Impact of lifestyle and environmental factors on fertility.

PURPOSE OF REVIEW: Infertility affects approximately 15% of couples, with male factors implicated in more than 50% of cases. Concerns over declining semen quality - evidenced by a more than 50% drop in sperm concentration over four decades - have triggered investigation into modifiable lifestyle and environmental factors. This review summarizes recent evidence on exposures that negatively impact male fertility.

RECENT FINDINGS: Smoking increases sperm DNA fragmentation (SDF) by approximately 10% and alters hormonal profiles; e-cigarettes may carry similar risks. Chronic alcohol use raises SDF by a comparable magnitude, disrupts the hypothalamic-pituitary-gonadal axis, and may cause testicular atrophy. Obesity impairs spermatogenesis through aromatase-mediated hormonal imbalance and inflammation; and even modest weight loss improves sperm parameters. Drug use - particularly steroids, cannabis, and opioids - may also suppress fertility. Environmental exposures such as heat waves, fine particulate matter, and endocrine-disrupting chemicals reduce semen quality and can contribute to testicular dysgenesis. Conversely, adherence to certain diets, antioxidant supplementation modestly improves sperm quality and reduce SDF.

SUMMARY: Lifestyle and environmental factors significantly impair male reproductive health through hormonal disruption, oxidative stress, and direct germ cell damage. These risks are common and often reversible. Identifying and modifying such exposures is essential for improving fertility outcomes and reducing long-term health burdens.