Why Should Men Prepare for Conception?
The goals of preconception care for men are to:
- increase the chances of natural conception;
- identify conditions that may reduce fertility;
- decrease the risk of pregnancy complications;
- reduce the likelihood of transmitting certain diseases to the future child;
- improve overall health.
Many causes of male infertility remain asymptomatic for a long time. A man may feel completely healthy while having impaired semen quality.
When Should You See a Urologist?
A preconception consultation is recommended for all men planning a pregnancy.
A medical evaluation is especially important if any of the following risk factors are present:
- age over 40 years [2,3];
- failure to achieve pregnancy after 6–12 months of regular unprotected intercourse (depending on the female partner’s age) [4];
- previous sexually transmitted infections (STIs);
- history of scrotal surgery;
- varicocele;
- undescended testicle during childhood (cryptorchidism);
- scrotal trauma;
- decreased libido and/or erectile dysfunction;
- diabetes mellitus;
- obesity;
- smoking;
- use of anabolic steroids or testosterone therapy.
Which Lifestyle Habits Affect Male Fertility?
Smoking
Smoking has been associated with reduced semen quality, increased oxidative stress, and damage to sperm DNA. Smoking cessation is one of the most important steps in preparing for conception [5–7].
Alcohol
Moderate alcohol consumption generally has little impact on fertility. However, regular or excessive alcohol intake may negatively affect hormonal balance and sperm production. Men planning pregnancy are advised to limit alcohol consumption as much as possible [8,9].
Body Weight
Both overweight and underweight men may experience impaired reproductive function. Achieving and maintaining a healthy body weight can improve hormonal balance and overall health [10].
Physical Activity
Regular moderate exercise is beneficial for reproductive health. Both physical inactivity and excessive exercise combined with anabolic steroid use should be avoided [9,10].
Scrotal Overheating
Normal sperm production requires the testes to remain cooler than core body temperature. Therefore, men should avoid frequent overheating of the scrotum, including:
- frequent sauna or steam bath use;
- prolonged hot baths;
- routinely placing a laptop on the lap;
- occupational exposure to high temperatures [5,10].
What Tests Are Recommended?
The extent of evaluation should be individualized and determined after consultation with a physician.
In most cases, the following may be recommended:
General Health Screening
- Complete blood count (CBC);
- Urinalysis;
- Blood chemistry tests when indicated.
Infection Screening
- HIV;
- Hepatitis B;
- Hepatitis C;
- Syphilis.
For men with risk factors, testing for sexually transmitted infections may also be recommended, including:
- Chlamydia trachomatis;
- Neisseria gonorrhoeae;
- Mycoplasma genitalium;
- Trichomonas vaginalis.
Fertility Assessment
Semen analysis (spermogram) is the primary test used to assess male fertility. However, it is not required for every man planning a pregnancy.
A semen analysis is generally recommended when:
- the female partner is older than 35 years;
- pregnancy has not occurred after 6–12 months of attempts;
- risk factors for male infertility are present;
- there is a history of cryptorchidism, varicocele, or scrotal surgery;
- testicular volume is reduced.
Semen analysis evaluates:
- ejaculate volume;
- sperm concentration;
- sperm motility;
- sperm vitality;
- sperm morphology.
If necessary, additional tests may be recommended, including:
- MAR test;
- sperm DNA fragmentation testing;
- hormonal evaluation;
- scrotal ultrasound.
Should Men Take Vitamins or Supplements?
There is no universal vitamin supplement recommended for all men planning conception.
If abnormalities in sperm production are identified, a physician may recommend specific nutrients or antioxidants. However, supplementation should be individualized, as current evidence supporting the routine use of fertility supplements remains limited.
How Often Should Couples Have Intercourse When Trying to Conceive?
A common misconception is that prolonged abstinence improves sperm quality. Current evidence does not support this belief.
The highest probability of conception is achieved when intercourse occurs every 1–2 days during the woman's fertile window. Frequent ejaculation does not appear to negatively affect semen quality in most men.
Conclusion
A comprehensive evaluation of male reproductive health can improve the likelihood of natural conception and help identify conditions that may require treatment before pregnancy.
Preparing for fatherhood is an important part of family planning and should ideally begin at least three months before attempting conception.
[1] World Health Organization, WHO Manual for the Standardized Investigation and Diagnosis of the Infertile Couple. 2000, Cambridge University Press: Cambridge.
https://www.who.int/publications/i/item/9780521431361
[2] Wesselink AK, Rothman KJ, Hatch EE, Mikkelsen EM, Sørensen HT, Wise LA. Age and fecundability in a North American preconception cohort study. Am J Obstet Gynecol 2017:667.e1–8.
[3]. Steiner AZ, Jukic AM. Impact of female age and nulligravidity on fecundity in an older reproductive age cohort. Fertil Steril 2016;105:1584–8. 6. Howe G, Westhoff C, Vessey M, Yeates D. Effects of age, cigarette smoking, and other factors on fertility: findings in a large prospective study. Br Med J 1985;290:1697–700.
[4] Gnoth C, Godehardt D, Godehardt E, Frank-Herrmann P, Freundl G. Time to pregnancy: results of the German prospective study and impact on the management of infertility. Hum Reprod 2003;18:1959–66
[5] Augood C, Duckitt K, Templeton AA. Smoking and female infertility: a systematic review and meta-analysis. Hum Reprod 1998;13:1532–9.
[6] Adena MA, Gallagher HG. Cigarette smoking and the age at menopause. Ann Hum Biol 1982;9:121–30.
[7] Mattison DR, Plowchalk DR, Meadows MJ, Miller MM, Malek A, London S. The effect of smoking on oogenesis, fertilization, and implantation. Semin Reprod Endocrinol 1989;7:291–304.
[8] Hakim RB, Gray RH, Zacur H. Alcohol and caffeine consumption and decreased fertility. Fertil Steril 1998;70:632.
[9]Hassan MA, Killick SR. Negative lifestyle is associated with a significant reduction in fecundity. Fertil Steril 2004;81:384–92.
[10] Прегравидарная подготовка. Клинический протокол Междисциплинарной ассоциации специалистов репродуктивной медицины (МАРС). Версия 3.1 / [Коллектив авторов]. — М.: Редакция журнала StatusPraesens, 2024. — 124 с.
