ArticlePhysical activity, fatness, educational level and snuff consumption as determinants of semen quality: findings of the ActiART study
Introduction
Infertility is an increasing public health problem, affecting about 15% of couples of fertile age (Boivin et al., 2007). Although reproductive abnormalities in the male partner are identified in about one-half of these cases, few risk factors for abnormal semen quality have been identified (Juul et al, 1999, Kovac et al, 2013). Emerging evidence suggests that lifestyle factors such as smoking (Ramlau-Hansen et al, 2007, Wegner et al, 2010), diet (Afeiche et al., 2014), physical activity (Hajizadeh Maleki et al, 2013, Vaamonde et al, 2006, Wise et al, 2011), overweight and obesity (Crujeiras, Casanueva, 2014, Sermondade et al, 2013), stress (Janevic et al., 2014), and sexual activity habits among others seem to have a cumulative effect on sperm quality (Wogatzky et al., 2012).
Physical activity is an efficient method for preventing weight gain, and has a broad and positive systemic influence, such as reducing the risk for cardiovascular diseases, stroke, type 2-diabetes, cancer and metabolic syndrome (US Department of Health and Human Services, 2008), and could therefore be potentially related to sperm quality. Closely related to physical activity is physical fitness, and particularly cardiorespiratory and muscular strength are considered powerful markers of health, as well as strong predictors of morbidity and mortality for cardiovascular disease and for all causes (Kodama et al, 2009, Ortega et al, 2012, Ruiz et al, 2008). Little information is available on whether fitness levels, e.g. cardiorespiratory fitness and muscular strength, are related to sperm quality.
As often happens in human physiology, too much or too little of something is not good. This is the case for body mass index (BMI) and semen quality, for which an inverted U-shape relationship has been proposed, i.e. too low or too high values of BMI are related to a poorer sperm quality (Jensen et al., 2004). This could also be the case for physical activity, as inactivity and sedentary lifestyle have a well-known harmful effect on many health outcomes (Pate et al., 2008), whereas too much physical activity has been negatively associated with semen quality (De Souza et al, 1994, Safarinejad et al, 2009, Vaamonde et al, 2006). In this context, recent studies support that recreationally active men have a healthier semen production than non-active men, but also than elite athletes, suggesting a U-shape relationship (Hajizadeh Maleki et al, 2013, Vaamonde et al, 2012).
The few studies analysing the association between regular physical activity and semen quality have shown inconclusive results (Braga et al, 2012, De Souza et al, 1994, Hajizadeh Maleki et al, 2013, Safarinejad et al, 2009, Vaamonde et al, 2006, Vaamonde et al, 2012, Wise et al, 2011, Wogatzky et al, 2012). Most of these studies have used self-report methods to assess physical activity, i.e. questionnaires. Therefore, new empirical and objective data about physical activity and sperm quality are needed to better understand the role of physical activity in male reproductive health.
In the present study, the association of objectively measured physical activity was analysed using accelerometry, with semen quality indicators among men attending an infertility clinic. In addition, the effect of other potentially related factors, such as fatness markers, educational level, television watching, consumption of smokeless tobacco (snuff, which is highly consumed in Nordic countries), handgrip strength and self-reported fitness were studied.
Section snippets
Study sample and design
Male participants from the Physical Activity and Assisted Reproductive Technology (ActiART) project were enrolled in the present study. Data were collected from the Centre for Reproduction at Uppsala University Hospital, Sweden between February 2011 and January 2014. As couples undergoing infertility treatment might change their everyday physical activity levels during the treatment period (Kucuk et al., 2010), only participants who were attending the clinic for the first time were recruited,
Characteristics
Characteristics of the study sample are shown in Table 1. A total of 53.2% (n = 33) of participants were overweight or obese (12.9%, n = 8, of them obese) and 18% (n = 11) had a waist circumference above the recommended limit of 102 cm. Mean time spent in MVPA was 53.2 min/d and in sedentary time was 11.7 h/d. The mean value of each semen parameter was above the WHO reference value for semen characteristics (36), whereas 27.4% (n = 17) of the participants had one parameter or more below these
Discussion
This study analysed the relationship of objectively measured physical activity, muscular strength, self-reported fitness, total and central adiposity and lifestyle variables such as educational level, employment status, snuff consumption, and television-watching, with semen quality parameters among men attending an infertility clinic. Several major findings were obtained: (i) higher BMI and waist circumference were related with semen volume, but not with the rest of semen parameters studied;
Acknowledgements
The authors thank all individuals for their participation. This work was supported by Karolinska Institutet Foundation grants [Refs: 2011FoBi1184]; Estonian National Kristjan Jaak scholarship program, implemented by the Archimedes Foundation [Refs: 16-3.5/1080]; Spanish Ministry of Economy and Competitiveness [RYC-2010-05957; RYC-2011-09011]; European Research Council, Marie Curie Actions, Intra-European Fellowships (IEF) [FP7-PEOPLE-2012-IEF, Ref. No. 329812]; grants from Uppsala University;
Signe Altmäe is a post-doctoral fellow at the University of Granada, School of Medicine and a part-time researcher at the Competence Centre on Health Technologies. Her research interests are female and male infertility, endometrial receptivity, early pregnancy establishment and supplementation during pregnancy.
References (60)
- et al.
Food intake and social habits in male patients and its relationship to intracytoplasmic sperm injection outcomes
Fertil. Steril
(2012) - et al.
Male obesity and alteration in sperm parameters
Fertil. Steril
(2008) - et al.
Effects of work and life stress on semen quality
Fertil. Steril
(2014) - et al.
Body mass index in relation to semen quality and reproductive hormones among 1,558 Danish men
Fertil. Steril
(2004) - et al.
The use of genomics, proteomics, and metabolomics in identifying biomarkers of male infertility
Fertil. Steril
(2013) - et al.
Assessment of the physical activity behavior and beliefs of infertile women during assisted reproductive technology treatment
Int. J. Gynaecol. Obstet
(2010) - et al.
Role of socio-cultural factors on changes in fitness and adiposity in youth: a 6-year follow-up study
Nutr. Metab. Cardiovasc. Dis
(2013) - et al.
Hand size influences optimal grip span in women but not in men
J. Hand Surg. [Am]
(2002) - et al.
Relationship between semen quality and tobacco chewing in men undergoing infertility evaluation
Fertil. Steril
(2005) - et al.
Abnormally high body mass index and tobacco use are associated with poor sperm quality as revealed by reduced sperm binding to hyaluronan-coated slides
Fertil. Steril
(2010)
Physical activity and semen quality among men attending an infertility clinic
Fertil. Steril
Dairy intake and semen quality among men attending a fertility clinic
Fertil. Steril
Health-related fitness in adolescents: underweight, and not only overweight, as an influencing factor. The AVENA study
Scand. J. Med. Sci. Sports
International estimates of infertility prevalence and treatment-seeking: potential need and demand for infertility medical care
Hum. Reprod
Obesity: modern man's fertility nemesis
Asian J. Androl
Socioeconomic position and the tracking of physical activity and cardiorespiratory fitness from childhood to adulthood
Am. J. Epidemiol
World Health Organization reference values for human semen characteristics
Hum. Reprod. Update
Obesity and the reproductive system disorders: epigenetics as a potential bridge
Hum. Reprod
Relationship between stress hormones and testosterone with prolonged endurance exercise
Eur. J. Appl. Physiol
The effect of endurance training on reproductive function in male runners. A “volume threshold” hypothesis
Sports Med
Gonadal hormones and semen quality in male runners. A volume threshold effect of endurance training
Int. J. Sports Med
Elbow position affects handgrip strength in adolescents: validity and reliability of Jamar, DynEx, and TKK dynamometers
J. Strength Cond. Res
Is semen quality affected by male body fat distribution?
Andrologia
Calibration of the Computer Science and Applications, Inc. accelerometer
Med. Sci. Sports Exerc
Levels and patterns of objectively assessed physical activity – a comparison between Sweden and the United States
Am. J. Epidemiol
Comparison of seminal oxidants and antioxidants in subjects with different levels of physical fitness
Andrology
Does weight loss improve semen quality and reproductive hormones? Results from a cohort of severely obese men
Reprod. Health
Body mass index and central adiposity are associated with sperm quality in men of subfertile couples
Hum. Reprod
The association of education with body mass index and waist circumference in the EPIC-PANACEA study
BMC Public Health
Influence of genital heat stress on semen quality in humans
Andrologia
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Signe Altmäe is a post-doctoral fellow at the University of Granada, School of Medicine and a part-time researcher at the Competence Centre on Health Technologies. Her research interests are female and male infertility, endometrial receptivity, early pregnancy establishment and supplementation during pregnancy.