What lifestyle modifications can I recommend to improve male fertility in my patients?

To improve male fertility, you can recommend several lifestyle modifications based on current UK guidelines integrated with recent research findings. First, advise men to stop smoking, as smoking is associated with reduced semen quality, although the direct impact on fertility is uncertain; cessation will also improve overall health ¹. Encourage maintaining a healthy body weight, as men with a BMI of 30 or over are likely to have reduced fertility, and weight loss may improve semen parameters ¹. Advise moderation in alcohol consumption, keeping within Department of Health recommendations (3 to 4 units per day), since excessive alcohol intake is detrimental to semen quality ¹. Recommend avoiding elevated scrotal temperature by considering loose-fitting underwear, although evidence on fertility improvement is uncertain ¹. Discuss occupational exposures that may reduce fertility and advise appropriate precautions ¹. Screen for and manage any prescription, over-the-counter, or recreational drug use that could impair fertility ¹.

Recent literature emphasizes the role of oxidative stress in sperm health and fertility, suggesting that lifestyle interventions aimed at reducing oxidative stress can be beneficial (Sengupta et al., 2024). This includes promoting a diet rich in antioxidants (e.g., fruits, vegetables, nuts) and possibly supplementing with antioxidants, although clinical evidence is still evolving (Moustakli et al., 2025; Bocu et al., 2025). Regular moderate exercise is also recommended to improve general health and reduce oxidative stress, which may positively affect sperm quality (Moustakli et al., 2025). Conversely, excessive caffeine intake does not have consistent evidence linking it to fertility problems, so no specific restriction is necessary ¹.

In summary, recommend smoking cessation, weight management, alcohol moderation, avoidance of heat exposure to the testes, occupational hazard assessment, and drug use review, combined with a healthy antioxidant-rich diet and regular exercise to mitigate oxidative stress and improve male fertility outcomes ¹; (Sengupta et al., 2024; Moustakli et al., 2025; Bocu et al., 2025).