Male Infertility: Prevention

To prevent male infertility, attention must be paid to reducing individual risk factors.Behavioral Risk Factors

  • Diet
    • Malnutrition – diet not complete, low in vital substances* (micronutrients); too high intake of saturated fatty acids, contained in sweets, snacks, ready-made mayonnaises, ready-made dressings, ready-made meals, fried foods, breaded foods.
    • Micronutrient deficiency (vital substances) – see prevention with micronutrients.
  • Consumption of stimulants
    • Alcohol* ,
    • Coffee, black tea
    • Tobacco (smoking)* *
  • Drug use
    • Cannabis (hashish and marijuana)1+2
    • Morphine2
    • Opiates2 – strong-acting painkillers such as morphine.
  • Physical activity
    • Excessive sports
    • Heavy physical labor
  • Psycho-social situation
    • Stress
  • Overweight (BMI ≥ 25; obesity).
    • Men with severe obesity are at increased risk for decreased testicular activity compared with normal-weight men; obesity promotes hypogonadism (underactivity of the gonads); however, obesity had no effect on sperm production-except for an increased DNA fragmentation index in the group of metabolically unhealthy obese men.
    • 10 kg overweight increase the risk of infertility by 10%.
  • Android body fat distribution, that is, abdominal/visceral, truncal, central body fat (apple type) – there is a high waist circumference or waist-to-hip ratio (THQ; waist-to-hip ratio (WHR)); increased abdominal fat leads to a decrease in free (biologically active) testosterone When measuring waist circumference according to the guideline of the International Diabetes Federation (IDF, 2005), the following standard values apply:
    • Men < 94 cm

    The German Obesity Society published somewhat more moderate figures for waist circumference in 2006: < 102 cm for men.

  • Underweight

1Oligozoospermia (< 20 million spermatozoa per milliliter) or impaired spermatogenesis (spermatogenesis)2Diminished testosterone production.

* Alcohol consumptionAlcohol consumption can impair fertility in both men and women.Sex hormones can no longer be broken down appropriately due to alcohol-related liver damage, leading to hormonal dysfunction at the hypothalamus (pituitary) level, i.e. at the level of the diencephalon and pituitary gland.Increased alcohol consumption can thus lead to poorer sperm quality: Sperm cell density is reduced and the proportion of malformed sperm cells increases. Furthermore, increased alcohol consumption leads to impaired libido, i.e. sexual desire.By the way: high alcohol consumption – man > 60 g/day; woman > 40 g/day – high alcohol concentrations have been shown to lead to brain atrophy – sperm and egg cells are damaged even at much lower alcohol concentrations! * * Tobacco consumptionMale: Smoking can lead to the restriction of sperm motility and thus reduce the chances of fertilization. Furthermore, it has been shown that histones and protamines (responsible for the packaging and stability of DNA genetic information in sperm) are present in smokers in a significantly reduced concentration than in non-smokers. This can lead to no or incomplete fertilization of the oocyte (egg cell) and thus to subfertility. Medications

  • Antibiotics1
    • Anthracyclines
    • Cotrimoxazole
    • Gentamycin
    • Sulfonamides
  • Antihypertensives (may cause impaired spermatogenesis (spermatogenesis) and erection)
    • Alpha-1 receptor blockers2 (doxazosin, prazosin, terazosin).
    • Beta blockers (beta receptor blockers)3 – (atenolol, betaxolol, bisoprolol, carvedilol, celiprolol metoprolol, nadolol, nebivolol, oxprenolol, pindolol, propranolol )
    • Reserpine3
  • Antidepressants (emission/ejaculation disorders).
    • Selective serotonin reuptake inhibitors (SSRIs) – fluoxetine2, sertraline2.
    • Tricyclic antidepressants (nonselective monoamine reuptake inhibitors, NSMRIs) – doxepin2, opipramol2
    • Serotonin-norepinephrine reuptake inhibitors (SNRIs) – duloxetine2, venlafaxine2
  • Antiepileptic drugs (pregabalin2, primidone3); disorders of testosterone metabolism.
  • Anxiolytics2
  • Benzodiazepines (male libido disorders).
  • Hair restorer (finasteride3)
  • Hormones
    • Glucocorticoids3
    • Sex hormones
  • Ketoconazole (androgen biosynthesis disorders)3
  • Non-steroidal anti-inflammatory drugs (NSAIDs) – ibuprofen (testosterone/LH ratio as a function of Leydig cell ↓).
  • Prostate drugs2 (dutasteride, finasteride).
  • Rauwolfia3
  • Spironolactone (androgen receptor antagonists).
  • Cytostatic drugs1 (substances that inhibit cell growth or cell division) – e.g., busulfan, chlorambucil, alkylanzien (cyclophosphamide), methotrexate (MTX).

1Oligozoospermia (< 20 million spermatozoa per milliliter) or impaired spermatogenesis (spermatogenesis)2Ejaculatory disorders including decreased ejaculate volume3Diminished testosterone productionDrugs that can cause erectile dysfunction can be found under the disease “Erectile Dysfunction (ED) or Erectile Dysfunction”. Environmental stress – intoxications (poisonings).

  • Ionizing rays
  • Electromagnetic fields: Microwave radiation (radar station)
  • Overheating of the testicles – work at the blast furnace, bakery, frequent sauna sessions; heated seats in the car: long and frequent driving with heated car seats can reduce the ability to conceive. The sperm become fewer in number (oligozoospermia), slower (asthenozoospermia) and more often malformed (teratozoospermia).
  • Air pollutants: particulate matter – particulate matter (PM2.5) in the air; increase in particulate matter concentration by 5 µg/m3 at a time
    • Decrease in sperm with normal shape and size by 1.29 percent
    • Proportion of sperm in the lowest tenth of sperm morphology increased by 26 percent
    • Slight increase in sperm concentration
  • Environmental toxins (occupational substances, environmental chemicals):
    • Bisphenol A (BPA); also the substitutes bisphenol F and S (BPF/BPS) interfere as endocrine disruptors (xenohormones) in the hormonal balance of living organisms
    • Organochlorines (e.g. dichlorodiphenyltrichloroethane (DDT), dioxins, polychlorinated biphenyls* , PCBs).
    • Solvents (e.g. glycol ether; carbon disulfide).
    • Non-ionic surfactants (e.g. alkyl phenols).
    • Pesticides, herbicides (e.g. dibromochloropropane (DBCP), ethylene dibromide).
    • Phthalates* (mainly as plasticizers for soft PVC).
    • Heavy metals (lead, mercury compounds).
    • Sunscreens such as 4-methylbenzylidene camphor (4-MBC), plasticizers di-n-butyl phthalate (DnBP), the antibacterial triclosan (e.g. in toothpaste and cosmetics).

* belong to the endocrine disruptors (synonym: xenohormones), which even in the smallest amounts can damage health by altering the hormonal system.

Prevention factors (protective factors)

  • The Mediterranean diet improves sperm quality in men.Younger nonobese women (BMI < 30) who followed a “Mediterranean” diet in the six months before assisted reproduction had significantly better odds of carrying a pregnancy to term in a prospective cohort study. The third of women with greater adherence to the Mediterranean diet achieved 50% pregnancy/48.8% carried pregnancy, while the pregnancy rate in the third of women with the lowest adherence to the Mediterranean diet was only 29%/carried pregnancy 26.6%.
  • Men who wore boxer shorts more often compared with men who preferred other underpants had 25% higher spermatozoa concentrations (95% CI = 7, 31%), 17% higher total spermatozoa counts (95% CI = 0, 28%), and 14% lower serum FSH levels (95% CI = -27, -1%).

Fertility preservation for oncology patients

Note: The cryopreservation of sperm cells and associated medical procedures are paid under certain conditions by the statutory health insurance. Excluded are under 18-year-olds and generally men over 50 years. Before the start of therapeutic measures – such as artificial insemination, also called in vitro fertilization (IVF) – is required in any case – in the sense of a holistic reproductive medical diagnosis – a health check for the man including a nutritional analysis.