The number of couples that seek advice, either because there are interested in starting a family or because they have been trying unsuccessfully for a long time, steadily increases.

It is well established that lifestyle factors affect fertility. Age, weight and smoking are the most important aspects to consider, but many others should be taken to account.


1. Fertility peaks at a young age for both men and women decline sharply, especially for the latter after 38. Although studies and professional development overwhelm youth, fertility preservation is an option to consider. Oocyte freezing for young women increases fertility autonomy and allows them to plan better their future. Age affects men as well, but their reproductive lifetime is longer.

2.  Weight is another factor to be considered. Being overweight with a body mass index (BMI) of >27 can affect ovulation and when BMI>30 the oocyte quality deteriorates, implantation decreases, miscarriage rates significantly increase and many complications through pregnancy are more frequent. More so, if the excess weight comes during pregnancy, it can lead to a trend in metabolic disease of the newborn. Excess weight in men negatively affects sperm count and sperm DNA fragmentation. Being underweight seems to have a similar effect in men, whilst in women cause menstrual problems and ovarian dysfunction, which can lead to infertility.

3.  A healthy diet with certain vitamins and groups of foods can enhance fertility. Sperm parameters improve by consuming folate, lycopene, fibres, fruits and vegetables. Antioxidants, like vitamin C, had been shown to decrease DNA fragmentation, improve sperm quality and increase live birth rate. Foods, that these can be found, are green leafy vegetables, legumes, tomatoes, broccoli, kiwi and many more. Replacing large proportion of animal protein, mainly of white meat, with vegetable protein (ie beans, spinach, tofu) improves ovulation in relevant patients. The use of supplements is frequent and advisable, but a balanced and varied diet is of utmost importance.

4. Regular and moderate exercise has a positive effect both in males and females, and if combined with diet for weight loss it positively affects sperm parameters, ovulation and pregnancy rates. On the contrary, very intense aerobic exercise for more than 4 hours per week can negatively influence the above. So, everything should be done in good measure.

5.  Cigarette smokers have a trend towards low sperm parameters and decrease sperm quality, due to more than 4000 chemicals found in tobacco smoke. Low ovarian reserve has been found more frequently in women who smoke, whereas pregnancy rates seem to be similar, but pregnancy complications increase thereafter, if smoking continues. Similar side-effects are noticed with the use of illicit drugs, so it is evident that smoking should be stopped for fertility to be enhanced.

6.  Another area of consideration is psychological stress, seen more often after several years of infertility. Apart from its negative effect on sperm parameters and menses, it affects gonadal function and hormonal balance. It can lead to low libido and thus reducing the frequency of sexual contacts. A specialized psychologist could be very helpful for a couple during their fertility journey.

7.  Prescription drugs are very commonly used, without thinking their side-effects to fertility. Even the most “innocent” ones, such as some anti-inflammatories, that women take for period pains, can postpone or affect ovulation. Specific antibiotics can affect sperm motility and some anti-hypertensives can cause erectile dysfunction. The couple needs to discuss all relevant medication, before embarking to pregnancy.

8.  Alcohol intake, increased caffeine intake and specific occupational hazards that have to do with exposure to chemicals, radiation and increased heat are additional factors that negatively affect fertility in both men and women.

In conclusion, lifestyle factors have a significant impact on fertility and it is important  to try and modify them, in order to control fertility potential.

Christina Ioakeimidou

MD, BSCCP, MRCOG, MSc in Human Reproduction & Development