained. Liraglutide, a weight-loss drug, showed significant improvements in testosterone levels and semen parameters in men with metabolic hypogonadism. Overall, weight improvement with glucagon-like peptide 1 (GLP-1) analogs is linked to better sperm count, concentration, and motility [81]. Bariatric surgeries, including gastric bypass, sleeve gastrectomy, and adjustable gastric banding, are known to impact weight loss and overall health significantly, but their effects on male fertility are less clear [86]. Current data suggest that these procedures can lead to hormonal changes, such as increases in testosterone levels and decreases in estrogen levels, which may enhance spermatogenesis and improve fertility [87].

Additionally, weight loss following surgery can alleviate obesity-related infertility factors such as erectile dysfunction and metabolic syndrome. However, the extent and consistency of these improvements can vary between individuals and types of surgery. While some studies suggest potential benefits to male fertility post-surgery, further research is needed to understand the long-term reproductive outcomes and the optimal timing for conception after surgical interventions. [88].

Exercise programs

Studies compare physically active men to sedentary ones, showing active men have better semen volume, motility, and morphology. One study found active men had a 73% higher sperm concentration, while those watching over 20 hours of TV weekly had a 44% reduction. Moderate physical activity may boost sperm count, while too much TV harms it [89,90].

Moderate-intensity exercise lowers oxidative stress and inflammation in healthy men, but strength and high-intensity training do not. For infertile men, high-intensity exercise reduces inflammation and stress, improves semen quality, and raises pregnancy rates [91]. While physical activity benefits male reproductive health, the type and intensity matter. More trials are needed to understand these effects.

Substance use modification

Cessation programs and the impact of reduced use

Recreational drug use can lead to various health issues, including male infertility. Cigarette smoking and alcohol harm semen quality, and many infertile men also use recreational drugs [92]. There’s limited research on how these drugs affect male fertility. Some studies show cannabis harms sperm production, but others find no impact. The effects of opiates, cocaine, and amphetamines on reproduction are also unclear and need further study [93].

Anabolic-androgenic steroids (AAS) severely impact testosterone production, fertility, and overall health. AAS users often have lower LH and FSH levels but higher testosterone and estradiol levels. Common side effects include gynecomastia, acne, hair loss, and reduced testis volume [94]. AAS use decreases sperm count and quality. Recovery of the hypothalamus-pituitary-testis (HPT) axis can vary, taking from 24 weeks to 2 years, influenced by the duration and dosage of AAS use. Treatments like hCG and selective estrogen receptor modulators (SERMs) can aid in faster recovery. Combining low-dose hCG and SERMs may help maintain the HPT axis for those not stopping AAS [95,96].

Stress reduction techniques

Mindfulness and stress management

Infertility often leads to severe psychological issues in both partners. Studies show couples undergoing fertility treatment often experience depression and anxiety. Combining medical, psychological, and social care helps address stress and treatment challenges. Psychosocial interventions can reduce stress and anxiety, improve marital relations, and increase pregnancy rates. One study showed that group psychoeducational support during IVF enhanced quality of life and resilience [97]. Another study found a mindfulness program decreased depression and shame and improved coping skills in women. Mindfulness interventions can boost self-compassion, emotion regulation, and coping strategies, positively affecting quality of life and pregnancy rates [98].

Long-term stress is a risk factor for health issues like high blood pressure and male reproductive health. Studies show conflicting results about stress’s impact on semen quality. One study found infertile men experienced more stressful life events but no difference in stress symptoms compared to fertile men. Stress did not affect testicular function or erectile dysfunction [99]. Psychological stress can severely impact spermatogenesis due to changes in testosterone secretion. Stress affects the hypothalamic-pituitary-gonadal axis, leading to decreased testosterone and impaired spermatogenesis. Despite limited evidence, stress’s role in male infertility should not be ignored, and patients should be informed and helped to manage it [46].

Avoidance of environmental and occupational hazards

Changes in workplace policies

Awareness is growing that the work environment might contribute to male infertility, now often considered idiopathic. Occupational exposure to radiant heat (e.g. bakers, kitchen workers, welders, furnace workers, ceramic workers) and other hazards can harm male reproductive health. Men exposed to high heat sources take longer to conceive and have poorer sperm quality. A study showed higher infertility rates in bakers compared to controls [100]. Also, chemicals like bisphenol A and phthalates may impact testicular function, though findings are inconsistent [101].

Shift work is a work schedule that falls outside the traditional 9-to-5 hours. This type of work is commonly used in sectors that require 24-hour service or extended operational hours, such as healthcare, law enforcement, manufacturing, retail, hospitality, and transportation. Shift work can include evening, night, early morning, and rotating shifts [102]. Shift work is linked to various health issues, including ulcers, sleep accidents, absenteeism, depression, and urological problems. While female infertility due to shift work is well-studied, less is known about its effects on men [103]. Men working non-standard shifts face intimacy issues and strained relationships. A study found higher infertility rates in shift workers. Reduced semen quality also seemed more common in shift workers. Circadian rhythm disturbances from shift work can disrupt the brain-gonadal axis, leading to infertility [104].

Therefore, heat exposure, chemical exposure, and shift work are potential contributors to male infertility, suggesting a need for new workplace policies.

Personal protective equipment uses

Radiofrequency (RF) can impact germ cells, affecting spermatogenesis, motility, and reducing sperm count. RF also causes genetic and hormonal changes and contributes to oxidative stress, which can reduce sperm quality [105]. Therefore, limited use of RF devices or protective gear is recommended for long-term fertility.

Ionizing radiation is known to damage testicular physiology and function. Studies show that men exposed to low radiation at work have more abnormal sperm, reduced motility, and increased cell vacuolization [106]. Urological procedures often use fluoroscopic guidance, so protection against radiation is important for both doctors and patients. Varicocele embolization, in particular, exposes young men to radiation, risking testicular damage. Using protective shields and sclerosing agents can help lower radiation exposure [107].

Controversies and limitations

The evidence on lifestyle effects on male infertility is currently poor, mainly due to the limitations of the present studies, thus preventing solid guidelines from being adopted and implemented. Smoking, alcohol, and drug use harm sperm quality, but details on types and amounts of substances are unclear due to unadjusted confounding factors. Sedentary lifestyles are linked to poor semen quality compared to regular exercise, but no direct training program comparisons are available. Thus, only general advice can be given, but this is critical for men suffering from infertility worldwide.

Conclusion and future directions

Various lifestyle factors and daily exposures can negatively affect human spermatogenesis, particularly through oxidative stress and sperm DNA fragmentation. However, lifestyle alterations can partially or entirely mitigate these detrimental impacts. For example, adopting a healthy diet, engaging in physical exercise, ceasing harmful addictions, and improving circadian rhythms through regular sleep contribute to positive changes that counteract poor lifestyle choices. In this context, healthcare providers and social media can enhance the knowledge and awareness of infertile couples regarding the adverse effects of lifestyle factors on fertility.

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Disclosure statement

No potential conflict of interest was reported by the author(s).