Proper nutrition, weight, and exercise may impact fertility. Though no definitive link has been drawn, choosing proper nutrition, whether it be choosing supplements or food groups, before and during attempts to conceive may be vital for improving fertility for both men and women. Men and women who are underweight or overweight are also at risk for negative side effects, including changes in hormone levels that heavily influence their fertility. Recent research suggests that weight plays an important role in fertility, and controlling and maintaining an ideal weight may provide a way for couples to increase their fertility. Exercise is suggested to be beneficial, though too much may be detrimental. Lean and underweight men or women who exercise vigorously may put themselves at risk for a decrease in fertility, thus finding a balance may provide the best chances of achieving a pregnancy.
While there are associations between psychological effects and infertility, it is hard to establish a cause-effect relationship. Tests are subjective, and there is no general consensus on how to measure psychological stress [2]. It is also worth noting that it is difficult to isolate psychological effects because subjects who are more depressed and anxious are also more inclined to participate in lifestyles that may negatively influence fertility, such as consuming alcohol [65]. Couples attempting to conceive may try relaxing and reducing exposure to stressors in an effort to increase fertility [76].
Recreational and prescription substances also appear to have significant impact on fertility. Though clear links are yet to be determined, there are negative trends, including decreased semen parameters or decreased ovarian reserve, associated with smoking and fertility. If couples are attempting to achieve a pregnancy, limiting or smoking cessation may provide more positive outcomes. It is difficult to establish a link between illegal drug use and infertility as there are many ethical issues that prevent researchers from discovering a definitive relationship. Researchers have also had issues with drawing a definitive link between infertility and prescription medication, which often have known side effects, though fertility side effects are not often a concern when prescribing. Further research on many medications and drugs is needed in order to make any recommendations. While there is evidence to support that alcohol does have an impact on fertility, it is also difficult to establish a definitive link as there is no standard “drink” or comparative way to measure alcohol consumption. Despite these drawbacks to recent research, decreasing or ceasing alcohol consumption may provide a better chance of achieving a viable pregnancy for the couple. Though caffeine appears to have a negative effect on fertility, additional research is needed to elucidate if there is a definitive relationship.
Concerning environmental exposures, assessing the exposures of each individual may be crucial to reproductive health of the couple. Eliminating every exposure is unrealistic; however, identifying, eliminating, or minimizing even one factor may have significant positive effects on fertility for both men and women.
Taking care of a current fertility problem may provide better fertility in the future. Taking preventative steps such as visiting your doctor and using contraception may help fertility. Making appointments with a doctor for both preventative measures and when problems arise may assist in increasing fertility for both men and women. In addition, using appropriate contraception may have a positive impact on a couple’s fertility. Other factors such as clothing choice, wet heat, and lubricants may also impact a couple’s fertility. Overall, while there is suggestive data, a clear negative influence of the type of underwear or clothing on semen quality has not been proven, and the overall effects on a couple’s fertility are still unknown. While there is suggestive data, there is very little actual evidence linking wet heat and fertility to suggest cessation of the use of wet heat. Research suggests that some lubricants can be beneficial for couples trying to conceive, and some lubricants may be detrimental to fertilization. Choosing an appropriate lubricant may provide the couple with improved chances of achieving a pregnancy.
The lifestyle factors discussed in the present review have the potential to impact fertility. It is important to understand the ways in which lifestyle behaviors may benefit or harm fertility in order to minimize complications and to maximize fertility outcomes. By understanding the impact of lifestyle on reproductive health, and by actively modifying lifestyle behaviors, men and women are capable of controlling their own fertility potential.
OR: Odds ratio; ROS: Reactive oxygen species; IUI: Intra uterine insemination; MDA: Malondialdehyde; RR: Relative risk; BMI: Body mass index; ED: Erectile dysfunction; SHBG: Sex Hormone-Binding Globulin; GnRH: Gonadotropin-Releasing Hormone; LH: Luteinizing Hormone; HA: Hyaluronan; TAC: Total antioxidant capacity; FSH: Follicle stimulating hormone; RFEMW: RadioFrequency ElectroMagnetic Waves; BPA: Bisphenol A; DDT: DichloroDiphenylTrichloroethane; DDE: DichloroDiphenyldichloroEthylene; 5-ASA: 5-Aminosalicylic acid.
RKS conceived the study, participated in the study design compilation of the contents and critical review of the paper. KRB and JMF were responsible for literature (Medline) search, compilation of the information, drafting and finalizing the paper. AA provided substantial contribution ranging from study idea, design, and critical review of the final paper. All authors read and approved the final manuscript.
KRB and JMF were summer interns at the Center for Reproductive Medicine, Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio. RS is the Coordinator of the Center for Reproductive Medicine, Cleveland Clinic, Cleveland Ohio. AA is the Director of the Center for Reproductive Medicine, Cleveland Clinic, Cleveland Ohio.
Kimberly L, Case A, Cheung AP, Sierra S, AlAsiri S, Carranza-Mamane B, Case A, Dwyer C, Graham J, Havelock J. et al. Advanced reproductive age and fertility: No. 269, November 2011. Int J Gynaecol Obstet. 2012;117:95–102. doi: 10.1016/j.ijgo.2011.11.002. [DOI] [PubMed] [Google Scholar]
Varshini J, Srinag BS, Kalthur G, Krishnamurthy H, Kumar P, Rao SB, Adiga SK. Poor sperm quality and advancing age are associated with increased sperm DNA damage in infertile men. Andrologia. 2012;44(Suppl 1):642–649. doi: 10.1111/j.1439-0272.2011.01243.x. [DOI] [PubMed] [Google Scholar]
Mutsaerts MA, Groen H, Huiting HG, Kuchenbecker WK, Sauer PJ, Land JA, Stolk RP, Hoek A. The influence of maternal and paternal factors on time to pregnancy–a dutch population-based birth-cohort study: the GECKO drenthe study. Hum Reprod. 2012;27:583–593. doi: 10.1093/humrep/der429. [DOI] [PubMed] [Google Scholar]
Matorras R, Matorras F, Exposito A, Martinez L, Crisol L. Decline in human fertility rates with male age: a consequence of a decrease in male fecundity with aging? Gynecol Obstet Invest. 2011;71:229–235. doi: 10.1159/000319236. [DOI] [PubMed] [Google Scholar]
Gianaroli L, Magli MC, Cavallini G, Crippa A, Capoti A, Resta S, Robles F, Ferraretti AP. Predicting aneuploidy in human oocytes: key factors which affect the meiotic process. Hum Reprod. 2010;25:2374–2386. doi: 10.1093/humrep/deq123. [DOI] [PMC free article] [PubMed] [Google Scholar]
Munné S, Held KR, Magli CM, Ata B, Wells D, Fragouli E, Baukloh V, Fischer R, Gianaroli L. Intra-age, intercenter, and intercycle differences in chromosome abnormalities in oocytes. Fertil Steril. 2012;97:935–942. doi: 10.1016/j.fertnstert.2012.01.106. [DOI] [PubMed] [Google Scholar]
Mendiola J, Torres-Cantero AM, Vioque J, Moreno-Grau JM, Ten J, Roca M, Moreno-Grau S, Bernabeu R. A low intake of antioxidant nutrients is associated with poor semen quality in patients attending fertility clinics. Fertil Steril. 2010;93:1128–1133. doi: 10.1016/j.fertnstert.2008.10.075. [DOI] [PubMed] [Google Scholar]
Wong WY, Zielhuis GA, Thomas CM, Merkus HM, Steegers-Theunissen RP. New evidence of the influence of exogenous and endogenous factors on sperm count in man. Eur J Obstet Gynecol Reprod Biol. 2003;110:49–54. doi: 10.1016/S0301-2115(03)00162-3. [DOI] [PubMed] [Google Scholar]
Jensen TK, Andersson AM, Jorgensen N, Andersen AG, Carlsen E, Petersen JH, Skakkebaek NE. Body mass index in relation to semen quality and reproductive hormones among 1,558 danish men. Fertil Steril. 2004;82:863–870. doi: 10.1016/j.fertnstert.2004.03.056. [DOI] [PubMed] [Google Scholar]
Chavarro JE, Toth TL, Wright DL, Meeker JD, Hauser R. Body mass index in relation to semen quality, sperm DNA integrity, and serum reproductive hormone levels among men attending an infertility clinic. Fertil Steril. 2010;93:2222–22231. doi: 10.1016/j.fertnstert.2009.01.100. [DOI] [PMC free article] [PubMed] [Google Scholar]
Eliran MorCorona G, Mannucci E, Schulman C, Petrone L, Mansani R, Cilotti A, Balercia G, Chiarini V, Forti G, Maggi M. Psychobiologic correlates of the metabolic syndrome and associated sexual dysfunction. Eur Urol. 2006;50:595,604. doi: 10.1016/j.eururo.2006.02.053. discussion 604. [DOI] [PubMed] [Google Scholar]
Winters SJ, Wang C, Abdelrahaman E, Hadeed V, Dyky MA, Brufsky A. Inhibin-B levels in healthy young adult men and prepubertal boys: Is obesity the cause for the contemporary decline in sperm count because of fewer sertoli cells? J Androl. 2006;27:560–564. doi: 10.2164/jandrol.05193. [DOI] [PubMed] [Google Scholar]
Ghanayem BI, Bai R, Kissling GE, Travlos G, Hoffler U. Diet-induced obesity in male mice is associated with reduced fertility and potentiation of acrylamide-induced reproductive toxicity. Biol Reprod. 2010;82:96–104. doi: 10.1095/biolreprod.109.078915. [DOI] [PMC free article] [PubMed] [Google Scholar]
Robker RL, Akison LK, Bennett BD, Thrupp PN, Chura LR, Russell DL, Lane M, Norman RJ. Obese women exhibit differences in ovarian metabolites, hormones, and gene expression compared with moderate-weight women. J Clin Endocrinol Metab. 2009;94:1533–1540. doi: 10.1210/jc.2008-2648. [DOI] [PubMed] [Google Scholar]
Clark AM, Thornley B, Tomlinson L, Galletley C, Norman RJ. Weight loss in obese infertile women results in improvement in reproductive outcome for all forms of fertility treatment. Hum Reprod. 1998;13:1502–1505. doi: 10.1093/humrep/13.6.1502. [DOI] [PubMed] [Google Scholar]
Han Z, Mulla S, Beyene J, Liao G, McDonald SD. Maternal underweight and the risk of preterm birth and low birth weight: A systematic review and meta-analyses. Int J Epidemiol. 2011;40:65–101. doi: 10.1093/ije/dyq195. [DOI] [PubMed] [Google Scholar]
Palmer NO, Bakos HW, Owens JA, Setchell BP, Lane M. Diet and exercise in an obese mouse fed a high-fat diet improve metabolic health and reverse perturbed sperm function. Am J Physiol Endocrinol Metab. 2012;302:E768–E780. doi: 10.1152/ajpendo.00401.2011. [DOI] [PubMed] [Google Scholar]
Wise LA, Rothman KJ, Mikkelsen EM, Sorensen HT, Riis AH, Hatch EE. A prospective cohort study of physical activity and time to pregnancy. Fertil Steril. 2012;97:1136,42 e1–1136,42 e4. doi: 10.1016/j.fertnstert.2012.02.025. [DOI] [PMC free article] [PubMed] [Google Scholar]
Gollenberg AL, Liu F, Brazil C, Drobnis EZ, Guzick D, Overstreet JW, Redmon JB, Sparks A, Wang C, Swan SH. Semen quality in fertile men in relation to psychosocial stress. Fertil Steril. 2010;93:1104–1111. doi: 10.1016/j.fertnstert.2008.12.018. [DOI] [PubMed] [Google Scholar]
Volgsten H, Skoog Svanberg A, Ekselius L, Lundkvist O, Sundstrom Poromaa I. Prevalence of psychiatric disorders in infertile women and men undergoing in vitro fertilization treatment. Hum Reprod. 2008;23:2056–2063. doi: 10.1093/humrep/den154. [DOI] [PMC free article] [PubMed] [Google Scholar]
Louis GM, Lum KJ, Sundaram R, Chen Z, Kim S, Lynch CD, Schisterman EF, Pyper C. Stress reduces conception probabilities across the fertile window: Evidence in support of relaxation. Fertil Steril. 2011;95:2184–2189. doi: 10.1016/j.fertnstert.2010.06.078. [DOI] [PMC free article] [PubMed] [Google Scholar]
Calogero A, Polosa R, Perdichizzi A, Guarino F, La Vignera S, Scarfia A, Fratantonio E, Condorelli R, Bonanno O, Barone N. et al. Cigarette smoke extract immobilizes human spermatozoa and induces sperm apoptosis. Reprod Biomed Online. 2009;19:564–571. doi: 10.1016/j.rbmo.2009.05.004. [DOI] [PubMed] [Google Scholar]
Mitra A, Chakraborty B, Mukhopadhay D, Pal M, Mukherjee S, Banerjee S, Chaudhuri K. Effect of smoking on semen quality, FSH, testosterone level, and CAG repeat length in androgen receptor gene of infertile men in an indian city. Syst Biol Reprod Med. 2012;58:255–262. doi: 10.3109/19396368.2012.684195. [DOI] [PubMed] [Google Scholar]
Wegner CC, Clifford AL, Jilbert PM, Henry MA, Gentry WL. Abnormally high body mass index and tobacco use are associated with poor sperm quality as revealed by reduced sperm binding to hyaluronan-coated slides. Fertil Steril. 2010;93:332–334. doi: 10.1016/j.fertnstert.2009.07.970. [DOI] [PubMed] [Google Scholar]
Viloria T, Garrido N, Fernandez JL, Remohi J, Pellicer A, Meseguer M. Sperm selection by swim-up in terms of deoxyribonucleic acid fragmentation as measured by the sperm chromatin dispersion test is altered in heavy smokers. Fertil Steril. 2007;88:523–525. doi: 10.1016/j.fertnstert.2006.11.135. [DOI] [PubMed] [Google Scholar]
Saleh RA, Agarwal A, Nada EA, El-Tonsy MH, Sharma RK, Meyer A, Nelson DR, Thomas AJ. Negative effects of increased sperm DNA damage in relation to seminal oxidative stress in men with idiopathic and male factor infertility. Fertil Steril. 2003;79(Suppl 3):1597–1605. doi: 10.1016/s0015-0282(03)00337-6. [DOI] [PubMed] [Google Scholar]