Being healthy does not always equate to having good fertility health.
Male fertility issues can arise from health and lifestyle reasons, regardless of age. Certain myths and beliefs surrounding fertility may influence practices and behaviour, which can impact upon conception.
Read on for best practices in sexual habits, diet, lifestyle and family planning, to optimise male fertility naturally.
Beliefs
Advice from KKH
Sexual habits
Abstinence
Abstinence over a few days “saves all my sperm” for the one sexual intercourse and increases the likelihood of conception.
Sperm stored in a man’s body for a long period of time may lose their motility. Having sex every two to three days is ideal, as this eliminates older sperm to not affect sperm quality. It also allows time for the testes to refill with sperm to be ready for the next ejaculation.
Timing
As long as we time it accurately, we can conceive at the first go.
Consider recreational sex as often as you can. Having regular sex two to three days before and on the ovulation day may optimise your likelihood of becoming pregnant. However, stress and anxiety from planning for “sex to procreate”, can hurt a healthy sexual relationship and lead to loss of sex drive. Accurately identifying the ovulation duration can also be logistically demanding.
Sex positions
Only certain sex positions are effective for conception.
There is no scientific evidence linking sex position and successful pregnancy. The key is increasing the frequency of sex to increase the chance of the egg meeting the sperm.
History of having a child
My wife and I have a child so we will not have problems having another child.
Some couples may experience secondary infertility due to age or other conditions that develop after a pregnancy, such as endometriosis, hormonal imbalance or sperm problems.
Lifestyle
Bike riding
Riding a bicycle or motorcycle for long hours is bad for my fertility.
Tight clothing or riding postures where the testes are constantly pushed towards the body may cause the groin to be at a high temperature and negatively affect the sperm.
This usually does not pose major issues to most men’s fertility. Men with existing sperm count and quality concerns should be mindful of these, to avoid exacerbating the issues.
Tight clothing and hot environment
Wearing tight undergarments or being in environments with hot temperature affects my fertility.
Prolonged or repeated exposure of a man’s groin to high temperatures (e.g. tight bottoms) can reduce sperm count and quality.
Keep your genital regions cool and wear comfortable underwear such as briefs and boxers. Where possible, take breaks away from environments with high temperature.
Fitness
I’m very fit and exercise regularly, so I should not have any issues with my fertility.
Male fertility can be affected by various factors, some arising from hormonal or genetic conditions. Physical activity may not directly boost or reduce male fertility.
Exercise and physical activity are beneficial to optimise weight while trying for a baby. However, fertility fitness cannot be predicted from physical fitness. Hence, it is still recommended to seek medical help should a couple have been trying to conceive regularly without success.
Smoking and vaping
Smoking or vaping does not affect my fertility.
Smoking or vaping can be toxic to sperm, as well as to a woman’s eggs and a developing embryo.
We recommend couples trying for a baby to enrol in a smoking cessation programme before embarking on conception. Many subfertility issues associated with smoking can be reversed within one year of cessation.
Diet
Sexual performance drugs
Sexual performance drugs such as Viagra can increase our chances of conception.
Sexual performance drugs are prescription medications, and can aid men with specific fertility issues. For example, Viagra is targeted at erectile dysfunction, to help men achieve a firm erection for successful penetration during sex. However, should a man’s fertility issues be unrelated with their erection ability, Viagra would not beneficial.
Typically, these drugs can help with enhancing the experience and intimacy between a couple during sex. Medical advice should be sought before consumption.
Illegal drugs can cause fatal health consequences.
Health food and supplements
Consuming health food and supplements, such as protein shakes, do not pose issues to my fertility.
Some energy drinks or health supplements contain ingredients, such as anabolic steroids and testosterones, which can influence hormone levels. This may affect sperm quality or production.
Protein shakes in the market typically do not contain such ingredients, and should not pose issues to fertility.
Study food labels and ingredients carefully to ensure that products are safe and certified by the Health Sciences Authority before consuming. Discuss with your clinician on the use of traditional Chinese medicine.
Caffeine and alcohol
Consuming caffeine and alcohol do not affect my fertility.
Heavy alcohol consumption can affect hormone levels and interfere with sperm production and function. It is recommended to reduce alcohol consumption to less than two drinks a day, and moderate daily caffeine intake (such as coffee or tea).
Diet and weight
Diet and weight do not play a role in fertility.
Obesity has been found to alter hormonal regulation, which can affect sperm production or quality, libido or cause erectile dysfunction. It is also associated with depression, which may adversely affect sexual health.
Stay healthy, have a balanced diet and lifestyle, and maintain a good body mass index (BMI).
Men who are trying for conception can consume food that help with hormone levels, reduce sperm DNA damage and improve sperm quality. These include food rich in L-carnitine; L-arginine; zinc; selenium; coenzyme Q10; vitamins A, C, D, E; and DHA.
Soy products
Consuming a lot of soy products (known to contain estrogen) is detrimental to my testosterone levels and will affect my fertility.
Studies have shown that consumption of soy products have not shown to affect bioavailable male hormones1. Having said that, it is recommended to eat or drink soy products in moderation and maintain a healthy, balanced diet.
Age
Younger age
Declining male fertility is due to ageing.
Men can experience fertility issues arising from health and lifestyle reasons regardless of a man’s age.
Older age
Age has no effect on my sperm and fertility. Some men in their 60s or 70s can also have children.
Increasing evidence suggest sperm quality declines with age. Sperm DNA damage has been observed to be significantly higher in older men, which can badly affect reproductive outcomes. Older men may also have increased incidence of sexual dysfunction.
Try to conceive early, as men aged older than 40 years contribute to reduced reproductive ability of a couple, especially when the female partner is also of advanced age.
Sperm disorders the main cause of subfertility in Singapore men
In Singapore, fertility issues affect approximately 15 per cent of couples.
Male subfertility is the underlying cause for one in three couples with fertility issues. The three major causes are erection, ejaculation and sperm disorders.
Sperm disorders occur due to abnormalities in sperm count, motility or morphology (shape). Locally, the most common fertility issues in men are due to declining sperm parameters, which include low sperm count, poor sperm movement and abnormally shaped sperm.
Erection and ejaculation disorders commonly manifest together and can pose a physical challenge in achieving conception, such as not being able to have sexual intercourse.
Treatment options for male subfertility
Should a couple be regularly trying without contraceptives for a year (or six months for those above 35 years old), but are not fruitful, please seek help from a specialist to enable the cause to be identified and managed.
Treatment for male subfertility largely depends on the underlying cause:
Should the cause be reversable, such as a previous vasectomy (male sterilisation); recent hormonal or steroid usage; sexual dysfunction or chronic diseases, treatments can be targeted to address these accompanying health concerns alongside techniques such as intrauterine insemination to help a couple achieve natural conception.
Should the cause be irreversible, such as testicular failure or genetic disorders, treatment options involving assisted reproductive techniques such as in-vitro fertilisation may offer a better chance at conception.
One-third of fertility issues in couples in Singapore remained unexplained. Treatment plans will be discussed and customised based on the couple’s health needs.
Don’t wait; seek treatment early
Time is crucial in fertility and conception. Stepping forward for a fertility check early enables more time to pinpoint and address the concerns, to help couples towards conceiving.
Men and women are equally important in the journey of conception. Fertility issues can be tremendously stressful, and the associated stigma emotionally and mentally draining. Strong understanding and support for each other is crucial along the fertility journey.
The KKIVF Centre at KKH provides comprehensive and holistic dyad-care for couples planning to start a family. Couples will be consulted by a fertility specialist as a pair, to better understand their fertility heath, and recommend tests to evaluate fertility potential and treatment targeted to address underlying causes of subfertility.
Hamilton-Reeves et al. Clinical studies show no effects of soy protein or isoflavones on reproductive hormones in men: results of a meta-analysis Fertil Steril. 2010 Aug;94(3):997-1007.
Dr Ee Tat Xin subspecialises in assisted reproductive programmes, fertility preservation and male infertility. A clinical assistant professor under the SingHealth Duke-NUS Academic Medical Centre, Dr Ee is actively involved in reproductive health research and medical education.
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