FACTS Spotlight: Male Fertility


June 21, 2021

By Taylor Keen, DO

Diet Matters in Male Fertility: A Research Review

Editor’s Note: As part of the FACTS series on male fertility, this month we published a review of the evidence on zinc and folate supplementation in infertility and research about male involvement in family planning. We also published an interview with a couple that’s used multiple fertility awareness-based methods (FABMs)successfully. Stay tuned for more to come, including a research review on the impact of environmental factors on male fertility.

This week’s review summarizes fascinating research[i] published in 2015 titled, “The Association between Dietary Patterns and Semen Quality in a General Asian Population of 7282 Males.” The synopsis below was written by Dr. Taylor Keen while on the FACTS online elective in fertility awareness. With nearly 230 students participating in our unique elective this year, FACTS is fulfilling its mission to educate medical professionals about the evidence behind FABMs and the value of understanding fertility. The compelling results of this article emphasize the vital relationship between a healthy lifestyle and fertility.


When thinking about fertility, it is important to recognize that a couple’s fertility is a combination of both female and male factors.

In this article, Liu et al examine the relationship between diet and semen quality as a reflection of male fertility. Previously proven risk factors for poor semen quality include genetics, endocrine abnormalities, obesity, age, smoking, alcohol use, and now, poor diet and nutrition.

Many studies have already been done in Western countries that suggest the current Western diet — high in calories, added fats, and sugar — negatively affects semen quality and male fertility, while diets consisting of healthy fats, whole grains, fish, and poultry exert a positive impact. This was the first study examining the relationships between diet and semen quality in an Asian population.


The cross-sectional study involved a total of 7,282 Taiwanese men between the ages of 18 and 75. It was run by a private practice called MJ Health Management Institution in Taiwan that conducted a standard medical screening program from 2008 to 2013. Participants completed a computerized diet questionnaire consisting of 19 foods, and documented how often and how much of each food they typically eat. Researchers then classified the participants into five different groups based on their answers: healthy diet, Western diet, high-carbohydrate diet, high-sugar diet, and high-sodium diet.

The healthy diet consisted of light and dark colored vegetables and fruits. The Western diet involved mostly dairy, seafood, and fried foods. The high-carbohydrate diet included refined grains, whole grains, and root vegetables. The high-sugar diet consisted of cake, cookies, additional sugars, and sweetened drinks. Lastly, the high-sodium diet was high in processed canned foods, instant noodles, and condiments.

Participants were instructed to abstain from intercourse for three days prior to collection of semen using home-collection kits. The samples were sent to the facility’s lab within one hour of collection. The semen parameters evaluated included sperm concentration, total sperm motility, progressive sperm motility, and normal sperm morphology.


The Western diet correlated with decreased sperm concentration and a decline in normal sperm morphology. A high-sugar diet correlated with decreased sperm concentration, whereas a high-carbohydrate diet was associated with decreased total and progressive sperm morphology.


This study clearly indicates that diet affects semen quality and can have implications on male fertility.

A typical Western diet, high-carbohydrate diet, and high-sugar diet were each found to have adverse effects on semen quality. Many studies have previously shown the association between a Western diet and high-sugar diet and decreased sperm quality. Yet, this was the first study to show an association between a high-carbohydrate diet and decreased sperm quality specifically.

As noted by the researchers, the Asian diet is much heavier in carbohydrates than the Western diet, and this finding could have specific implications for this population. There is a hypothesis that the high number of soybeans containing phytoestrogens in the Asian diet could play more of a role than carbohydrates, but more research needs to be done to evaluate this proposed relationship.

While the large sample size of over 7,000 men is one of the study’s strengths, one of the main limitations is that the results apply to Taiwanese men specifically and not necessarily to other populations. However, comparable studies in other populations have resulted in similar associations. Another study limitation is that the questionnaire could be very subjective, and the participants may have provided different answers knowing the researchers would be evaluating them. There is also opportunity for errors with home semen collection and the need to send the sample to the lab on their own, and the article does not state how the samples were transported. Lastly, the participants were required to pay to participate, which could exclude poorer populations whose diet may vary significantly from middle- and upper-class populations.

Ultimately, this is an important study because it further strengthens the association between diet and semen quality and highlights the impact of lifestyle factors on fertility. When couples begin an infertility evaluation, assuming there are no serious health problems to address, often the recommendation is to start with lifestyle changes including diet and exercise. This is a simple, cost-effective intervention that can have a significant impact on fertility. Further studies evaluating why a high-carbohydrate diet affects sperm motility while the Western diet affects sperm concentration and morphology would be an interesting next step.


[i] Liu CY, Chou YC, Chao JC, Hsu CY, Cha TL, Tsao CW. The Association between Dietary Patterns and Semen Quality in a General Asian Population of 7282 Males. PLoS One. 2015;10(7):e0134224. Published 2015 Jul 28. doi:10.1371/journal.pone.0134224.

About the Author

Taylor Keen, DO

Taylor Keen, DO conducted this review of research as a fourth-year medical student at A.T. Still University – Kirksville College of Osteopathic Medicine. She will be starting family medicine residency this summer at UMKC Family Medicine in Kansas City, Missouri. Dr. Keen greatly enjoyed learning more about women’s health through the FACTS elective and plans to implement many of the concepts she learned in her future practice.


The FACTS CME Course is HERE!

The FACTS 4-part CME Course – Fertility Awareness Based Methods (FABMs) for Family Planning and Restorative Reproductive Women’s Healthcare prepares you as a medical professional to present more comprehensive options for family planning and women’s health monitoring and management of a range of reproductive health concerns. Through online lectures, live case study discussions, and readings, this course will explore the broad applications of modern Fertility Awareness-Based Methods (FABMs) and their role in pregnancy prevention, infertility, and women’s health.

The course is divided into four parts; you may elect to do any or all of them and they may be completed in any order. Each part is worth up to 14 AAFP-approved CME credits.

In Part A, An Introduction to Modern FABMs for Family Planning, participants will survey modern evidence-based FABMs, including the research underlying the development of the different methods, their effectiveness rates to prevent pregnancy, and the benefits and challenges of using each method. Participants may engage in live case-based discussions to learn how to read the charts of various FABMs.

In Part B, Special Topics in FABMs for Helping Couples Achieve or Avoid Pregnancy, participants can further their knowledge on the subject of fertility awareness and its applications in family planning. Part B will focus on the role of FABMs to address infertility and early pregnancy loss, and on the availability of apps marketed to help people avoid pregnancy. Learners may participate in case-based discussions that explore the medical applications of FABMs, including their role in addressing infertility and other conditions.

In Part C, FABMs for Restorative Reproductive Medicine and at Various Stages of Life, participants will learn how internal hormone shifts result in observable external signs, or biomarkers, that women can learn to use to chart their cycles and monitor their health. Participants will learn how medical professionals trained in restorative reproductive medicine can use this information to care for women in a more comprehensive way. We will also discuss how FABMs can be used throughout a woman’s reproductive life, from adolescence and the postpartum period to perimenopause.

In Part D, Medical Applications of FABMs, participants will connect the science of endocrinology to core concepts of FABMs, which may be used to diagnose and manage common women’s health conditions, including abnormal uterine bleeding, endometriosis, polycystic ovarian syndrome (PCOS), and premenstrual syndrome (PMS). They will learn how FABMs are used to monitor women’s health and facilitate the diagnosis and treatment of various women’s medical conditions, and how these methods empower a woman to understand her body and physiology better.

Click here to download the full lesson schedule for the course. 

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