In the modern age, lifestyle plays a very crucial role to keep us mentally and physically healthy and when it comes to mens health, we often talk about cholesterol, diabetes, hypertension, early onset heart attack, life expectancy and so on but when it comes to reproductive health, leading to infertility or reproductive losses, males seem to be less informed. Nowadays, there is a high rise of delayed marriages and couples opting for only one or two children as infertility is now a major concern for such couples.

In about 50% of such cases, infertility is attributable to the male partner, mainly due to a failure in spermatogenesis and according to several studies, a severe decline in the sperm quality has been observed mostly contributed by the lifestyle, including smoking, drinking, long driving hours, stress and pollution. In a study done by Levine H et al., 2017, it was reported that there is a decline of 5060% in sperm counts amongst men from North America, Europe, Australia and New Zealand.

It is important to understand the various factors which impact sperm quality as well as the male fertility. In an interview with HT Lifestyle, Upasana Mukherjee, Senior Genetic Counsellor at Neuberg Center for Genomic Medicine, shared The modern man, during his reproductive period, is exposed to the negative influence of widespread lifestyle-related habits such as smoking, alcohol, recreational drugs, less physical activity etc. Effect of cigarette smoking on male fertility may result from the combined roles of elevated oxidative stress, DNA damage, and cell apoptosis, which could explain not only the reduction in semen quality but also impaired spermatogenesis, sperm maturation, and sperm function reported to be present in smokers compared to non-smokers."

She added, "Smoking is not only associated with decreased sperm quality, it has also been found to be responsible for morphological changes of sperm and also with sperm DNA damage. The high sperm DNA fragmentation rate can contribute to male infertility and has also been associated with multiple miscarriages. It is found that the higher the sperm DNA damage index, the lesser the chances of achieving an ongoing pregnancy. Sperm DNA fragmentation analysis is now offered by many labs to assess the level of damaged sperms. This in turn can help the couple to take alternative reproductive methods (ART) for a successful pregnancy. Chronic alcohol consumption has also been found to have a detrimental effect on both semen quality and the levels of male reproductive hormones.

Gaur D.S et al.,2010 conducted a study on the male partners of couples facing primary infertility and they found that teratozoospermia (abnormal sperm morphology) was present in 63% and 72% of males who drank alcohol moderately (4080g/day) and heavily (>80g/day), respectively. None of the heavy alcohol drinkers were normozoospermic and most were oligozoospermic (64%), which is suggestive of progressive testicular damage in relation to increasing daily alcohol intake. Although the effects of alcohol on male reproductive function are dependent on the intake amount, a threshold amount of alcohol beyond which the risk of male infertility increases has not yet been determined. Several recreational drugs such as marijuana, cocaine, anabolicandrogenic steroids (AAS), opiates (narcotics) and methamphetamines are examples of illicit drugs that exert a negative impact on male fertility.

Upasana Mukherjee highlighted, About 15% of males with infertility have an underlying genetic cause. The genetic landscape of male infertility is highly complex, and at least 200 genes have been implicated in spermatogenesis. Over 25% azoospermic males have genetic causes. These include mostly chromosomal abnormalities (e.g sex chromosome abnormalities, Y chromosome microdeltion) involved in severe spermatogenic impairment and autosome-linked gene variations involved in central hypogonadism, monomorphic teratozoospermia, congenital obstructive azoospermia, and familial cases of quantitative spermatogenic disturbances. Genetic testing is relevant for its diagnostic value, clinical decision making, and appropriate genetic counseling.

According to Dr Sheetal Sharda, Clinical Geneticist and Director- Genomics Development and Implementation, unlike women, men are less aware about their reproductive health and when it comes to being evaluated for infertility or pregnancy loss, often the female is evaluated first but pregnancy and a positive pregnancy outcome are both dependent on both the partners. She revealed, With better understanding and awareness, timely evaluation for a genetic diagnosis and making lifestyle modifications can improve the reproductive health of both the partners.

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Men's health and infertility: Is it lifestyle or genetics? Experts answer - Hindustan Times