15-20% of couples in India suffer from infertility, and of these, male infertility contributes to 40-50% of all such cases. The high prevalence of male infertility in India is likely due to a combination of factors, including the country’s large population, poor awareness about proper nutrition for fertility and reproductive health, and limited access to quality food s well as healthcare.
While there are several reasons why Indian Males are getting more prone to infertility – an increasing number of males, at least in urban areas, are getting married later in age and starting families even later. Sperm quality and quantity may have started to decline by the time modern Indian males get on family way.
In addition, changing life styles due to increasing incomes and urbanization are exposing males to environmental as well as lifestyle factors such as staying indoors with little access to sunlight, stressful work conditions, disruptions in food and sleep cycles and lack of effective physical activities. Lastly cool lifestyle factors such as drinking, smoking and accompanied obesity can also lead to male infertility.
Despite the high prevalence of male infertility in India, there is a glaring lack of awareness and understanding about the condition and its causes. Additionally, there is a lack of access to quality healthcare and right advice in many parts of the country, which makes it difficult for couples struggling with infertility to get the right help that they need.
Causes of Male Infertility in India
Male infertility is a growing problem in India. While the exact cause of male infertility is difficult to fathom being a multi-factorial condition, there are several factors that contribute to it. These include:
Poor diet and nutrition: A continued lack of essential nutrients can lead to problems with sperm production and its quality
Environmental factors: Exposure to certain chemicals and pollutants can damage sperm and lead to infertility
Stress: Stress can impact hormone levels and interferes with sperm production
Smoking: Smoking cigarettes can reduce sperm count and quality
Alcohol use: Excessive alcohol consumption can also reduce sperm count and quality
Age: As men age, their fertility declines. This is due to changes in hormone levels and a decrease in sperm product
There are several characteristic features of male infertility, such as oligospermia, i.e., low sperm concentration in semen; asthenozoospermia, i.e., an absolute lack of motility or a decreased motility of spermatozoa; and teratozoospermia, i.e., an insufficient number of spermatozoa of normal structure. Leaver et al point out that these disorders constitute over 90% of male infertility causes.
According to an extensive meta-analysis covering 185 studies, including over 40,000 men from developed countries, the number of spermatozoa, i.e., the main factor determining the quality of semen, decreased by 50%–60% over the period 1973–2011.
Effect of Diet on Male Fertility
Furthermore, recent research data point to the fact that diet is directly associated with semen quality and that overall lifestyle plays a crucial role in maintaining proper reproductive functions.
An unhealthy hypercaloric diet, excessive intake of poly un-saturated fats and trans-fatty acids, high glycemic index, and low nutritional density may be directly associated with increased oxidative stress, which constitutes the underlying cause of obesity, intestinal dysbiosis, type 2 diabetes, and insulin resistance.
The above-mentioned metabolic disorders are associated with a deterioration of fertility mainly due to the generation of oxidative stress, regarded as one of the main factors leading to decreased sperm quality and a higher risk of infertility, as well as hormonal and immunological disorders.
Thus, an increase in white adipose tissue leads to an increase in the production of pro-inflammatory cytokines and reactive oxygen species, as well as the aromatase activity that is responsible for the conversion of testosterone to oestradiol. On the other hand, obese men with type 2 diabetes and insulin resistance are more likely to experience secondary hypogonadism and lower levels of sex hormone-binding protein (SHBG). Moreover, hyperglycemia has a negative impact on sperm motility and the fertilization process.
Effect of Trans Fats and Poly-Unsaturated Fatty Acids
It was demonstrated that spermatogenesis is negatively affected by trans-fatty acids, as both polyunsaturated fatty acids (PUFA), as well as trans-fatty acids accumulate in the testes; however, unlike PUFA, the content of trans-fatty acids in semen and their consumption is associated with poorer sperm quality, as well as with lower sperm concentration in ejaculate.
Animal studies suggest that a diet rich in trans fats may be associated with reduced testosterone production and testicular mass, as well as the initiation of pathological changes in the testes. In fact, omega-6 fatty acids as available in Seed Oils, are also worth mentioning; in particular, if their supply is too high in relation to omega-3 fatty acids. They may also adversely affect fertility since they are likely to induce inflammation of a slight intensity, oxidative stress, dysfunction of the endothelium, and atherosclerosis.
A cross-sectional study conducted on a group of 209 healthy men indicates that the intake of trans and omega-6 fatty acids, as well as the reduction of omega-3 intake are associated with deterioration of testicular endocrine function, i.e., lower concentration levels of free testosterone and total testosterone, and with lower testicular volume.
So want to plan family – cut down outside food and shift to better quality Ghee and Coconut Oil for cooking at home and shun all seed oils such as sunflower oil, soyabean oil and mustard oil.
Antioxidants for Male Infertility–What is the Evidence?
On the basis of 7 randomized studies involving the live birth rate following antioxidant supplementation, it was demonstrated that such supplementation in infertile men can improve the live birth rate. However, the authors of the review emphasize that the studies are ambiguous and subject to a high risk of error.
Thus, the need for more good quality research on efficacy, safety, and the recommended doses of antioxidants was also stressed in other research studies.
Usage of Minerals – Zinc
Zinc constitutes the basic element in the context of male fertility. Both seminal plasma and the prostate gland are characterized by its high content. The appropriate level of zinc in semen is essential for the production of spermatozoa, preservation of their correct morphology, sperm count and function, and thus, for the proper course of fertilization.
Moreover, testicular development and the proper course of steroidogenesis depends on zinc—the deficiency of this element is observed in patients with hypogonadism and underdeveloped secondary sexual traits, as well as in patients with oligospermia, astenozoospermia, and azoospermia.
Appropriate zinc concentrations in semen are associated with higher concentrations of spermatozoa in ejaculate, higher motility, viability, and increased antioxidant activity due to excessive amounts of superoxide anions by inhibiting nicotinamide adenine dinucleotide phosphate oxidase (NADPH oxidase).
Zinc in the testis is crucial for spermatogenesis and the physiology of spermatozoa and according to researchers, zinc is effective in protecting sperm from bacterial and chromosome damage. Due to strong antioxidant properties, an adequate amount of zinc in the semen plasma shows protective effects.
Trace Mineral – Selenium
Another significant microelement is selenium, which is a component of glutathione peroxidase and thus increases the enzymatic antioxidant activity. In several studies, lower selenium levels in the semen of infertile men were found in comparison to the healthy population. However, both the deficiency and the excess of selenium may result in fertility disorders and abnormal semen parameters.
Moreover, selenium has a protective effect against oxidative stress on sperm DNA and simultaneously increases motility and sperm viability. In the course of normal spermatogenesis, apart from glutathione peroxidase, selenoprotein P is the key element. In fact, the greatest amount of selenium occurs in the testis in this form.
Other Antioxidants – Vitamin C and Vitamin E
In addition to selenium, vitamin C and tocopherol / Vit E also present antioxidant properties by means of free radical neutralization. Therefore, it is important for the diet to be rich in vegetables and fruits, which are the main sources of these elements.
Furthermore, apart from its antioxidant properties, tocopherol is likely to have a protective effect against heavy metal damage. Vegetables and fruits, especially raw green-leaved vegetables, are a source of folic acid, which is important in the course of spermatogenesis, particularly in the supplementation combined with zinc.
According to researchers, coenzyme Q10 may also be relevant in terms of semen quality, since in its reduced form, as ubiquinol and ubisemichinone radical, it has an antioxidant effect and is involved in all energy-dependent processes, including sperm motility.
Remarkably, ubiquinone is capable of regenerating other antioxidants, such as vitamin C and vitamin E. On the basis of the meta-analysis, patients receiving coenzyme Q10 showed a higher level of this substance in semen, as well as an increased concentration and better sperm motility compared to placebo. However, it is quite possible that coenzyme Q10 available diet alone is not sufficient and does not result in the improvement of semen quality parameters—thus, supplementation is highly recommended.
Lycopene, a powerful antioxidant belonging to the carotenoid family, seems to show promising results. It is indicated that lycopene reduces lipid peroxidation and DNA damage, strengthens the immune system, and increases the number and survival of sperm. Zaremba et al. demonstrated a positive correlation between the consumption of lycopene and normal sperm morphology.
Many beneficial properties are also attributed to N-acetyl-cysteine (NAC), which is involved in glutathione synthesis (GSH) and has the ability to capture ROS. The presence of NAC in the diet of infertile men has been associated with an increased number and motility of spermatozoa, as well as an increased number of normal structure spermatozoa following 3 months of supplementation. Moreover, a decrease in sperm DNA fragmentation and an increase in protamine levels, as well as a decrease in FSH and LH and an increase in testosterone levels in blood were observed with NAC supplementation.
To summarize – the most frequently needed and used antioxidants, both in monotherapy and combined supplementation, include vitamin E and Vitamin C, L-carnitine, coenzyme Q10, zinc, selenium, folic acid, and N-acetylcysteine.
Omega-3 Fatty Acids
Omega-3 fatty acids, which are precursors to eicosanoids, are also known to have anti-inflammatory and antioxidant properties. Compared to other body tissues and cells, testis and spermatozoa have a higher concentration of polyunsaturated fatty acids and effective fertilization depends on the lipid composition of the sperm membrane.
A meta-analysis of 16 randomized controlled trials showed a positive relationship between omega-3 supplementation and semen quality parameters in infertile men. Moreover, pro-healthy dietary models containing fish and seafood were also associated with better sperm quality in observational studies.
In addition, the consumption of 75 g of walnuts per day over a 12 week period was associated with a longer lifespan, motility, and sperm morphology. Interestingly, according to another study, the addition of 60 g of nut mixture to the Western diet, apart from improving the abovementioned parameters, also resulted in an increase in sperm count.
Macro-Minerals; Magnesium, Calcium, Copper, Manganese
It is also recommended to provide an adequate supply of magnesium and calcium. Magnesium constitutes a key element in the course of spermatogenesis and sperm motility, and also in the female reproductive tract.
Furthermore, calcium affects the motility, hyperactivation, and capitulation of sperm and ultimately, the acrosome reaction, leading to sperm penetration into the oocyte.
In addition, copper is also necessary for the proper functioning of sperm and manganese affects the motility of sperm and the fertilization process.
Nutrition thus can affect – both negatively and positively, the quality of human semen. The diet should include vegetables and fruit, fish and seafood, red meat, nuts, seeds, whole-grains and fibre-rich products, poultry, and dairy products.
On the other hand, low consumption of fruit and vegetables and products with an antioxidant potential, a high calorific intake, a diet rich in poly unsaturated fatty acids and trans fats, processed foods and low fish consumption, have a negative impact on the quality of semen, which may contribute to reduced male fertility.
