Lifestyle Choices and Sperm Toxins
Optimizing the overall testicular environment in which the sperm are being produced can often improve sperm quality. There are a wide variety of adverse lifestyle-related activities that can make the environment for sperm production suboptimal.
As mentioned previously, the human spermatogenic cycle is approximately 75 days (or a little over 10 weeks). Negative lifestyle choices (such as using a hot tub or sauna) can potentially have a negative effect on all of the sperm in the body. After one of these negative factors has occurred, it generally takes the body at least 2.5 months to completely get the old “damaged” batch of sperm out and a new “undamaged” batch of sperm back in the ejaculate. Along the same lines, any positive lifestyle changes that have been made (such as quitting smoking, decreasing alcohol intake, etc.) take at least one spermatogenic cycle (two and a half months) and sometimes two cycles (5 months) to be fully reflected in the semen parameters.
There are a number of activities that are known to decrease the quantity and/or quality of sperm. An important point to remember is that the biology of each man is different, so the degree of negative impact of each of these activities on each individual can vary widely from person to person. For example, some men could sit in a sauna for 4 hours a day and not have any change in their semen parameters, while others could start to have significant changes after just 10 minutes of sauna use. Since there is no way to determine each individual’s distinct response to each risk factor, I recommend avoiding all potentially detrimental activities while a couple is actively trying to conceive a pregnancy.
One final point to consider is the constant barrage of news articles in the popular media that claim to show that certain foods, supplements, or activities have been found to be associated with improvements or decreases in sperm numbers and/or quality. Whether it’s avocados, non-stick pots and pans, or the type of laundry detergent you are using, everything seems to have some scientific study associated with it showing that this breakthrough finding is either your ticket to pregnancy or your ultimate barrier to conceiving. Almost all of these studies are small and uncontrolled, and have little scientific merit by themselves. In this book, I have tried to identify the risk factors and beneficial activities that have decent scientific data backing up their use or avoidance. So before you rip up your carpet (because of those nasty perfluorochemicals), throw away your bedding and sofas (because of insidious off-gassing from the flame retardant chemicals), or stop taking showers (due to the evil phthalates in your shower curtain), read through this section to see which interventions are actually based on sound scientific findings at this time. Leave the sensationalism to the newspapers and cable TV- they constantly need new fresh content to try and catch your eye, regardless of the scientific merit of their claims.
Tobacco in all of its forms (cigarettes, cigars, chewing tobacco, snuff) can be detrimental to fertility (as well as to a man’s general health). Although nicotine by itself is felt to have a mild negative impact on fertility, by far the greatest impact is from the tobacco-related toxic byproducts (e.g. polycyclic aromatic hydrocarbons, vinyl chloride, benzoprene, etc.). These dangerous byproducts are known to have a dose-dependent negative impact on fertility in several ways, including:
1) Direct toxic effect on sperm production
2) Increased oxidative stress on the body
3) Hormonal disturbances that can disrupt the normal pituitary/testicular balance
Numerous studies have linked tobacco products to decreases in sperm production and sperm quality. IVF success rates have also been shown to be reduced in smokers as well.
Tobacco cessation is typically a very difficult process due to the highly addictive nature of nicotine. Improvements in fertility have been seen with cessation of all tobacco-related product use, although this can prove to be a very hard process. Strategies to help with tobacco cessation include:
-To help decrease cravings for nicotine. Examples include:
a) Buproprian (Zyban)- a prescription medication
b) Varenicline (Chantix)-a prescription medication
2) Behavioral Therapy/Group Therapy/Self Help programs
-Example: Freedom from Smoking Program (American Lung Association)
3) Cognitive therapy (working with a psychologist)
4) Nicotine replacement therapy
Nicotine replacement therapy can help to satisfy the cravings for nicotine while avoiding the toxic byproducts of tobacco. It is often used as an adjunct therapy to some of the other tobacco cessation techniques listed above, with a slow weaning of the nicotine replacement leading towards complete cessation of all nicotine products. Other people simply use the nicotine replacements long-term, with no intention of stopping the use of nicotine, but thereby avoiding tobacco products. As mentioned above, nicotine by itself has been found in some studies to potentially have a mild negative effect on male fertility. However, eliminating the other 2000+ chemicals found in tobacco can only benefit a man’s fertility potential. If nicotine replacement is needed to achieve this, then it is well worth the trade-off in terms of the small potential negative impact of nicotine itself on sperm function.
Types of nicotine replacement
5) Nasal spray
6) Electronic cigarettes
Electronic cigarettes have proven to be quite effective with my patients, as it satisfies both the nicotine cravings, as well as the familiar oral stimulation of smoking. Many e-cigarettes also have ways to gradually taper the amount of nicotine that is delivered, which can help to achieve eventual cessation.
Illicit Drug Use
Essentially all illegal drugs (such as marijuana, heroin, cocaine, etc.) have been shown to have a negative impact on male fertility parameters when studied. These negative effects include decreased testosterone levels, lower sperm production and quality, inhibition of egg/sperm interaction, erectile dysfunction, and ejaculatory problems. For these reasons, I recommend that men wishing to establish a pregnancy stop the use of all of these agents.
Mild alcohol intake by the male partner has not been found to have a significant negative impact upon fertility when studied across large populations of people. However, greater amounts of alcohol intake can have a significant negative impact on sperm numbers and quality. Excessive alcohol intake can cause:
1) Hormonal abnormalities (e.g. lower testosterone levels, elevated FSH and estradiol levels)
2) Direct toxic effect on sperm production
Alcohol tends to have a dose-dependent impact on testicular function. The general recommendation for men who are trying to have children is to limit their alcohol intake to no more than 4 drinks per week.
Cell phone use
Cell phones generate electromagnetic radiation (CPEMR) at a frequency of 1.8 gigahertz. Some scientific studies have showed a negative impact on semen parameters with regular cell phone use of over 4 hours per day. However, it remains unclear whether regular cell phone use (where the cell phone is held up to one’s ear) can significantly impact sperm quality, since the radiation generated by these devices generally travels only a short distance.
I feel that the bigger concern is the use/storage of these devices near the scrotum. When this cell phone-released radiation is near the scrotum, it has been shown to increase oxidative stress in the region of the testicles as well as impact mitochondrial function. The Environmental Working Group reviewed 10 research studies on the topic, and found that significant changes in sperm density and motility were associated with men who kept their cellular phones in the their pants pockets or on their belts. This group came up with 4 recommendations to decrease cell phone-related radiation exposure to the scrotum.
These recommendations include:
1) Text more, talk less
-Phones emit less radiation with texting than calling
2) Skip radiation shields (antenna caps/keypad covers)
-These shields reduce the connection quality and force the phone to use more energy
(i.e. emit more radiation)
3) If using a headset, hold the phone away from your body (not in pants pocket or on belt)
-The constant low emission radiation emitting by the phone seeking to keep a constant
connection creates a zone of radiation around the scrotal area
4) Call when the signal is strong
-Radiation exposure increases significantly when cell phone signals are weak
The key issue with cell phones is proximity to the scrotum while in use. The amount of radiation absorbed by the body decreases dramatically with even small increases in the distance of the cell phone from the body. A cell phone that is turned off is fine to keep in your front pants pocket. However, if the cell phone is turned on, then the further away it is from the scrotum, the better. The worst scenario is having a turned on cell phone in your front pants pocket (and it is even worse to be talking on a Bluetooth headset at the same time). Better is to have the cell phone clipped to a belt or in the back pocket. Even better would be storing it in a lower pants pocket (like in cargo pants). The best scenario is to keep the cell phone in a coat pocket, shirt pocket, or bag/briefcase while carrying it around.
Most studies have shown that caffeine/coffee intake does not have a negative impact on semen parameters. However, some studies have suggested a possible negative effect if daily caffeine intake exceeds 800 mg. This would be the daily equivalent of:
Percolated Coffee ~100/cup 8 cups
Drip Coffee ~145mg/cup 5 ½ cups
Espresso Coffee ~100mg/cup 8 cups
Tea ~50mg/cup 16 cups
Coke ~35mg/12oz can 23 cans
Mountain Dew ~54mg/12oz can 15 cans
Red Bull ~80mg/8.5oz can 10 cans
As long as caffeine intake does not exceed the above listed amounts, it probably will not have a significant negative impact on male fertility.
Air pollution can come from many different sources, including car exhaust, industrial production, the burning of coal and wood. There are thousands of potential toxins in air pollution, with some of the more common being carbon monoxide, sulfur dioxide, and ozone. Significant exposure to air pollution have been linked to decreases in sperm quality as well as increased sperm DNA damage. Strategies to limiting air pollution exposure include limiting outdoor activity levels when local air quality conditions are poor. Also try to avoid traffic congested streets if possible. When driving in traffic, keep the windows up and hit use the ‘recirculate’ button, allowing the cars filters to clean the air.