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Mediterranean Diet and Male Fertility

Hospital CUF Porto, 4100-180 Porto, Portugal
Centro de Biotecnologia e Química Fina (CBQF), Escola Superior de Biotecnologia da Universidade Católica Portuguesa, 4169-005 Porto, Portugal
Departamento de Urologia, Hospital da Luz Arrábida, 4400-346 Vila Nova de Gaia, Portugal
i3S—Instituto de Investigação e Inovação em Saúde, 4200-135 Porto, Portugal
Author to whom correspondence should be addressed.
Endocrines 2023, 4(2), 394-406;
Submission received: 14 March 2023 / Revised: 22 May 2023 / Accepted: 30 May 2023 / Published: 1 June 2023
(This article belongs to the Special Issue Male Infertility and Endocrine Metabolism)


Diet has an impact on male reproductive potential, but few studies have focused on the specific impact of food groups or dietary patterns on fertility. Male reproductive health, as indicated by improved semen parameters and increased chances of conceiving, is associated with the Mediterranean diet, while the Western diet is considered a risk factor for male infertility. The potential mechanisms that may explain the impact of these diets on semen quality are still largely unknown. However, numerous studies suggest that nutritional interventions are crucial for the preservation and improvement of male fertility. This review aims to summarize the most recent evidence on the influence of components of the Mediterranean diet on sperm parameters. Unlike other risk factors, dietary modulation represents a great opportunity for improving overall health and can also be an important tool in recommendations for male reproductive health.

1. Introduction

In the past few decades, Western countries have seen a substantial increase in total calorie intake, added sugars, refined carbohydrates, fats, and red meat consumption [1]. This decline in diet quality has been associated with the worsening of human semen quality parameters among Western populations [2,3,4], which may result in fertility problems in the future [4].
Apart from the traditional risk factors (hormonal disorders, physical problems, chromosomal abnormalities, etc.), lifestyle factors, particularly diet, may have a critical influence on male fertility [5,6]. In fact, many studies have strongly associated diet composition with semen quality parameters, notably sperm count, concentration, and motility [5,7,8,9,10]. Unlike other risk factors, diet represents an interesting possibility for intervention as it is an important modifiable determinant of male fertility [11]. Adolescents are a particularly vulnerable population that could benefit the most from lifestyle intervention strategies [12]. All health promotion and disease prevention policies will also have a positive impact on their future reproductive health [12].
Several studies support the hypothesis that specific micronutrients and food compounds can affect semen quality parameters [5,6,7,13,14,15,16]. In recent years, studies have focused on the effects of dietary patterns. The traditional Mediterranean Diet (MedDiet), characterized by a high intake of vegetables, legumes, fruits, nuts, grains, fish, seafood, and olive oil, and moderate physical activity, has been shown to confer numerous and well-described health improvements, including on reproductive potential, mainly due to potent anti-inflammatory and antioxidant substances naturally present in these foods [17].
Previous research indicates that the adoption of MedDiet food patterns by men is linked to greater reproductive success [15,16,18,19,20]. Current evidence, based on observational epidemiological studies, shows that a high intake of fish and plant-based foods, such as fruits, legumes, and whole grains, and a low intake of meat and processed foods are associated with semen quality parameters amelioration, although they do not consistently correlate to all semen variables [15,16,18,19,20].
While most dietary recommendations for health promotion are designed to prevent or modify the risk of cardiovascular disease and other major chronic diseases, it is unclear if they can also influence male reproductive potential. We aim to summarize the latest evidence concerning the impact of components of the MedDiet on sperm parameters, challenging its role as an essential tool in recommendations for male reproductive health.

2. Mediterranean Diet versus Western Dietary Pattern

The MedDiet encourages increased consumption of fruits, vegetables, whole grains, nuts, seafood, and low-fat dairy (Figure 1) [21]. This diet is a synonym of a restricted intake of simple carbohydrates, cholesterol, saturated and trans fats, and a higher intake of fiber, vitamins, minerals, and other non-nutritional components with potent antioxidant and anti-inflammatory properties [21].
Cutillas-Tolín and col. (2015) [18] analyzed the relationship between the MedDiet and the Western diet with semen quality parameters in 209 young and healthy men (aged 18–23 years). The researchers found that men who adhered more closely to the MedDiet had normal total sperm count and were more likely to have normal body mass index values, be non-smokers, and have a more active lifestyle [18]. In contrast, among those who preferred a daily Western dietary pattern, low sperm concentration was observed, particularly in overweight and obese men [18]. Indeed, foods included in the Western-style diet (Figure 1), such as high-fat dairy, red meats, and processed meat products (sources of saturated fat and trans fatty acids, respectively), have been inversely related to overall sperm parameters and total sperm count [22,23].
Recently, Cao and col. (2022) [24] published a systematic review and meta-analysis that aimed to explore the effects of higher and lower consumption of healthy diets, including the MedDiet, on semen quality. They found that men with greater compliance to healthy diets had the greatest sperm concentration, progressive sperm motility, and total sperm count [24]. However, other parameters, such as sperm morphology, total sperm motility, and semen volume, seemed to be similar compared to men with the lowest ingestion of healthy diets [25].
The regular intake of sugar-sweetened beverages has been associated with weight gain and obesity, which in turn increase insulin resistance and negatively affect semen quality through increased oxidative stress [5]. Lower semen volume, sperm concentration, total sperm count, and total motility have been reported among sugar-sweetened beverage consumers [5]. Since artificially sweetened beverages are not associated with weight gain and obesity itself, this type of beverage has become popular and frequently consumed in the last decades [5]. However, Meldgaard and col. (2022) [24] recently found that semen quality in young men was not significantly affected by the consumption of sugar-sweetened or artificially sweetened beverages. Nonetheless, the percentage of morphologically normal sperm was slightly lower among consumers of artificially sweetened beverages at least 3 days per week [24].
In a systematic review by Falsig and col. (2019) [26], the results from observational studies were found to be consistent with those from randomized controlled trials (RTCs) concerning the adoption of a healthy diet rich in omega-3 fatty acids (from fish and seafood) and improved semen parameters. Positive associations with omega-3 fatty acids were observed in the following parameters: reduced risk of asthenozoospermia; normal morphology; increased total sperm count, concentration, motility, and volume; and reduced sperm DNA fragmentation [26]. Additionally, some findings indicate that the consumption of foods rich in omega-3 fatty acids may also improve fecundity [27].
Fish and seafood are not the only sources of omega-3 fatty acids. Nuts, such as walnuts, hazelnuts, and almonds, are nutrient-dense foods traditionally present in the MedDiet, and are rich in omega-3 fatty acids, as well as vitamins C and E, selenium, and zinc [28]. Interestingly, in the FERTINUTS (Effect of Nut Consumption on Semen Quality and Functionality in Healthy Males) study, Salas-Huetos and col. (2018) [28] found that when young, healthy men were invited to consume a Western diet enriched with 60 g of nuts for 14 weeks, considerable improvements in total sperm count and vitality, as well as total and progressive motility and morphology of sperm were observed compared to a control group. Nut consumption was also associated with a significant reduction in sperm DNA fragmentation, which can justify these positive results in sperm parameters [28].
Over the last several decades, the Western diet has been the culprit for the growing rate of obesity, which has had a significant negative effect on fertility due to its impact on hormonal levels, sperm function, and gamete molecular composition (Figure 2) [1,11,16,29]. Despite the fact that a higher body mass index has been associated with compromised sperm production and quality [6,30], the molecular mechanisms underlying obesity and male infertility are still not totally understood [31]. Increased body fat mass has been related to impaired reproductive potential due to its effect on the molecular and physical structure of sperm [6,32,33]. Obese men are more likely to be infertile due to the larger proportion of DNA fragmentation, abnormal morphology, and low mitochondrial membrane potential, which have been linked to high levels of ROS [32,33]. Regular consumption of a Western diet is directly associated with the high prevalence of obesity and its comorbidities (such as insulin resistance and diabetes) and has also been related to low sperm quality or function [34,35]. For instance, high-energy and high-fat diets (particularly those higher in animal fat and processed foods) have been associated with testicular disruption and, thus, impairments in spermatogenesis [11].
The high proportion of adipose tissue is also associated with increased conversion of testosterone to estrogen (mainly through increased aromatase activity), decreased production of testosterone due to the increased secretion of leptin, and decreased gonadotrophin secretion (Figure 2) [36]. However, these conditions can potentially be reversed with diet- and exercise-induced weight loss [29,37]. Interestingly, weight-loss surgeries performed on morbidly obese men, despite inducing an increase in total testosterone and follicle-stimulating hormone levels, do not impact semen quality parameters [38]. Taken together, it seems that diet quality, but not total energy intake, may have a more noticeable impact on spermatogenesis [39].
There are many interesting interventional trials focused on the effect of increasing the intake of certain foods and/or administering specific nutritional supplements on semen quality parameters without other changes in dietary habits or lifestyle. Recently, Montano and col. (2022) [40] evaluated the outcomes of a dietary and exercise intervention on the semen quality of healthy, young, normal-weight men. The men randomly selected for the intervention group were invited to modify their habits in a relatively short time (4 months), whereas men enrolled in the control group received only general recommendations concerning a healthy lifestyle [40]. The main findings of this randomized trial, known as the “Fertilità, Ambiente, alimentazione, STile di vita” (FASt) study, showed that a lifestyle intervention based on MedDiet principles and regular exercise practice led to an increase in sperm concentration, as well as higher total and progressive motility [40]. Additionally, the proportion of spermatozoa with abnormal morphology and the number of round cells were reduced in these men. Overall, the semen quality parameters of men who modified their lifestyle by adopting a healthy diet and exercising regularly improved significantly compared to those who only received generic health advice. The authors concluded that lifestyle interventions could be paramount in healthy young men for protecting and potentially enhancing semen quality [40].

3. Mechanisms of Mediterranean Diet Effects on Semen Parameters

Adherence to the MedDiet pattern is associated with a diminished risk of low sperm concentration and total count, as previously mentioned. Although the biological mechanisms linking diet, sperm function, and fertility are not yet fully understood, potential mechanisms are discussed here.
MedDiet foods are naturally rich in nutrients with anti-inflammatory effects [41]. Chronic low-grade inflammation may affect reproduction through anatomical or functional changes in the male accessory gland and/or through direct negative effects on spermatozoa [41]. The association between adherence to the MedDiet and semen quality may also be mediated by increased intake of omega-3 fatty acids found in fish and fish oils [42], as well as in nuts [28]. Sperm and testicular cells, compared to other cells or tissues, have a higher concentration of long-chain polyunsaturated fatty acids (LC-PUFAs), particularly docosahexaenoic acid (DHA; 22:6 n-3) [26]. DHA is thought to play an important role in the regulation of membrane fluidity and spermatogenesis and is involved in acrosome reaction and sperm–oocyte fusion [26]. Several studies show that DHA levels in spermatozoa from asthenozoospermic and oligozoospermic men are significantly lower compared to normospermic men [26]. Seafood is also characterized by a high content of fat-soluble vitamins (vitamins A, D, E, and K), which play a crucial role in fertilization [27].
The typical foods of the MedDiet have a low content of saturated and trans fatty acids, two components that can trigger or worsen inflammation and thus affect semen quality [43]. The intake of trans fatty acid-rich foods, such as processed and ultra-processed foods, has been associated with disruptions in testosterone levels, testicular function, and sperm cell membrane quality [44]. Low testosterone levels and lower testicular volume have been reported among unhealthy diet consumers [45]. Furthermore, both saturated and monounsaturated fatty acids content in sperm are negatively linked to sperm motility and sperm concentration, while spermatozoa and seminal plasma DHA content could be considered as predictors of cryopreservation success (sperm DHA were associated with sperm motility and viability after freezing/thawing) [45]. Considering this, MedDiet adoption should be considered to improve overall health and male fertility.
Greater adherence to the MedDiet is significantly associated with improved semen quality, higher sperm concentration, total sperm count, and total and progressive sperm motility [19,46,47,48,49,50], as well as lower DNA fragmentation [50]. These benefits of the MedDiet on semen features are believed to be due to the high intake of fruits and vegetables rich in antioxidant vitamins (such as beta-carotene and vitamins A, C, and E), minerals (such as magnesium), and polyphenols [51]. As sperm membranes are highly sensitive to oxidative damage caused by reactive oxygen species (ROS), the benefit of this diet on semen quality may be due to the greater intake of foods naturally rich in antioxidants and carotenoids [51].
Antioxidants found in plant-based foods can play a significant role in influencing semen quality. Indeed, antioxidants are important for reproductive health, as they protect against excessive production of ROS, which can harm sperm DNA integrity, sperm cell plasma membranes, sperm quantity and function, such as motility, and sperm–oocyte fusion [52,53]. Moreover, these substances also help to prevent sperm agglutination by neutralization of hydroxyl, superoxide, and hydrogen peroxide radicals [53]. The MedDiet, which emphasizes a higher plant-food intake rich in antioxidants rather than meat and meat products, can have favorable effects on semen indicators. For instance, carotenoids have been associated with higher sperm motility in young, healthy males [51].
Men who consume a diet high in antioxidants and folate have been found to have better semen quality and less DNA damage in spermatozoa. Dark green leafy vegetables are a good source of folate, which is essential for spermatogenesis, DNA and protein synthesis, and DNA and protein methylation processes. Seminal plasma with low folate concentration is linked to sperm DNA damage, as folate shortage increases DNA fragility due to the misincorporation of uracil instead of thymine. If the removal of the misincorporated uracil fails, it can result in double-strand breaks that cause chromosome instability during normal repair processes. Folate deficiency also reduces the supply of methyl groups, which play an important role in DNA protection against damaging exposures [52]. Higher intakes of folate-rich foods, such as fruits and vegetables, have been linked to decreased DNA fragmentation and enhanced motility [20].
Berries, such as blueberries, strawberries, and raspberries, as well as grapes and red wine, are high in fiber, vitamin C, and antioxidant polyphenols. Resveratrol is a potent polyphenol found in these foods, which are typically included in the MedDiet. Several studies have demonstrated that resveratrol may be beneficial for human male fertility due to its proven antioxidant effects and positive effects on several enzymatic pathways [54]. Although the ideal concentration of daily resveratrol consumption and/or supplementation is still unknown, it is consensual that it has beneficial effects on spermatogenesis and contributes to better sperm parameters [55], particularly in obese men [56].
In recent years, multiple studies have emerged concerning the effects of gut microbiota on general health, specifically on fertility. It is well recognized that diet largely affects gut microbiota composition [56,57,58]. High intake of fat and/or simple sugars, as seen in Western-style diets, are two of the primary causes of intestinal dysbiosis. This condition results in a quantitative and qualitative imbalance of intestinal microbiota that disrupts the intestinal barrier [56]. The increased permeability of the intestinal barrier promotes chronic systemic inflammation, which further contributes to obesity and several metabolic diseases [58]. According to recent animal [59,60] and human [61] studies, a high-fat diet may also lower sperm quality by altering the gut microbiota, while modulating the gut microbiota may increase sperm quality.

4. Nutritional Supplements

According to a systematic review by Falsig and col. (2019) [26], omega-3 supplements and dietary intake of omega-3 may improve semen quality parameters in infertile men and men from couples seeking fertility treatment. Supplementation with omega-3 capsules containing DHA was found to increase sperm motility [62], reduce sperm DNA fragmentation [63], as well as increase sperm concentration, total sperm count, and normal morphology [18,64]. However, further research is required to fully clarify the effect of omega-3 on semen quality, and studies with fecundity as an endpoint are needed. Nevertheless, the available results suggest that supplementation or a high intake of omega-3 fatty acids may be recommended to infertile men for improving semen quality parameters [62,63,64]. A considerable number of infertile men with idiopathic oligoasthenoteratozoospermia might benefit from administration of omega-3 fatty acids (DHA + Eicosapentaenoic acid, EPA, 20:5n-3) (1.84 g/d for 32 weeks), achieving greater antioxidant activity in human seminal fluid, resulting in enhanced sperm count, motility, and morphology [65,66].
Recently, a meta-analysis reported a significant enhancement of sperm motility together with an increased concentration of seminal DHA for infertile men supplemented with omega-3 fatty acids (DHA or EPA treatments either alone or in combination with other micronutrients) [42]. Furthermore, another meta-analysis of 16 RCTs showed that semen parameters improve after omega-3 fatty acids supplementation and decrease with a diet rich in saturated and trans fatty acids [67]. When taken together, these findings may confirm the relevant role of a controlled fatty acids diet in male fertility. However, more studies are needed as the available RCTs on this topic have severe limitations, such as a relatively low number of participants and the existence of different treatment regimens concerning the dose and duration of follow-up.
Regarding micronutrient supplementation, it is important to consider that the administration of one micronutrient may affect the bioavailability of others. For instance, iron supplements may increase urinary excretion of zinc. This is particularly true for divalent cations, given their role in oxidative stress protection. Although ROS have negative effects on spermatogenesis, RCTs of antioxidants versus placebos have been disappointing. Nevertheless, it has been demonstrated that serum antioxidant status is directly associated with sperm concentration, motility, and normal morphology [68,69].
A few years ago, the effects of specific nutrients and nutritional supplements on male infertility were reviewed [70]. Oral complexes of selenium; selenium plus vitamin A; vitamin C; vitamin E; L-carnitine plus L-acetylcarnitine; beta-carotene, alpha-tocopherol, and arachidonic acid; coenzyme Q10; clomiphene citrate plus vitamin E; EPA plus DHA; and ubiquinol, were administered to improve sperm quality (sperm concentration, motility, and morphology), or to prevent sperm DNA fragmentation. Only the studies that included supplements of carnitine, coenzyme Q10, and selenium showed some beneficial effects on sperm parameters, even though the potential underlying biological mechanisms were not addressed [70].
Antioxidant supplements have shown some potential in treating idiopathic oxidative stress in spermatozoa [71,72]; however, the safety of these dietary supplements is unclear, especially at higher doses, so the possible risks for consumers are unknown. Interestingly, a higher intake of foods rich in antioxidants has been associated with better sperm quality [72], whereas antioxidant supplements have not [73].
Vitamin and antioxidant supplements have been shown to be effective in improving male fertility, with a 26% increase in conception rate compared to 11% for placebo or no therapy [74]. As a result, given the increasing popularity of nutritional supplements in Western countries, studying the role that dietary compounds play in male infertility is a promising area of research. In this context, to provide men with safe and reliable recommendations, it is mandatory to conduct large and well-conducted RCTs.

5. The Dark Side

The consumption of plant-based foods represents several well-recognized health benefits. However, we cannot ignore the numerous chemical substances used in intensive agriculture, particularly those used for pest control [75]. Pesticides are potent endocrine disruptors with several effects on male fertility [76]. Although the processes by which pesticides disrupt male reproductive function are still unclear, pesticide exposure is known to cause hormone imbalances, germ cell death, testicular atrophy, and reduced spermatogenesis [77]. Evidence suggests that high consumption of foods of plant origin with high levels of agrotoxic residues is associated with a lower total sperm count and motility, as well as a lower percentage of morphologically normal sperm [78]. Nevertheless, the richness of fruits and vegetables in some antioxidant substances, such as flavonoids, can mitigate the effects of pollutants and/or promote their elimination from tissues and fluids [79]. Interestingly, a recent RTC conducted on healthy young men from a highly polluted area of Italy has demonstrated positive effects of the MedDiet and regular physical activity on semen quality [40].
Fish and seafood are excellent sources of omega-3 fatty acids. However, it is important to acknowledge that the consumption of fish, especially shark, swordfish, king mackerel, tilefish, and tuna, is the primary source of methylmercury in the general population [80]. In fact, methylmercury is the most common organic mercury compound found in the environment, and it has been shown to have neurologic and reproductive detrimental effects. However, it is still unclear how the consumption of fish contaminated by methylmercury affects semen quality parameters [80].
The MedDiet pattern includes a moderate amount of alcohol consumption, particularly red wine, during meals. Red wine is particularly rich in resveratrol, a polyphenol with potent antioxidant properties. Nevertheless, chronic alcohol consumption has been linked to a decline in sperm quality, with a dose-dependent effect on sperm volume, motility, and morphology [47,81,82]. Alcohol intake affects spermatogenesis at both the pituitary and testes levels [8]. Alcohol suppresses the hypothalamic-pituitary-testis (HPT) axis and has direct toxic effects on Leydig and Sertoli cells [8], leading to progressive testicular damage [83]. Although the amount of alcohol that increases the risk of male infertility remains to be determined, abstinence from alcohol is known to restore alcohol-associated azoospermia [82].
Caffeine and theobromine are methylxanthine derivatives. The main sources of caffeine consumption are coffee, tea, and colas, as well as energy drinks and chocolate [84]. Theobromine is found in chocolate, tea leaves, and the cola nut. Although the traditional MedDiet does not include ingestion of these foods, they are widely consumed worldwide. There are conflicting reports regarding the relationship between caffeine intake and male infertility [6]. Albeit caffeine consumption did not have a noticeable effect on sperm counts (even when exceeding 800 mg/day, equivalent to at least 4 cups of coffee daily), coffee drinking was found to reduce sperm motility, and a high intake of colas significantly affected sperm quality markers [47,85]. Similarly, the systematic review conducted by Ricci and col. [13] concluded that semen parameters were altered by caffeine-containing soft drinks, a finding that was not observed with caffeine from coffee and tea. These findings suggest that low-to-moderate tea and coffee intake should not have a deleterious influence on sperm health [86,87].

6. Critical Analysis

The MedDiet encompasses more than just a food pattern. It is a healthy lifestyle that includes cuisine, agriculture, cultural heritage, and social habits related to food (such as commensality and conviviality), as well as encouraging regular exercise [88]. The sedentary behavior observed in Western societies and Western-style diet consumers is associated with reduced exposure to sunlight and an increased risk of vitamin D deficiency. Currently, it is widely accepted that vitamin D is not only crucial for bone metabolism, but it may also play a role in male fertility [88]. Although higher serum levels of this vitamin have been positively associated with sperm motility, indicating that it may contribute to optimal sperm function [88], Amini and col. (2020) [89] found no benefits of oral vitamin D supplementation on sperm cell quality in infertile men. Further studies in this field are necessary. For now, the evidence concerning vitamin D supplementation and sperm quality seems to be only effective in cases of insufficiency [89].
The adoption of the MedDiet pattern may pose challenges in non-Mediterranean countries due to poor availability and accessibility to MedDiet-specific foods [90]. However, it is important to note that the consumption of health-promoting foods, such as legumes, vegetables, fruits, and whole grains, and the reduced intake of red meat, processed meats, high-fat dairy, sugars, caffeine, and alcohol, is common in other healthy patterns, including the so-called Prudent diet and DASH (Dietary Approaches to Stopping Hypertension) [90]. These diets share a wealth of nutrients and non-nutritional compounds associated with well-being, disease prevention, and fertility [91].
Another important consideration is the use of nutritional supplements, either as single nutrients or as a mix of nutrients. The overall diet, which includes diverse nutrients and bioactive non-nutrient plant compounds, appears to be a better predictor of health than nutrients alone. Nutritional supplements should only be prescribed in situations of increased nutritional needs or proven nutritional insufficiency. This could explain why the MedDiet pattern is more often associated with better semen quality than nutritional supplements.
A Western diet has been associated with an increased risk of metabolic diseases, atherosclerosis, neurodegeneration, cancer, and infertility [6,11,29,65,67]. Dietary changes may be helpful in improving male fertility and fecundability. Healthy diets, such as MedDiet, which is rich in omega-3 fatty acids, antioxidants, and vitamins, and low in trans and saturated fatty acids, have been associated with better semen quality [92]. In fact, diets that include fish, shellfish, seafood, poultry, cereals, vegetables and fruits, and low-fat dairy products, have more benefits to male reproductive health than diets that include red and processed meats, full-fat dairy products, sugar, coffee, and alcohol [11]. It is also important to consider the balance between omega-3 and omega-6 fatty acids. An excessive intake of omega-6 may have negative effects on fertility since they are prone to causing mild inflammation and oxidative stress [93].
It is essential to underscore some limitations of the available studies. Firstly, it is not currently possible to predict if the beneficial effects of the MedDiet on semen quality can lead to a higher probability of successful conception. Additionally, most of the conclusions from the studies included herein are based on results from only one semen sample from each participant, which, in turn, were selected from in vitro fertilization clinics. Since these men may have distinct health problems, be overweight, and do not exercise, we consider that some findings may not be applicable to a healthy population. Finally, men who adhere more closely to the MedDiet generally have a healthier profile.
As far as we know, it is currently not possible to establish a direct causal relationship between adherence to the MedDiet and improved semen quality. It is possible that this type of healthy diet is associated with an overall healthy lifestyle, which may have a positive impact on semen quality. Furthermore, most studies that have investigated the impact of a healthy diet on semen quality have only assessed sperm parameters and antioxidant capacity, which are limited in their ability to determine the fertility potential of an individual. Therefore, it would be valuable to investigate if the improved semen quality parameters translated into enhanced fecundity and successful pregnancies. We believe that the associations presented here require further confirmation in larger scale prospective cohort studies and well-designed RCTs.
The MedDiet is undoubtedly a globally recognized healthy food pattern. According to the Developmental Origins of Health and Disease (DOHaD) paradigm, the exposition to environmental factors, including diet, during early life may impact adult health and increase the risk of chronic noncommunicable diseases [94]. Therefore, the adoption of a healthy diet and lifestyle would not only benefit male fertility but also provide an excellent opportunity for men to maximize sperm epigenetic integrity and optimize the health of their offspring.

7. Conclusions and Future Directions

The association between the healthy MedDiet pattern and sperm quality is not yet fully understood. However, it is indisputable that the amount and quality of the nutrients can affect sperm quality parameters. The best example of this is the impact of dietary fat composition. It is well-recognized that diets high in saturated fats and low in polyunsaturated fatty acids or with an unbalanced omega-6/omega-3 ratio can have a negative effect on sperm quality.
Our analysis contributes significantly to the field of nutrition and male reproduction. However, further investigation is needed to uncover the molecular mechanisms underlying the action of nutrients and natural compounds on sperm quality, which can help the development of new interventional strategies.

Author Contributions

Writing—original draft preparation, I.T. and N.T.; writing—review and editing, I.T. and N.T. All authors have read and agreed to the published version of the manuscript.


This research received no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

Not applicable.

Conflicts of Interest

The authors declare no conflict of interest.


  1. Meldrum, D.R.; Morris, M.A.; Gambone, J.C. Obesity pandemic: Causes, consequences, and solutions-but do we have the will? Fertil. Steril. 2017, 107, 833–839. [Google Scholar] [CrossRef]
  2. Levine, H.; Jørgensen, N.; Martino-Andrade, A.; Mendiola, J.; Weksler-Derri, D.; Mindlis, I. Temporal trends in sperm count: A systematic review and meta-regression analysis. Hum. Reprod. Update 2017, 23, 646–659. [Google Scholar] [CrossRef] [PubMed]
  3. Mann, U.; Shiff, B.; Patel, P. Reasons for worldwide decline in male fertility. Curr. Opin. Urol. 2020, 30, 296–301. [Google Scholar] [CrossRef]
  4. Sengupta, P.; Dutta, S.; Krajewska-Kulak, E. The disappearing sperms: Analysis of reports published between 1980 and 2015. Am. J. Men’s Health 2017, 11, 1279–1304. [Google Scholar] [CrossRef]
  5. Hayden, R.P.; Flannigan, R.; Schlegel, P.N. The role of lifestyle in male infertility: Diet, physical activity, and body habitus. Curr. Urol. Rep. 2018, 19, 56. [Google Scholar] [CrossRef] [PubMed]
  6. Durairajanayagam, D. Lifestyle causes of male infertility. Arab. J. Urol. 2018, 16, 10–20. [Google Scholar] [CrossRef] [PubMed]
  7. Cutillas-Tolín, A.; Adoamnei, E.; Navarrete-Muñoz, E.M.; Vioque, J.; Moñino-García, M.; Jørgensen, N.; Chavarro, J.E.; Mendiola, J.; Torres-Cantero, A.M. Adherence to diet quality indices in relation to semen quality and reproductive hormones in young men. Hum. Reprod. 2019, 34, 1866–1875. [Google Scholar] [CrossRef]
  8. Gabrielsen, J.S.; Tanrikut, C. Chronic exposures and male fertility: The impacts of environment, diet, and drug use on spermatogenesis. Andrology 2016, 4, 648–661. [Google Scholar] [CrossRef]
  9. Ricci, E.; Al-Beitawi, S.; Cipriani, S.; Alteri, A.; Chiaffarino, F.; Candiani, M.; Gerli, S.; Vigano, P.; Parazzini, F. Dietary habits and semen parameters: A systematic narrative review. Andrology 2018, 6, 104–116. [Google Scholar] [CrossRef]
  10. Ricci, E.; Bravi, F.; Noli, S.; Ferrari, S.; De Cosmi, V.; La Vecchia, I.; Cavadini, M.; La Vecchia, C.; Parazzini, F. Mediterranean diet and the risk of poor semen quality: Cross-sectional analysis of men referring to an Italian Fertility Clinic. Andrology 2019, 7, 156–162. [Google Scholar] [CrossRef]
  11. Salas-Huetos, A.; Bulló, M.; Salas-Salvadó, J. Dietary patterns, foods and nutrients in male fertility parameters and fecundability: A systematic review of observational studies. Hum. Reprod. Update 2017, 23, 371–389. [Google Scholar] [CrossRef]
  12. Sawyer, S.M.; Azzopardi, P.S.; Wickremarathne, D.; Patton, G.C. The age of adolescence. Lancet Child Adolesc. Health 2018, 2, 223–228. [Google Scholar] [CrossRef] [PubMed]
  13. Ricci, E.; Vigano, P.; Cipriani, S.; Somigliana, E.; Chiaffarino, F.; Bulfoni, A. Coffee and caffeine intake and male infertility: A systematic review. Nutr. J. 2017, 16, 37. [Google Scholar] [CrossRef] [PubMed]
  14. Bold, J.; Swinburne, D. Pre-conceptual guidelines for men: A review of male infertility experience, including nutrition and lifestyle factors. Dietetics 2022, 1, 164–181. [Google Scholar] [CrossRef]
  15. Efrat, M.; Stein, A.; Pinkas, H.; Unger, R.; Birk, R. Dietary patterns are positively associated with semen quality. Fertil. Steril. 2018, 109, 809–816. [Google Scholar] [CrossRef]
  16. Salas-Huetos, A.; James, E.R.; Aston, K.I.; Jenkins, T.G.; Carrell, D.T. Diet and sperm quality: Nutrients, foods and dietary patterns. Reprod. Biol. 2019, 19, 219–224. [Google Scholar] [CrossRef] [PubMed]
  17. Rosato, V.; Temple, N.J.; La Vecchia, C.; Castellan, G.; Tavani, A.; Guercio, V. Mediterranean diet and cardiovascular disease: A systematic review and meta-analysis of observational studies. Eur. J. Nutr. 2019, 58, 173–191. [Google Scholar] [CrossRef]
  18. Cutillas-Tolín, A.; Mínguez-Alarcón, L.; Mendiola, J.; López-Espín, J.J.; Jørgensen, N.; Navarrete-Muñoz, E.M.; Torres-Cantero, A.M.; Chavarro, J.E. Mediterranean and western dietary patterns are related to markers of testicular function among healthy men. Hum. Reprod. 2015, 30, 2945–2955. [Google Scholar] [CrossRef] [PubMed]
  19. Karayiannis, D.; Kontogianni, M.D.; Mendorou, C.; Douka, L.; Mastrominas, M.; Yiannakouris, N. Association between adherence to the Mediterranean diet and semen quality parameters in male partners of couples attempting fertility. Hum. Reprod. 2017, 32, 215–222. [Google Scholar] [CrossRef]
  20. Oostingh, E.C.; Steegers-Theunissen, R.P.M.; de Vries, J.H.M.; Laven, J.S.E.; Koster, M.P.H. Strong adherence to a healthy dietary pattern is associated with better semen quality, especially in men with poor semen quality. Fertil. Steril. 2017, 107, 916–923. [Google Scholar] [CrossRef]
  21. Tosti, V.; Bertozzi, B.; Fontana, L. Health benefits of the mediterranean diet: Metabolic and molecular mechanisms. J. Gerontol. A 2018, 73, 318–326. [Google Scholar] [CrossRef] [PubMed]
  22. Afeiche, M.C.; Williams, P.L.; Gaskins, A.J.; Mendiola, J.; Jørgensen, N.; Swan, S.H.; Chavarro, J.E. Meat intake and reproductive parameters among young men. Epidemiology 2014, 25, 323–330. [Google Scholar] [CrossRef] [PubMed]
  23. Mendiola, J.; Torres-Cantero, A.M.; Moreno-Grau, J.M.; Ten, J.; Roca, M.; Moreno-Grau, S.; Bernabeu, R. Food intake and its relationship with semen quality: A case-control study. Fertil. Steril. 2009, 91, 812–818. [Google Scholar] [CrossRef]
  24. Meldgaard, M.; Brix, N.; Gaml-Sørensen, A.; Ernst, A.; Ramlau-Hansen, C.H.; Tøttenborg, S.S.; Hougaard, K.S.; Bonde, J.P.E.; Toft, G. Consumption of sugar-sweetened or artificially sweetened beverages and semen quality in young men: A cross-sectional study. Int. J. Environ. Res. Public Health 2022, 19, 682. [Google Scholar] [CrossRef] [PubMed]
  25. Cao, L.L.; Chang, J.J.; Wang, S.J.; Li, Y.H.; Yuan, M.Y.; Wang, G.F.; Su, P.Y. The effect of healthy dietary patterns on male semen quality: A systematic review and meta-analysis. Asian J. Androl. 2022, 24, 549–557. [Google Scholar]
  26. Falsig, A.L.; Gleerup, C.S.; Knudsen, U.B. The influence of omega-3 fatty acids on semen quality markers: A systematic PRISMA review. Andrology 2019, 7, 794–803. [Google Scholar] [CrossRef]
  27. Gaskins, A.J.; Sundaram, R.; Buck Louis, G.M.; Chavarro, J.E. Seafood intake, sexual activity, and time to pregnancy. J. Clin. Endocrinol. Metab. 2018, 103, 2680–2688. [Google Scholar] [CrossRef]
  28. Salas-Huetos, A.; Moraleda, R.; Giardina, S.; Anton, E.; Blanco, J.; Salas-Salvadó, J.; Bulló, M. Effect of nut consumption on semen quality and functionality in healthy men consuming a Western-style diet: A randomized controlled trial. Am. J. Clin. Nutr. 2018, 108, 953–962. [Google Scholar] [CrossRef]
  29. Kahn, B.E.; Brannigan, R.E. Obesity and male infertility. Curr. Opin. Urol. 2017, 27, 441–445. [Google Scholar] [CrossRef]
  30. Hunter, E.; Avenell, A.; Maheshwari, A.; Stadler, G.; Best, D. The effectiveness of weight-loss lifestyle interventions for improving fertility in women and men with overweight or obesity and infertility: A systematic review update of evidence from randomized controlled trials. Obes. Rev. 2021, 22, e13325. [Google Scholar] [CrossRef]
  31. Ferramosca, A.; Zara, V. Diet and Male Fertility: The impact of nutrients and antioxidants on sperm energetic metabolism. Int. J. Mol. Sci. 2022, 23, 2542. [Google Scholar] [CrossRef]
  32. Lobascio, A.M.; De Felici, M.; Anibaldi, M.; Greco, P.; Minasi, M.G.; Greco, E. Involvement of seminal leukocytes, reactive oxygen species, and sperm mitochondrial membrane potential in the DNA damage of the human spermatozoa. Andrology 2015, 3, 265–270. [Google Scholar] [CrossRef]
  33. Sermondade, N.; Faure, C.; Fezeu, L.; Shayeb, A.G.; Bonde, J.P.; Jensen, T.K. BMI in relation to sperm count: An updated systematic review and collaborative meta-analysis. Hum. Reprod. Update 2013, 19, 221–231. [Google Scholar] [CrossRef] [PubMed]
  34. Varani, J. Healthful eating, the Western style diet and chronic disease. Appro Poult. Dairy Vet. Sci. 2017, 1, 3. [Google Scholar] [CrossRef]
  35. Walczak-Jedrzejowska, R.T.; Wolski, J.K.; Slowikowska-Hilczer, J. The role of oxidative stress and antioxidants in male fertility. Cent. Eur. J. Urol. 2013, 66, 60–67. [Google Scholar] [CrossRef]
  36. Palmer, N.O.; Bakos, H.W.; Fullston, T.; Lane, M. Impact of obesity on male fertility, sperm function and molecular composition. Spermatogenesis 2012, 2, 253–263. [Google Scholar] [CrossRef] [PubMed]
  37. Hakonsen, L.B.; Thulstrup, A.M.; Aggerholm, A.S.; Olsen, J.; Bonde, J.P.; Andersen, C.Y.; Bungum, M.; Ernst, E.H.; Hansen, M.L.; Ernst, E.H.; et al. Does weight loss improve semen quality and reproductive hormones? Results from a cohort of severely obese men. Reprod. Health 2011, 8, 24. [Google Scholar] [CrossRef]
  38. Reis, L.O.; Zani, E.L.; Saad, R.D.; Chaim, E.A.; de Oliveira, L.C.; Fregonesi, A. Bariatric surgery does not interfere with sperm quality—A preliminary long-term study. Reprod. Sci. 2012, 19, 1057–1062. [Google Scholar] [CrossRef]
  39. Rato, L.; Alves, M.G.; Cavaco, J.E.; Oliveira, P.F. High-energy diets: A threat for male fertility? Obes. Rev. 2014, 15, 996–1007. [Google Scholar] [CrossRef] [PubMed]
  40. Montano, L.; Ceretti, E.; Donato, F.; Bergamo, P.; Zani, C.; Viola, G.C.V.; Notari, T.; Pappalardo, S.; Zani, D.; Ubaldi, S.; et al. Effects of a lifestyle change intervention on semen quality in healthy young men living in highly polluted areas in Italy: The FASt randomized controlled trial. Eur. Urol. Focus 2022, 8, 351–359. [Google Scholar] [CrossRef] [PubMed]
  41. La Vignera, S.; Condorelli, R.A.; Vicari, E.; Tumino, D.; Morgia, G.; Favilla, V.; Cimino, S.; Calogero, A.E. Markers of semen inflammation: Supplementary semen analysis? J. Reprod. Immunol. 2013, 100, 2–10. [Google Scholar] [CrossRef] [PubMed]
  42. Hosseini, B.; Nourmohamadi, M.; Hajipour, S.; Taghizadeh, M.; Asemi, Z.; Keshavarz, S.A.; Jafarnejad, S. The effect of omega-3 fatty acids, EPA, and/or DHA on male infertility: A systematic review and meta-analysis. J. Diet. Suppl. 2019, 16, 245–256. [Google Scholar] [CrossRef] [PubMed]
  43. Chavarro, J.E.; Minguez-Alarcon, L.; Mendiola, J.; Cutillas-Tolin, A.; Lopez-Espin, J.J.; Torres-Cantero, A.M. Trans fatty acid intake is inversely related to total sperm count in young healthy men. Hum. Reprod. 2014, 29, 429–440. [Google Scholar] [CrossRef]
  44. Minguez-Alarcon, L.; Chavarro, J.E.; Mendiola, J.; Roca, M.; Tanrikut, C.; Vioque, J.; Jørgensen, N.; Torres-Cantero, A.M. Fatty acid intake in relation to reproductive hormones and testicular volume among young healthy men. Asian J. Androl. 2017, 19, 184–190. [Google Scholar] [CrossRef]
  45. Collodel, G.; Moretti, E.; Noto, D.; Corsaro, R.; Signorini, C. Oxidation of polyunsaturated fatty acids as a promising area of research in infertility. Antioxidants 2022, 19, 1002. [Google Scholar] [CrossRef]
  46. Salas-Huetos, A.; Babio, N.; Carrell, D.T.; Bulló, M.; Salas-Salvadó, J. Adherence to the Mediterranean diet is positively associated with sperm motility: A cross-sectional analysis. Sci. Rep. 2019, 9, 3389. [Google Scholar] [CrossRef]
  47. Braga, D.P.; Halpern, G.; Figueira, R.; Setti, A.S.; Iaconelli, A.; Borges, E. Food intake and social habits in male patients and its relationship to intracytoplasmic sperm injection outcomes. Fertil. Steril. 2012, 97, 53–59. [Google Scholar] [CrossRef]
  48. Jurewicz, J.; Radwan, M.; Sobala, W.; Radwan, P.; Bochenek, M.; Hanke, W. Dietary patterns and their relationship with semen quality. Am. J. Men’s Health 2018, 12, 575–583. [Google Scholar] [CrossRef]
  49. Mínguez-Alarcón, L.; Mendiola, J.; López-Espín, J.J.; Sarabia-Cos, L.; Vivero-Salmerón, G.; Vioque, J.; Navarrete-Muñoz, E.M.; Torres-Cantero, A.M. Dietary intake of antioxidant nutrients is associated with semen quality in young university students. Hum. Reprod. 2012, 27, 2807–2814. [Google Scholar] [CrossRef]
  50. Vujkovic, M.; de Vries, J.H.; Lindemans, J.; Macklon, N.S.; van der Spek, P.J.; Steegers, E.A.; Steegers-Theunissen, R.P. The preconception Mediterranean dietary pattern in couples undergoing in vitro fertilization/intracytoplasmic sperm injection treatment increases the chance of pregnancy. Fertil. Steril. 2010, 94, 2096–2101. [Google Scholar] [CrossRef] [PubMed]
  51. Zareba, P.; Colaci, D.S.; Afeiche, M.; Gaskins, A.J.; Jørgensen, N.; Mendiola, J.; Swan, S.H.; Chavarro, J.E. Semen quality in relation to antioxidant intake in a healthy male population. Fertil. Steril. 2013, 100, 1572–1579. [Google Scholar] [CrossRef] [PubMed]
  52. Boxmeer, J.C.; Smit, M.; Weber, R.F.; Lindemans, J.; Romijn, J.C.; Eijkemans, M.J.; Maklon, N.S.; Steegers-Theunissen, R.P. Seminal plasma cobalamin significantly correlates with sperm concentration in men undergoing IVF or ICSI procedures. J. Androl. 2007, 28, 521–527. [Google Scholar] [CrossRef] [PubMed]
  53. Ahmadi, S.; Bashiri, R.; Ghadiri-Anari, A.; Nadjarzadeh, A. Antioxidant supplements and semen parameters: An evidence based review. Int. J. Reprod. Biomed. 2016, 14, 729–736. [Google Scholar] [CrossRef]
  54. Illiano, E.; Trama, F.; Zucchi, A.; Iannitti, R.G.; Fioretti, B.; Costantini, E. Resveratrol-based multivitamin supplement increases sperm concentration and motility in idiopathic male infertility: A pilot clinical study. J. Clin. Med. 2020, 9, 4017. [Google Scholar] [CrossRef] [PubMed]
  55. Mongioì, L.M.; Perelli, S.; Condorelli, R.A.; Barbagallo, F.; Crafa, A.; Cannarella, R.; La Vignera, S.; Calogero, A.E. The role of resveratrol in human male fertility. Molecules 2021, 26, 2495. [Google Scholar] [CrossRef] [PubMed]
  56. Bibbo, S.; Ianiro, G.; Giorgio, V.; Scaldaferri, F.; Masucci, L.; Gasbarrini, A.; Cammarota, G. The role of diet on gut microbiota composition. Eur. Rev. Med. Pharmacol. Sci. 2016, 20, 4742–4749. [Google Scholar]
  57. Vancamelbeke, M.; Vermeire, S. The intestinal barrier: A fundamental role in health and disease. Expert Rev. Gastroenterol. Hepatol. 2017, 11, 821–834. [Google Scholar] [CrossRef]
  58. Rychter, A.; Skoracka, K.; Skrypnik, D. The influence of western-style diet on the permeability of the intestinal barrier. Metab. Disord. Forum 2019, 10, 88–97. [Google Scholar]
  59. Ding, N.; Zhang, X.; Zhang, X.D.; Jing, J.; Liu, S.S.; Mu, Y.P.; Peng, L.L.; Yan, Y.J.; Xiao, G.M.; Bi, X.Y.; et al. Impairment of spermatogenesis and sperm motility by the high-fat diet-induced dysbiosis of gut microbes. Gut 2020, 69, 1608–1619. [Google Scholar] [CrossRef]
  60. Zhang, P.; Feng, Y.; Li, L.; Ge, W.; Yu, S.; Hao, Y.; Shen, W.; Han, X.; Ma, D.; Yin, S.; et al. Improvement in sperm quality and spermatogenesis following faecal microbiota transplantation from alginate oligosaccharide dosed mice. Gut 2021, 70, 222–225. [Google Scholar] [CrossRef]
  61. Yang, H.; Zhang, J.; Xue, Z.; Zhao, C.; Lei, L.; Wen, Y.; Dong, Y.; Yang, J.; Zhang, L. Potential pathogenic bacteria in seminal microbiota of patients with different types of dysspermatism. Sci. Rep. 2020, 10, 6876. [Google Scholar] [CrossRef]
  62. Gonzalez-Ravina, C.; Aguirre-Lipperheide, M.; Pinto, F.; Martin-Lozano, D.; Fernandez-Sanchez, M.; Blasco, V.; Santamaria-Lopez, E.; Candenas, L. Effect of dietary supplementation with a highly pure and concentrated docosahexaenoic acid (DHA) supplement on human sperm function. Reprod. Biol. 2018, 18, 282–288. [Google Scholar]
  63. Martinez-Soto, J.C.; Domingo, J.C.; Cordobilla, B.; Nicolas, M.; Fernandez, L.; Albero, P.; Gadea, J.; Landeras, J. Dietary supplementation with docosahexaenoic acid (DHA) improves seminal antioxidant status and decreases sperm DNA fragmentation. Syst. Biol. Reprod. Med. 2016, 62, 387–395. [Google Scholar] [CrossRef] [PubMed]
  64. Safarinejad, M.R. Effect of omega-3 polyunsaturated fatty acid supplementation on semen profile and enzymatic anti-oxidant capacity of seminal plasma in infertile men with idiopathic oligoasthenoteratospermia: A double-blind, placebo-controlled, randomised study. Andrologia 2011, 43, 38–47. [Google Scholar] [CrossRef] [PubMed]
  65. Nassan, F.L.; Chavarro, J.E.; Tanrikut, C. Diet and men’s fertility: Does diet affect sperm quality? Fertil. Steril. 2018, 110, 570–577. [Google Scholar] [CrossRef]
  66. Safarinejad, M.R.; Safarinejad, S. The roles of omega-3 and omega-6 fatty acids in idiopathic male infertility. Asian J. Androl. 2012, 14, 514–515. [Google Scholar] [PubMed]
  67. Skoracka, K.; Eder, P.; Łykowska-Szuber, L.; Dobrowolska, A.; Krela-Kazmierczak, I. Diet and nutritional factors in male (in)fertility-underestimated factors. J. Clin. Med. 2020, 9, 1400. [Google Scholar]
  68. Benedetti, S.; Tagliamonte, M.C.; Catalani, S.; Primiterra, M.; Canestrari, F.; De Stefani, S.; Palini, S.; Bulletti, C. Differences in blood and semen oxidative status in fertile and infertile men, and their relationship with sperm quality. Reprod. Biomed. Online 2012, 25, 300–306. [Google Scholar] [CrossRef]
  69. Eroglu, M.; Sahin, S.; Durukan, B.; Ozakpinar, O.B.; Erdinc, N.; Turkgeldi, L.; Sofuoglu, K.; Karateke, A. Blood serum and seminal plasma selenium, total antioxidant capacity and coenzyme q10 levels in relation to semen parameters in men with idiopathic infertility. Biol. Trace Elem. Res. 2014, 159, 46–51. [Google Scholar] [CrossRef]
  70. Giahi, L.; Mohammadmoradi, S.; Javidan, A.; Sadeghi, M.R. Nutritional modifications in male infertility: A systematic review covering 2 decades. Nutr. Rev. 2016, 74, 118–130. [Google Scholar] [CrossRef]
  71. Showell, M.; Mackenzie-Proctor, R.; Brown, J.; Yazdani, A.; Stankiewicz, M.; Hart, R. Antioxidants for male subfertility. Cochrane Database Syst. Rev. Antioxid. 2014, 1, 1–188. [Google Scholar] [CrossRef]
  72. Tremellen, K.; Miari, G.; Froiland, D.; Thompson, J. A randomised control trial examining the effect of an antioxidant (Menevit) on pregnancy outcome during IVF-ICSI treatment. Aust. N. Z. J. Obstet. Gynaecol. 2007, 47, 216–221. [Google Scholar] [CrossRef] [PubMed]
  73. Steiner, A.Z.; Hansen, K.R.; Barnhart, K.T.; Cedars, M.I.; Legro, R.S.; Diamond, M.P.; Krawetz, S.A.; Usadi, R.; Baker, V.L.; Coward, R.M.; et al. The effect of antioxidants on male factor infertility: The Males, Antioxidants, and Infertility (MOXI) randomized clinical trial. Fertil. Steril. 2020, 113, 552–560. [Google Scholar] [CrossRef]
  74. Smits, R.M.; Mackenzie-Proctor, R.; Yazdani, A.; Stankiewicz, M.T.; Jordan, V.; Showell, M.G. Antioxidants for male subfertility. Cochrane Database Syst. Rev. 2022, 5, CD007411. [Google Scholar] [CrossRef] [PubMed]
  75. Aktar, M.W.; Sengupta, D.; Chowdhury, A. Impact of pesticides use in agriculture: Their benefits and hazards. Interdiscip. Toxicol. 2009, 2, 1–12. [Google Scholar] [CrossRef] [PubMed]
  76. Bretveld, R.; Brouwers, M.; Ebisch, I.; Roeleveld, N. Influence of pesticides on male fertility. Scand. J. Work. Environ. Health 2007, 33, 13–28. [Google Scholar] [CrossRef]
  77. Mehrpour, O.; Karrari, P.; Zamani, N.; Tsatsakis, A.M.; Abdollahi, M. Occupational exposure to pesticides and consequences on male semen and fertility: A review. Toxicol. Lett. 2014, 230, 146–156. [Google Scholar]
  78. Chiu, Y.H.; Afeiche, M.C.; Gaskins, A.J.; Williams, P.L.; Petrozza, J.C.; Tanrikut, C.; Hauser, R.; Chavarro, J.E. Fruit and vegetable intake and their pesticide residues in relation to semen quality among men from a fertility clinic. Hum. Reprod. 2015, 30, 1342–1351. [Google Scholar] [CrossRef]
  79. Montano, L.; Maugeri, A.; Volpe, M.G.; Micali, S.; Mirone, V.; Mantovani, A.; Navarra, M.; Piscopo, M. Mediterranean Diet as a shield against male infertility and cancer risk induced by environmental pollutants: A focus on flavonoids. Int. J. Mol. Sci. 2022, 23, 1568. [Google Scholar] [CrossRef] [PubMed]
  80. Mínguez-Alarcón, L.; Afeiche, M.C.; Williams, P.L.; Arvizu, M.; Tanrikut, C.; Amarasiriwardena, C.J.; Ford, J.B.; Hauser, R.; Chavarro, J.E.; Earth Study Team. Hair mercury (Hg) levels, fish consumption and semen parameters among men attending a fertility center. Int. J. Hyg. Environ. Health 2018, 221, 174–182. [Google Scholar] [CrossRef]
  81. Ricci, E.; Al Beitawi, S.; Cipriani, S.; Candiani, M.; Chiaffarino, F.; Vigano, P. Semen quality and alcohol intake: A systematic review and meta-analysis. Reprod. Biomed. Online 2017, 34, 38–47. [Google Scholar] [CrossRef] [PubMed]
  82. Sermondade, N.; Elloumi, H.; Berthaut, I.; Mathieu, E.; Delarouziere, V.; Ravel, C.; Mandelbaum, J. Progressive alcohol-induced sperm alterations leading to spermatogenic arrest, which was reversed after alcohol withdrawal. Reprod. Biomed. Online 2010, 20, 324–327. [Google Scholar] [CrossRef] [PubMed]
  83. Gaur, D.S.; Talekar, M.S.; Pathak, V.P. Alcohol intake and cigarette smoking: Impact of two major lifestyle factors on male fertility. Indian J. Pathol. Microbiol. 2010, 53, 35–40. [Google Scholar] [PubMed]
  84. Lim, H.S.; Hwang, J.Y.; Choi, J.C.; Kim, M. Assessment of caffeine intake in the Korean population. Food Addit. Contam. Part A Chem. Anal. Control. Expo. Risk Assess. 2015, 32, 1786–1798. [Google Scholar] [CrossRef] [PubMed]
  85. Jensen, T.K.; Swan, S.H.; Skakkebaek, N.E.; Rasmussen, S.; Jørgensen, N. Caffeine intake and semen quality in a population of 2554 young Danish men. Am. J. Epidemiol. 2010, 171, 883–891. [Google Scholar] [CrossRef]
  86. Poole, R.; Kennedy, O.J.; Roderick, P.; Fallowfield, J.A.; Hayes, P.C.; Parkes, J. Coffee consumption and health: Umbrella review of meta-analyses of multiple health outcomes. BMJ 2018, 22, 359. [Google Scholar] [CrossRef]
  87. Medina, F.X. Looking for commensality: On culture, health, heritage, and the Mediterranean Diet. Int. J. Environ. Res. Public Health 2021, 18, 2605. [Google Scholar] [CrossRef]
  88. Blomberg Jensen, M.; Bjerrum, P.J.; Jessen, T.E.; Nielsen, J.E.; Joensen, U.N.; Olesen, I.A.; Petersen, J.H.; Juul, A.; Dissing, S.; Jørgensen, N. Vitamin D is positively associated with sperm motility and increases intracellular calcium in human spermatozoa. Hum. Reprod. 2011, 26, 1307–1317. [Google Scholar] [CrossRef]
  89. Amini, L.; Mohammadbeigi, R.; Vafa, M.; Haghani, H.; Vahedian-Azimi, A.; Karimi, L.; Jahanfar, S.; Jamialahmadi, T.; Talebi, A.; Sahebkar, A. Evaluation of the effect of vitamin D3 supplementation on quantitative and qualitative parameters of spermograms and hormones in infertile men: A Randomized controlled trial. Complement. Ther. Med. 2020, 53, 102529. [Google Scholar] [CrossRef]
  90. Tsofliou, F.; Vlachos, D.; Hughes, C.; Appleton, K.M. Barriers and facilitators associated with the adoption of and adherence to a Mediterranean Style diet in adults: A systematic review of published observational and qualitative studies. Nutrients 2022, 14, 4314. [Google Scholar] [CrossRef]
  91. Alesi, S.; Villani, A.; Mantzioris, E.; Takele, W.W.; Cowan, S.; Moran, L.J.; Mousa, A. Anti-inflammatory diets in fertility: An evidence review. Nutrients 2022, 14, 3914. [Google Scholar] [CrossRef] [PubMed]
  92. Gaskins, A.J.; Colaci, D.S.; Mendiola, J.; Swan, S.H.; Chavarro, J.E. Dietary patterns and semen quality in young men. Hum. Reprod. 2012, 27, 2899–2907. [Google Scholar] [CrossRef]
  93. DiNicolantonio, J.J.; O’Keefe, J.H. Importance of maintaining a low omega–6/omega–3 ratio for reducing inflammation. Open Heart 2018, 5, e000946. [Google Scholar] [CrossRef] [PubMed]
  94. Martin-Gronert, M.S.; Ozanne, S.E. Mechanisms underlying the developmental origins of disease. Rev. Endocr. Metab. Disord. 2012, 13, 85–92. [Google Scholar] [CrossRef] [PubMed]
Figure 1. Characteristics of Mediterranean and Western diets.
Figure 1. Characteristics of Mediterranean and Western diets.
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Figure 2. Effects of Western-style diet on semen quality.
Figure 2. Effects of Western-style diet on semen quality.
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Tomada, I.; Tomada, N. Mediterranean Diet and Male Fertility. Endocrines 2023, 4, 394-406.

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Tomada, Inês, and Nuno Tomada. 2023. "Mediterranean Diet and Male Fertility" Endocrines 4, no. 2: 394-406.

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