A Scoping Review of Lifestyle Interventions for Improving Sperm Parameters

Introduction Since ۱۹۹۰, sperm concentration has declined by more than ۵۲% in Western men and over ۶۰% globally. Recent meta-analyses indicate that ۴۰–۵۰% of male infertility cases are attributable to modifiable lifestyle factors. Obesity is associated with a ۲۲% reduction in sperm count and ۲۴% decrease in progressive motility; cigarette smoking increases sperm DNA fragmentation by ۱۹%; alcohol consumption reduces semen volume by ۱۸%; and diets high in processed foods elevate oxidative stress by ۳۵%. In contrast, preliminary interventional studies have reported substantial improvements in sperm parameters following lifestyle modification. The present review aimed to map the scope and nature of lifestyle interventions effective in enhancing sperm quality among men of reproductive age. Methods This scoping review followed the five-stage framework of Arksey and O’Malley and the Joanna Briggs Institute guidelines (۲۰۲۰), with reporting aligned to the PRISMA Extension for Scoping Reviews (PRISMA-ScR). A comprehensive search was conducted across PubMed, Scopus, Embase, Cochrane Library, and SID up to December ۲۰۲۵ using the PCC strategy (Population: men of reproductive age; Concept: lifestyle interventions including diet, physical activity, weight loss, smoking/alcohol cessation; Context: improvement in sperm parameters). Human observational and interventional studies published in English or Persian were included. Screening was performed independently by two reviewers using Rayyan software; data were extracted using standardised JBI templates and synthesised descriptively through thematic categorisation. Results: Of ۶۸۷ records identified, ۱۲ studies (۹ interventional trials, ۳ systematic reviews) met the inclusion criteria after deduplication and screening. The interventions clustered into five main categories: Weight loss and low-calorie/Mediterranean diets (۹–۲۳% improvement in sperm concentration and motility) Moderate-intensity aerobic exercise (۷–۱۸% increase in progressive motility) Smoking cessation (up to ۲۲% improvement in morphology within ۳–۶ months) Alcohol reduction or abstinence (increased testosterone and semen volume) Dietary antioxidant and zinc supplementation (۲۰–۳۵% reduction in sperm DNA fragmentation). Most interventions lasted ۱۲–۲۴ weeks, with the greatest benefits observed when multiple modalities were combined. Discussion and Conclusion Evidence from the included studies consistently demonstrates that integrated lifestyle programmes—combining weight reduction, antioxidant-rich diets, moderate aerobic exercise, and cessation of smoking and alcohol—can produce clinically meaningful improvements across all sperm parameters within ۳–۶ months. These effects are mediated primarily through reduced oxidative stress, restoration of hypothalamic-pituitary-gonadal axis function, and optimisation of the metabolic profile. Given their low cost, high accessibility, and favourable safety profile, such interventions should be regarded as first-line therapy in men presenting with abnormal semen parameters. Future research should focus on long-term randomised controlled trials with live-birth outcomes as the primary endpoint.

Keywords:

Lifestyle interventions , Sperm parameters , Male infertility , Scoping review