Impact of a 12-week Yoga Intervention on Seminal Oxidative Stress, Sperm Quality, and DNA Fragmentation Index in Infertile Men: A Pre–post Intervention Study

Abstract

Background and Aim:

Oxidative stress (OS) and oxidative DNA damage are significant contributors to male infertility, negatively affecting sperm function and genomic integrity by modulating the sperm DNA fragmentation index (DFI). Elevated reactive oxygen species (ROS) levels lead to the accumulation of harmful DNA adducts such as 8-hydroxy-2’-deoxyguanosine (8-OHdG), which can impair fertility and increase cancer risk. Our study intended to investigate the effects of a 12-week yoga intervention on seminal ROS levels, OS marker, sperm quality, and sperm DFI in primary infertile men.

Materials and Methods:

Out of a total of 78 primary infertile men who met the specific inclusion and exclusion criteria, 42 participants successfully completed the 12-week yoga intervention. Semen analyses were conducted at pre- and postintervention, as per World Health Organization-21 guidelines (sixth edition), ROS levels were measured by the luminol assay, and 8-OHdG levels were evaluated using ELISA. The sperm DFI was assessed by the Sperm Chromatin Structure Assay.

Results:

The 12-week yoga intervention resulted in significant improvements in total sperm count (from 34 to 129 million sperm/ejaculate) and progressive motility (from 15% to 35%). Seminal ROS levels significantly decreased from 45.3 to 16.5 relative light units (RLU)/s/million sperm (P < 0.001), and 8-OHdG levels decreased from 86.47 to 48.2 ng/ml (P < 0.001). A decreasing trend (P = 0.068) in DFI was observed at postyoga intervention.

Conclusion:

Our study revealed that regular yoga practice significantly improves sperm function and reduces OS and DNA damage in infertile men. These findings support yoga as a beneficial adjunct therapy for the management of unexplained male infertility and can potentially enhance fertility outcomes.

Introduction

Male infertility affects over 15% of couples across the globe, with male factor accounting for nearly half of these cases.[1,2] Among the various factors impacting male fertility, sperm DNA fragmentation has emerged as a critical determinant of reproductive success.[3] Elevated levels of sperm DNA fragmentation are associated with reduced fertility, impaired embryo development, and an increased risk of miscarriage.[4,5] Furthermore, the DNA fragmentation index (DFI) has been linked to a higher incidence of autosomal dominant diseases, congenital malformations, childhood cancers, and neuropsychiatric disorders.

DNA fragmentation can occur due to persistence of nicks created during meiosis and is exacerbated by oxidative stress (OS), particularly following spermiogenesis. OS is defined by an imbalance between antioxidants and reactive oxygen species (ROS), which results in cellular damage.[6,7] Sperm, being highly polarized and rich in polyunsaturated fatty acids, is predominantly exposed to oxidative damage due to its limited antioxidant defense mechanisms.[8,9] In addition, defects in protamination further increase susceptibility to oxidative-induced DNA damage.[10,11] OS-induced damage includes the accumulation of DNA adducts, such as 8-hydroxyguanine (8-OHdG), which disrupt genomic integrity and can lead to mutations, genetic instability, global hypomethylation, and epimutations.[12,13] The implications of sperm nuclear DNA damage extend beyond immediate reproductive outcomes, potentially influencing the health trajectory of offspring through both genetic and epigenetic mutations.[14] This predisposes progeny to increased susceptibility to genetic and epigenetic disorders.[15] To enhance male fertility outcomes, there is a need for safe, accessible, affordable, and effective adjunct therapies that can mitigate OS and oxidative DNA damage.[16]

Yoga, an ancient practice that incorporates meditation, breathing techniques, and physical postures, has shown promise in enhancing overall well-being, including reproductive health.[17,18,19,20] Emerging evidence suggests that yoga interventions can reduce OS, alleviate psychological stress, and improve sperm quality and function. However, only a limited number of studies have specifically explored its impact on sperm DNA fragmentation in infertile men.[14,15,21,22] This is particularly significant as DNA damage in infertile men has been associated with an increased risk of tumor progression and the development of cancer. In addition, it heightens the risk of cancer in offspring and contributes to other neuropsychiatric disorders due to a higher rate of de novo germline mutations in sperm with elevated levels of oxidative DNA damage.[23] Regular yoga practice may play a vital role in improving DNA integrity, as previous studies have shown that consistent practice can significantly reduce OS within 30 days. This study aims to evaluate the effects of a 12-week yoga intervention on seminal parameters, ROS, 8-OHdG levels, and sperm DFI in primary infertile men. We hypothesize that regular yoga practice will reduce seminal ROS levels, thereby decreasing sperm DNA fragmentation, improving sperm quality, and ultimately enhancing fertility outcomes. This research contributes to the understanding of alternative therapeutic approaches for addressing male infertility and optimizing reproductive health.

Materials and Methods

Study design

This study employed a pre–post yoga intervention assessment involving 42 infertile men, aged 25–40 years, recruited from the Andrology Clinic at AIIMS, New Delhi. Participants underwent a structured yoga intervention designed to improve reproductive health [Table 1].

Table 1.

The module of 60 min yoga intervention given to subjects

Yoga module				Duration (total: 60 min)
Session preparation instruction and prayer				5
Yogic Sukshma Vyayama		Finger, wrist, elbow, and shoulder loosening, toe, ankle and knee bending		5
Yogasna
Standing		Trikonasana, Katichakrasana, Tadasana, Veerbhadrasana		10
Sitting		Gomukhasan, Paschim-utanasana, Shashaankasan, vakrasan		10
Prone		Ek-pada-shalabhasana, Bhujangasana, Poorna-shalabhasana, Pavan Muktanasan		10
Supine		Uttanapadasana, Setubhandhasana, Pavamuktanasan, Matsyasana		10
Relaxation, Pranayama, Dhyana		Savasana, Kapalbhati, Ujjayi, Bhramari pranayama		10

Outlines the 60-min yoga intervention administered to subjects, including preparation, Sukshma Vyayama (subtle exercises for joint and muscle loosening), various Yogasanas (standing, sitting, prone, and supine postures), and concluding with relaxation, Pranayama (breathing techniques), and Dhyana (meditation). Each segment is allocated specific durations to ensure a balanced practice

Subject recruitment criteria

The study included men aged 25–40 years diagnosed with primary infertility who were not on medications affecting reproductive health, free from infectious diseases, and had made no recent lifestyle or dietary changes in the past 3 months. Participants adhered to regular healthy dietary routines and had not participated in clinical trials involving physical activities within the last 4 weeks. Individuals were excluded if they had undergone recent surgeries, experienced infections, or had female partners with known ovarian function or hormonal abnormalities.

Sample size estimation

The sample size was calculated based on an anticipated minimum 20% reduction in ROS levels after 12 weeks of yoga intervention, starting from a baseline ROS level of 40.52 RLU (Mishra et al., 2014). To achieve 90% power with a 5% significance level (type I error) and account for a 30% loss to follow-up, the required sample size was determined to be 78 participants. This sample size ensures sufficient statistical power to detect the expected reduction in ROS levels over the study period. The study design aimed to maintain a homogenous and representative sample, facilitating a focused evaluation of yoga’s impact on primary infertile men.

Yoga intervention

The yoga intervention comprised 60-min sessions conducted 5 days a week for a total of 12 weeks, focusing on a combination of asanas (physical postures), pranayama (breathing techniques), and meditation. Each session began with a prayer, followed by “Sukshma Vyayama” which included finger, wrist, elbow, and shoulder loosening exercises, as well as toe, ankle, and knee bending. Participants then engaged in a series of asanas, including Trikonasana (Triangle Pose), Katichakrasana (Waist Twisting Pose), Tadasana (Mountain Pose), Virabhadrasana (Warrior Pose), Gomukhasana (Cow Face Pose), Paschimottanasana (Seated Forward Bend), Bhujangasana (Cobra Pose), Uttanapadasana (Raised Leg Pose), Setu Bandhasana (Bridge Pose), and Matsyasana (Fish Pose). Each session concluded with pranayama, followed by meditation (Dhyana) and deep relaxation through Shavasana (Corpse Pose) and Bhramari Pranayama, a breathing technique known for its calming effects. In addition, guided Yoga Nidra was incorporated to enhance relaxation. This structured approach aimed to enhance physical well-being, reduce stress, and promote relaxation, potentially improving fertility outcomes in the participants. A detailed yoga session breakdown is provided in Table 1.

Sample collection and semen analysis

Semen samples were collected at baseline (preyoga) and after 12 weeks of the yoga intervention for semen analysis, following the World Health Organization 2021 guidelines. The research was conducted after obtaining ethical approval (IECPG-325/29-04-2021) from the Institutional Ethics Committee of AIIMS, New Delhi, India, and also registered in Clinical Trials Registry – India (CTRI no. REF/2021/09/047421). Before their participation in the study, all individuals provided their written informed consent.

This process ensured that the study adhered to ethical standards and that participants were fully informed about the nature and purpose of the research.

Reactive oxygen species level estimation

ROS concentration was assessed by the chemiluminescence method using luminol. 400 μl of liquefied whole semen was added to with 10 μl of a 5 mM luminol solution made in dimethyl sulfoxide to determine the ROS levels. It was incubated for 5 min to allow the generation of chemiluminescent signals and measured with luminometer (Berthold Detection Systems GmbH, Pforzheim, Germany). ROS level was quantified as relative light units per second per million spermatozoa (RLU/s/10^6 spermatozoa).

8OHdG assay

The 8-OHdG level was determined by ELISA. Before that, semen samples were obtained in a sterile container and allowed to liquefy at room temperature for 30 min. The liquefied semen was centrifuged at 300 × g for 10 min at 4°C to pellet the sperm, discarding the supernatant, and washing the pellet with phosphate-buffered saline (PBS). The sperms were then resuspended in PBS, and 100 μL of this suspension was transferred into an MCT, then, an equal volume of ice-cold ethanol was added to precipitate proteins and incubated at −20°C for 30 min, it was centrifuged at 12,000 × g for 10 min, the obtained pellet was washed with 70% ethanol, air-dried, and then dissolved in the lysis buffer provided in the 8-OHdG ELISA kit. The ELISA plate was prepared by coating the wells with the capture antibody, followed by washing to remove unbound antibodies. Next, 50 μL of standards, controls, and the prepared sperm extracts were added to the wells and incubated for the specified time. Afterward, the detection antibody was added, and the washing step was repeated. The substrate solution was then added to initiate the colorimetric reaction, which was stopped with the provided stop solution after the designated time. The absorbance was measured using a microplate reader, and the concentration of 8-OHdG was calculated by comparing the sample absorbance to a calibration curve generated from the standards.

Sperm chromatin structure assay

The DFI, indicative of DNA damage, was assessed using the Sperm Chromatin Structure Assay (SCSA). Semen samples were collected and allowed to liquefy at room temperature for 30 min before being diluted in PBS to achieve a final concentration of approximately 2 × 10^6 sperm/mL. The diluted samples were then mixed with TNE buffer (0.01 M Tris-HCl, 0.15 M NaCl, 1 mM EDTA, pH 7.4) in a 1:1 ratio and treated with 0.1 N hydrochloric acid (HCl) for 30 s to denature the DNA, which was critical for distinguishing intact from damaged DNA. After the acid treatment, the samples were neutralized with an appropriate volume of TNE buffer and stained with acridine orange (AO) solution at a concentration of 6 mg/mL, prepared in TNE buffer. AO intercalates into DNA, fluorescing green when bound to intact double-stranded DNA and red when bound to denatured single-stranded DNA. The stained samples were analyzed using a flow cytometer equipped with a 488 nm laser and appropriate filters to detect green fluorescence (515–530 nm) and red fluorescence (>630 nm). The assay quantified the ratio of red fluorescence to total fluorescence (red plus green), yielding the DFI, which reflects the extent of sperm DNA damage. A higher DFI indicated higher DNA fragmentation.

Statistical analysis

The statistical software used for data analysis was Stata 14.0, developed by Stata Corp LLC in Texas, USA. Descriptive statistics, including means and standard deviations (SDs) as well as medians (with minimum and maximum values), were calculated to assess the distribution of quantitative data along with post hoc power analysis. The analysis revealed that certain variables exhibited a skewed distribution, while others adhered to a normal distribution. To compare continuous variables before and after the yoga intervention, the paired t-test was employed for normally distributed data, while the Wilcoxon signed-rank test was used for skewed data. P <0.05 was considered statistically significant, indicating meaningful differences in the measured parameters as a result of the yoga intervention.

Results

Demographic and clinical characteristics

A total of 78 males were enrolled for this study with strict adherence of inclusion and exclusion criteria. After dropout, 42 participants completed the 12-week yoga intervention and they have been considered for further analysis. The reasons for dropout included poor compliance due to difficulties attending sessions regularly, the impact of COVID-19, and a reluctance to continue the yoga intervention as a complementary approach. All the participants who completed the yoga program and provided responses to all questionnaires, thus being included in the analyses. The average age of participants was 31 years (mean ± SD, 31 ± 6.2 years), with a duration of infertility ranging from 2 to 15 years (median, 6 years). Participants reported an average frequency of intercourse of four times per week. The mean body mass index was 23.7 kg/m² (mean ± SD, 23.7 ± 3.1 kg/m²). Socioeconomic status was assessed using the Kuppuswamy score and averaged 12 (range: 4–28). Hormonal profiles indicated mean follicle-stimulating hormone levels of 9.8 mIU/L (mean ± SD, 9.8 ± 3.6 mIU/L) and mean luteinizing hormone levels of 4.2 mIU/L (mean ± SD, 4.2 ± 1.7 mIU/L). Smoking was reported by 33% of participants and categorized as heavy (4%), mild (3%), and occasional (5%). Alcohol consumption was reported by 25% of participants, with similar categorizations: heavy (2%), mild (3%), and occasional (4%). A comprehensive summary of the study participants’ baseline clinical and demographic characteristics is given in Table 2.

Table 2.

The baseline demographic and clinical characteristics of the study

Characteristics		Baseline values (mean±SD or n) (n=42)
Age (years), mean±SD		31±6.2
Duration of infertility (years)		6 (2,15)
Frequency of intercourse (day/weeks)		4 (1,5)
BMI (kg/m2), mean±SD		23.7±3.1
Socioeconomic status (Kuppuswamy score)		12 (4.28)
FSH (mIU/L), mean±SD		9.8±3.6
LH (mIU/L), mean±SD		4.2±1.7
Smoking status, n (%) (heavy, mild, and occasional)		12 (33) (4, 3, 5)
Alcohol consumption status, n (%) (heavy, mild, and occasional)		9 (25) (2, 3, 4)

Summarizes the baseline demographic and clinical characteristics of the study participants, including age, duration of infertility, frequency of intercourse, BMI, socioeconomic status (Kuppuswamy score), and hormone levels (FSH and LH). Lifestyle factors such as smoking and alcohol consumption are also detailed, with percentages and categorizations into heavy, mild, and occasional usage. Data are presented as mean±SD or numbers with ranges where applicable. SD: Standard deviation, BMI: Body mass index, FSH: Follicle-stimulating hormone, LH: Luteinizing hormone

Effect of yoga in semen parameters

The yoga intervention significantly improved various semen parameters, as evidenced by the analyses conducted pre- and postyoga intervention [Table 3]. The total sperm count increased significantly from 34 million sperm per ejaculate to 129 million (P < 0.001) [Figure 1a]. Progressive motility also showed significant improvement, rising from 15% to 35% (P < 0.05), suggesting better sperm functionality [Figure 1b]. Detailed comparisons revealed that while semen volume increased from 2.8 ± 0.9 to 3.4 ± 1.2 ml and pH decreased slightly from 8.2 ± 0.2 to 8.0 ± 0.1, these changes were not statistically significant. The liquefaction time remained stable at around 31.5 ± 2.5 min. Importantly, sperm concentration rose from a median of 10 million/ml to 38 million/ml (P < 0.01), thus enhanced sperm density. In addition, the total sperm count rose significantly from a median of 34 million to 129 million per ejaculate (P < 0.001). Collectively, these results underscore the positive impact of the yoga intervention on male reproductive health, demonstrating significant improvements in sperm quality and quantity, which may contribute to enhanced fertility outcomes.

Table 3.

Comparison of seminal parameters pre- versus postyoga intervention

Seminal parameters		Preyoga (n=42), mean±SD or medians or n		Postyoga (n=42), mean±SD or medians or n		P
Volume (mL), mean±SD		2.8±0.9		3.4±1.2		NS
pH, mean±SD		8.2±0.2		8.0±0.1		NS
LT (min), mean±SD		31.5±2.5		30±3.4		NS
PM (%), median (minimum–maximum)		15 (0–40)		35 (0–50)		<0.05*
SC (million/mL), median (minimum–maximum)		10 (2–32)		38 (6–63)		<0.01**
TSC million/ejaculate), median (minimum–maximum)		34 (24–136)		129 (41–252)		<0.001***

*P<0.05, **P<0.01, and ***P<0.001. A comparison of seminal parameters before and after the 12-week yoga intervention. Parameters include semen volume, pH, LT, PM, SC, and TSC. Data are expressed as mean±SD or median (minimum–maximum). Statistical significance is indicated as follows. PM: Progressive motility, LT: Liquefaction time, SC: Sperm concentration, TSC: Total sperm count, NS: Nonsignificant difference, SD: Standard deviation

Figure 1.

The graph showing the effect of Yoga intervention on (a) Total sperm count (million/ejaculate) and (b) progressive motility of sperm infertile men (*P < 0.05, **P < 0.01, ***P < 0.001; Data is represented in median)

Effect of yoga on in seminal oxidative stress markers

We evaluated the effects of a 12-week postyoga intervention on seminal ROS levels in infertile men, given the significant impact of OS on sperm quality and reproductive outcome. The results demonstrated a substantial reduction in seminal ROS levels following the yoga intervention. Specifically, seminal ROS levels decreased significantly from 45.3 RLU/s/million sperm before the intervention to 16.8 RLU/s/million sperm after the intervention (P < 0.001), as illustrated in Figure 2a. This marked reduction in OS indicates that the yoga intervention effectively mitigated OS markers, which may contribute to improved sperm quality and overall fertility potential in the participants.

Figure 2.

The graph shows the (a) seminal reactive oxygen species level (RLU/s/million sperm) and (b) 8-OHdG (ng/ml) level between Pre- versus post-yoga. *P < 0.05, **P < 0.01, ***P < 0.001; Data is represented in median

Reduction of oxidative DNA damage at post-yoga intervention

We assessed the levels of 8-OHdG, an indicator of oxidative DNA damage the effectiveness of the yoga intervention in mitigating OS in infertile men. Semen samples were collected pre- and 12 weeks of postyoga intervention, and 8-OHdG levels were quantified using ELISA. Our results indicated a significant decrease in 8-OHdG levels, with concentrations dropping from 86.47 ng/ml in preyoga samples to 48.2 ng/ml in postyoga samples (P < 0.001), as illustrated in Figure 2b. This substantial reduction highlights the potential of yoga as an effective strategy to reduce OS-related DNA damage. By lowering 8-OHdG levels, the yoga intervention may help preserve genomic integrity, thereby enhancing sperm quality and overall reproductive health.

Impact of yoga on sperm DNA fragmentation index

Given the increasing evidence that OS contributes to sperm DNA damage and infertility, we aimed to assess the impact of a 12-week postyoga intervention on sperm DFI in infertile men. Using the SCSA, we measured DFI pre- and postintervention to evaluate the molecular effects of lifestyle modifications on male fertility. Figure 3a displays dot plot cytograms from flow cytometry analysis, illustrating sperm distribution based on red (PEcy5 and FL3) and green (FITC and FL1) fluorescence values, which indicate levels of DNA fragmentation. Our results showed a notable decrease in DFI in the postyoga group compared to preyoga measurements, although this change did not reach statistical significance (P = 0.068), as illustrated in Figure 3b. This trend may be linked to reduced ROS levels, leading to diminished oxidative DNA damage and a lower production of DNA adducts. In addition, the yoga intervention may have positively influenced the expression of DNA repair and tumor suppressor genes, which are essential for maintaining genomic integrity. This is due to high DFI, decreased ROS, increased oxidative DNA damage, and produced adducts, reduced enzyme DNA repair gene activity leading to cell death. The addition of Yoga-primed serum in androgen-dependent and independent cancer cell line reduces cancer cell line proliferation and enhanced apoptosis.[23,24] Thus, Yoga has a significant impact on improvement in male infertility including sperm parameters.

Figure 3.

Effect of Yoga on sperm DNA fragmentation (DFI). (a) Cytogram from FACS for pre- and postyoga. Dot plot cytograms of semen samples at both baseline (T = 0 week) and at the end of 12-week Yoga intervention (T = 12 weeks) by Sperm Chromatin Structure Assay. APC (FL3) on X-axis represents fragmented DNA and FITC (FL1) on Y-axis represents native DNA showing percentage of spermatozoa with high levels of DNA fragmentation. Each dot in the cytogram represents a single sperm with red and green fluorescence values. (b) Bar graph of the sperm DNA Fragmentation Index (DFI) between Pre- and PostYoga. The mean value of percentage DFI in each patient shows a significant decrease in postyoga group as compared to preyoga group. *P < 0.05, **P < 0.01, ***P < 0.001; Data are represented in median

Discussion

This study presents significant findings regarding the effects of a 12-week yoga intervention on sperm quality and OS levels in infertile men, marking an important contribution to the exploration of nonpharmacological approaches to enhance male fertility. Out of the initial 78 participants, 42 men completed the yoga program, allowing for a detailed analysis of various semen parameters and OS markers. Our results demonstrated a significant increase in total sperm count, which rose from a median of 34 million to 129 million sperm per ejaculate. This substantial enhancement suggests that yoga may effectively stimulate spermatogenesis, the process of sperm production, and indicate improved testicular function. Progressive motility also improved significantly, increasing from 15% to 35%. This improvement in motility is particularly noteworthy, as higher motility is crucial for the sperm’s ability to navigate the female reproductive tract to achieve fertilization. These findings align with previous research indicating that lifestyle interventions, including yoga, can positively influence semen parameters in men with infertility issues.[25,26] Previous studies from our laboratory have documented a significant increase in total sperm count and enhancement in sperm motility was observed in the male partners of RPL patients.[12] In addition, the study assessed OS through the measurement of seminal ROS and 8-OHdG, a key biomarker for oxidative DNA damage. The significant reduction in ROS levels from 45.3 to 16.8 RLU/s/million sperm (P < 0.001) indicates that the yoga intervention effectively mitigated OS, which is known to be detrimental to sperm quality and overall reproductive health. Similarly, the decline in 8-OHdG levels from 86.47 ng/ml to 48.2 ng/ml (P < 0.001) suggests a reduction in oxidative DNA damage, thereby preserving genomic integrity. Due to a higher dropout rate among the recruited participants, a post hoc power analysis was performed based on the observed outcomes in the present study. The analysis demonstrated a strong statistical power of 99%, which was sufficient to detect significant changes in ROS and 8-OHdG levels, ensuring the reliability of the results. Similar power was observed for sperm DFI and other variables, reinforcing the robustness of the findings. These findings are particularly relevant given the established links between OS and male infertility, including potential de novo mutations and epimutations that can affect offspring.[22] Similar findings were seen in fathers of children with nonfamilial sporadic heritable retinoblastoma.[27] While the study observed a trend toward reduced sperm DFI postintervention, this change was not significant (P = 0.068). This finding highlights that improvement in DNA integrity requires longer intervention.[28,29] Previous research has suggested that significant changes in sperm DNA integrity might take two spermatogenic cycles to manifest, indicating a need for extended duration in future studies to fully understand the impact of yoga on DFI.[15,27]

Yoga offers multiple benefits through several mechanisms. The physical aspect of yoga improves blood flow to the pelvic region, optimizing testicular function and sperm maturation.[30] Yoga also reduces OS, which affects sperm DNA, proteins, and prevent lipid per-oxidation. By enhancing mitochondrial integrity, yoga helps regulate ROS levels, improves mitochondrial function, and reduces DNA damage.[19] ROS-induced oxidative DNA damage leads to nucleotide alterations, chromatin cross-linking, and DNA strand breakage in sperm.[31] ROS-induced DNA damage, including 8-OHdG accumulation, leads to genomic instability and increased epimutations, affecting embryonic development.[32,33] Yoga, by combining pranayama, meditation, and asanas, helps reduce OS. Significant reductions in ROS and 8-OHdG levels have been observed with yoga therapy. A recent study showed that a 12-week yoga trial reduced plasma malondialdehyde (MDA) levels and increased total antioxidants in patients with major depressive disorder.[34] Sperm is particularly vulnerable to damage from elevated free radicals due to limited antioxidant defenses and inadequate base excision repair (BER) mechanisms.[35] The repair of oxidative damage in sperm largely depends on the oocyte machinery, with postfertilization repair being influenced by the extent of oxidative damage and oocyte age.[36] Inadequate management of OS in sperm may increase the risk of childhood malignancies.[37] Yoga can enhance antioxidant defense by increasing the activity of antioxidant enzymes such as glutathione peroxidase and superoxide dismutase, helping to neutralize free radicals and reduce OS, thereby improving sperm quality.[38] Previous studies from our laboratory have shown that yoga upregulates the expression of anti-inflammatory genes, increases BER pathway gene expression, and downregulates pro-inflammatory genes.[39,40] Yoga’s incorporation of pranayama and meditation activates the parasympathetic nervous system through vagal stimulation,[41,42] reducing cortisol levels and mitigating the effects of chronic stress.[43] Elevated cortisol disrupts hormonal balance and spermatogenesis, and stress reduction through yoga helps regulate the hypothalamic–pituitary–gonadal axis.[44,45,46] Yoga also normalizes cortisol levels and enhances brain-derived neurotrophic factor, Dehydroepiandrosterone, and serotonin, promoting neuroplasticity.[47,48] A study on 88 nurses practicing yoga for 8 weeks showed reduced serum cortisol, interleukin-1 (IL-1), and IL-6 levels, alongside increased antioxidant capacity.[38,42] Therefore, yoga interventions can enhance overall health, reduce genetic–epigenetic disease burdens, and promote reproductive health in subsequent generations.[14]

Despite the promising results, there were several limitations of this study. The relatively small sample size may constrain the generalizability of the findings, and future studies should aim for larger cohorts to validate these effects across diverse populations. In addition, the 12-week intervention period may not be sufficient to capture long-term improvements in sperm quality and DNA integrity. It would be beneficial for future research to extend the duration of yoga practice and include long-term follow-up assessments to evaluate the sustainability of these improvements. In summary, our study highlights the potential of yoga as a noninvasive, complementary intervention to improve sperm quality and reduce OS in infertile men. By integrating yoga into fertility treatment protocols, healthcare providers may offer patients an effective strategy to enhance reproductive outcomes and increase carry home live birth rates.

Conclusion

Our study demonstrates that a 12-week yoga intervention significantly improves sperm quality and reduces OS in infertile men with poor semen parameters. The notable decrease in seminal ROS and OS marker 8-OHdG suggests that yoga may enhance sperm health through the mitigation of oxidative damage. Future research should focus on the long-term effects of yoga on male fertility in diverse populations and explore the underlying physiological mechanisms. Overall, yoga emerges as a promising nonpharmacological strategy for enhancing male fertility, improving reproductive outcomes in couples opting for assisted conceptions, and reducing genetic and epigenetic disease burden in the offspring.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

The authors gratefully acknowledge the financial support for this project provided by the Indian Council of Medical Research (ICMR: I1454) and the Department of Science and Technology (DST: D583), New Delhi, India.