- Good Sleep
- Scrotal Temperature
- Occupational hazards
- Drugs (including cigarette smoking)
- Infections in testis
1. Adequate Sleep:
We spend almost a third of our life sleeping. Good quality sleep is essential for good health and feeling of well-being. Sleep patterns have changed considerably in the western world in the last 50 years. Sleep curtailment is common in modern society, and although it is often considered harmless it can cause physical effects like drowsiness, tiredness, changes in blood pressure, poor performance, loss of attention and motivation. All these effects lead to diminished mental concentration and intellectual capacity and increase in the likelihood of accidents at work and during driving. Sleep deprivation can cause people to fall asleep at work, feel tired and have memory blanks. They are unable to think, handle stress, maintain a healthy immune system, and moderate their emotions. Chronic sleep loss can reduce the capacity of even young adults to perform basic metabolic functions, such as processing and storing carbohydrates or regulating hormone secretion. Sleeplessness also increases glucose levels leading to increased Reactive Oxygen Species (ROS) (see below). Hormones coming from the brain can be affected by lack of sleep which in turn could affect the testis and male organs. There is strong evidence to suggest that reproductive hormonal secretion is controlled by both sleep and circadian rhythms (roughly 24-hour cyclical behaviour of the human body).
Tip: Try to get normal sleep on a regular basis for at least 6-8 hours
Researchers have observed that men with increased body mass index (BMI) (>25kg/m2) were significantly more likely to be infertile than men who had normal weight. They also found that men’s BMI was an independent risk factor for infertility. The sperm quality is likely to be substandard in overweight and obese men with hormonal fluctuations being more common.
Obese men exhibit reduced testosterone levels accompanied by elevated oestrogen levels. It is also interesting to note that underweight men who had a BMI under 20 also suffered from lower sperm counts according to a Danish study. There is some evidence to suggest that obesity can affect puberty in boys. Blood testosterone levels are decreased in obese men. Total body fat, intra-abdominal fat, and subcutaneous fat are all associated with low testosterone levels.
Tip: You can check your BMI on www.nhs.uk/Tools/Pages/healthyweightcalculator.aspx; Lose excess weight; Get proper advice and dietary help starting at your GP’s surgery
3. Stress (Psychosocial environment):
Psychological stress at the workplace could have an effect on fertility and studies on stress have shown varying results. However, there seems to a significant dose–response relationship between level of perceived job stress and poor sperm quality.
Tip: Try to get more relaxation time by means of a hobby or -even better- sport. Yoga and meditation are excellent. Learn to know and accept your limitations.
There is no doubt that physical activity is beneficial for human health. Indeed, increasing the amount of physical activity does produce extensive health improvements. However, excessive exercise is a physical stress that could upset the internal body environment (homeostasis). The body responds to this stress by the release of various hormones principally from the adrenal gland-steroids, adrenaline and noradrenaline.
Tips: Exercises like jogging, running are good way of improving circulation in the pelvis. Avoid stressful exercises and prolonged cycling.
5. Scrotal temperature:
In humans, testicular function is temperature dependent. Normal testicular function requires a temperature of 2–4°C below the body temperature. It is higher in the daytime, in the summer months, and in leisure time compared with working hours. In a Danish study a sedentary position at work was a significant source of increased scrotal skin temperature. The same study showed that even moderate and physiological elevation in scrotal skin temperature was associated with a substantially reduced sperm concentration.. Long distance driving can upset the scrotal temperature. Results have shown that sperm counts of professional drivers are lower and commonly abnormal.
Tip: Avoid hot baths, saunas; wear loose clothing preferably cotton. If you have a desk job make sure you take breaks now and then and change your posture (e.g. sitting to standing or walking around).
6. Occupational hazards:
Contact with chemicals can affect both the sperm count and sperm function. This includes pesticides, herbicides, fumigants, lead, mercury, cadmium, boron, DDT, dibromochloropropane, hexachlorobenzene; Exposure to heat, welding, farming, solvents (carbon disulphide, glycol ethers, methylene chloride, styrene and tetrachloroethylene
Tips: If you think you have been exposed to toxic materials, make sure you wear protective gear and get appropriate advice.
Cigarette Smoking: is associated with reduction in sperm concentration, motility and appearance (morphology). Sperm from smokers have reduced fertilizing capacity, and embryos display lower implantation rates. Cigarette smoking is one of the causes of increased ROS (see below) production in seminal fluid of infertile men.
Tip: You have to aim for a total stoppage.
Other drugs that can affect sperm are anabolic steroids, testosterone, sulphasalazine (Crohn’s disease), nitrofurantoin (urinary infections), aminoglutethamide, barbiturates, anticonvulsants, colchicine (arthritis), adrenal steroids, niridazole, alcohol, Recreational drugs, chemotherapy drugs.
Tip: Try to avoid unnecessary medications; Always make sure you ask for the details of side effects and complications of any drug that is prescribed to you by doctors or pharmacists.
8. Testicular infection:
Infection of the testis (Orchitis or epididymo-orchitis) can damage the testis and its adjacent organs or cause obstruction to the passage of sperm. Acute and chronic infections of the urinary tract or testes and associated structures may play a role in male infertility. Sexually transmitted infections are due to intimate sexual contact and include human papillomavirus [HPV], cytomegalovirus [CMV], herpes simplex virus [HSV], human herpesvirus type 6 [HHV-6], Epstein-Barr virus [EBV], hepatitis B virus [HBV], and Chlamydia trachomatis [CT]. These infections may not cause any symptoms. In addition there are other infections which can affect testicular function like syphilis and gonorrhoea which do manifest symptoms.
Tip: If you suspect that you may have an infection either because of symptoms or because of a recent contact consult your GP or your local STI (also called as Genito-Urinary Medicine (GUM)) Clinic. All infections should be appropriately investigated and treated by experts.
You might have read a variety of advertisements on vitamin pills claiming to be specific for men, aimed at increasing vigour, vitality and fertility. In reality if you eat a healthy and balanced diet, you get all essential elements of diet you need. Fresh natural food also contains beneficial elements some not yet discovered by science.
Anti-oxidants: There is a lot of hype about anti-oxidants at the moment. They are substances which can slow down or prevent the production of free radicals, which start chain reactions that damage cells. To know more about the oxidation process that produces free radicals and its effects, and understanding how reactive oxygen species (ROS) are produced see below.
Tip: Antioxidents and Trace elements (see below) can help sperm count and function. However if you are taking supplements in the form of capsules stick to the recommended dose; excessive use could be counter productive or even harmful.
[Reactive Oxygen Species: Like other cells of the body which use oxygen, sperm produce reactive oxygen species (ROS) (oxygen ions and peroxides), mostly originating from their normal metabolic activity. ROS can damage mitochondria (present in its tail in large numbers) which are responsible for production of energy in the cell. Human sperm generate the superoxide anion (O2-) which becomes hydrogen peroxide (H2O2). This is generally not harmful. However, it can form hydroxyl (OH-) radical producing toxic effects. Spermatozoa and seminal fluid contain a number of ROS scavengers, including enzymes and also a variety of other substances thereby keeping everything in balance. Excessive ROS production in the semen however leads to deterioration of spermatozoa quality and function. Interestingly although ROS are known mostly for their detrimental effects on sperm functions, there is now increasing evidence to suggest that low concentrations of ROS participate in normal cell mechanisms. Abnormal sperm and white cells are source of ROS in seminal fluid. Interestingly, ROS also control epididymal maturation and physiological maturation of sperm, attachment to the egg and acrosome reaction. Dietary anti-oxidants protect cells from the harmful effects of free radical radicals.
Anti-oxidants: Olive oil, onion, apples, cooked tomatoes, crimini mushrooms, whey, tea, essiac tea, green tea, red wine, watermelon, pink grapefruits, pomegranate, papaya, blue berry, goji berry, mashed potatoes
ROS Activation: Mental stress, diabetes, increased sugar intake, cigarette smoking, lead, red meat]
Vitamins are a group of substances essential in small amounts for normal cell function, growth and development and not synthesized in the human body. They are either water or fat soluble.
|Retinol (Vitamin A)||Vision and skin health
Vitamin A is necessary for the later stages of germ cell differentiation in the testis. It may regulate gene expression in the testis by direct interaction with the chromosomal material. It is also a major anti-oxidant.
Sweet potatoes, Carrots, Pumpkin, Pink Grapefruit, Mangoes, Apricots, Oranges, Spinach, Kale, Broccoli
Eggs, Fish, Cod liver, whole milk, butter, shellfish
|Thiamine (B1)||Helps body cells convert carbohydrates into energy. It is also essential for the functioning of the heart, muscles, and nervous system
Role in maturation of sperm (acrosome reaction)
|Beri beri||Yeast, pork, whole grain cereals|
|Riboflavin (B2)||Maintenance of inner lining and skin||Inflammation of mouth and skin||Milk, leafy green vegetables, liver and kidneys|
|Niacin (B3)||Body metabolism||Inflammation of the skin, vagina, rectum and mouth, as well as mental slowing||Cereals, green vegetables, meat, fish, liver, milk|
|Pantothenic acid (B5)||Its active form Coenzyme A is essential for basic chemical reactions of metabolism||Inflammation of skin, fatty liver||Liver, kidney, egg-yolk, milk, sweet potatoes, sweet bran, peas|
|Pyridoxine (B6)||Cellular metabolism||Inflammation of the skin and mouth, nausea, vomiting, dizziness , weakness and anaemia||Grains, seeds, leafy vegetables|
|Biotin (B7)||Metabolism of fats and carbohydrates||Rare||Daily requirement is catered by intestinal bacteria|
|Folic Acid (B9)||New cells; nucleic acid synthesis (the genetic material) Synthesize , repair DNA;
|Anaemia (Megaloblastic); Neural defects in embryos||Liver, leafy vegetables, fruits, mushrooms|
|Cobalmin (B12)||Nucleic acid synthesis (the genetic material of all cells)||Anaemia (Pernicious)||Liver, shell fish, eggs, milk|
|Ascorbic Acid (C)||Synthesis of collagen, the framework protein for tissues of the body, anti-oxidant;
Component of sperm
|Scurvy||Oranges, lemons, limes|
|Ergo (D2) or cholecalciferol (Vit D3)||Promotes absorption and metabolism of calcium and phosphorus; Immune system regulator||Osteomalacia/Rickets||Exposure to sun light; milk, yogurt, Fatty fish|
|Tochopherols (E)||Anti-oxidant||Rare||Avocado, asparagus, milk, nuts, seeds, spinach|
|Coagulation Vitamin (K)||Blood clotting||Abnormal bleeding||Leafy vegetables, fruits, spinach|
Trace Elements also known as micronutrients are found only in minute quantities in the body – yet they are vitally important. Small amounts of supplements can be beneficial.
Selenium: Micronutrient essential for cellular functions but toxic in large amounts. It is required for human sperm maturation and sperm motility
Dietary selenium sources: Nuts, cereals, meat, fish, and eggs. Brazil nuts are the richest dietary source. High levels also are found in kidney, tuna, crab and lobster
Zinc: Zinc is important in several aspects of male reproduction. Zinc concentrations are very high in the male genital organs compared with other tissues and body fluids particularly in the prostate gland, which is largely responsible for the high zinc content in sperm. Spermatozoa themselves also contain zinc, which is derived from the testis. Zinc is involved in spermatogenesis, testosterone production, fertilisation capability of sperm. In addition it is necessary for a healthy immune system.
Sources: Pumpkin seeds, nuts, meat, poultry and seafood.
Essential Fatty acids: pumpkin seeds
The concentrations of calcium, magnesium, and zinc are highly correlated.
Mr Vinod Nargund is a Consultant Urological Surgeon specialising in Urological cancer, male sexual and fertility problems. He was trained in Urology at the City Hospital Belfast, the Royal Infirmary Bradford and the Churchill and John Radcliffe Hospitals in Oxford. You can view all of his qualifications on his biography page.