Introduction: Pre-conception care is the provision of biomedical, behavioural and social health interventions to women and couples before conception occurs. Such care is also required for men. At least some of male infertility are caused by inappropriate lifestyles. In this study, prevalence of such factors known to affect male fertility potential were investigated. In addition, efficacy of modification of the lifestyles as pre-conception care was analyzed.
Methods: 402 consecutive male partners of infertility couples were enrolled and asked about their lifestyles. These patients were promoted to modify their inappropriate lifestyles as pre-conception care. The lifestyle includes factors such as smoking, chronic alcohol use, inappropriate underwear use, excessive body weight, length of abstinence and so on. Male patients were also examined by a Urologist (A.K.) to check up general health and urologic disorders. Semen quality was compared between before and after the promotion by student T test or chi-square test.
Results: Median age of male patients was 35 years old. 91/402 subjects (23%) were current smokers. 189/402 (47%) were chronic alcohol users. 277/402 (69%) used fitted underwear. The lifestyle increasing scrotal temperature including excessive time bathtub/sauna use were found in 302/402 (75%). Body mass index was 30 kg/m2 or above in 28/402 (7%). Blood tests revealed hypogonadism in 61/359 (17%), zinc deficiency in 58/357 (16%), abnormal lipid metabolism in 145/392 (37%), and abnormal liver function in 145/368 (39%). Palpable varicoceles were found in 96 (26%). Including the common causes of male infertility, most of the patients (397/402, 99%) had at least one factor. Then, changes in semen parameters were analyzed comparing before and after the promotion of lifestyle modification. Median intervals of semen analyses were 28 days. Abstinence was decreased from 3.7 days to 2.9 days (p < 0.001). Oligozoospermia was decreased from 197/401 to 123/366 (p < 0.001). Asthenozoospermia was decreased from 299/400 to 195/365 (p < 0.001). Oligoasthenozoospermia was decreased from 153/400 to 83/367 (p < 0.001). Median sperm DNA fragmentation index was decreased from 32% to 21% (n=71, p=0.0075). Total motile sperm count (median) was improved even in those with grades II to III varicocele (n=86, 13.6 million increase, p=0.0403), hypogonadism (n=51, 21.8 million increase, p=0.0142), but not in those with zinc deficiency, nor in those with erectile dysfunction.
Conclusions: The promotion of lifestyle modification as a part of preconception care for male partners of infertile couples could improve semen quality without urologic intervention.
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