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Professional Education
Omega 3 and Chances of Conception
Omega 3 fatty acids play a key role in reproductive health, influencing hormone signalling, inflammation and conception likelihood. This article explores their importance during the pre‑conception phase.
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Ovarian Reserve: Quality Over Quantity
Ovarian reserve reflects more than egg quantity, with quality and environment playing a key role in fertility outcomes.Explore how AMH, AFC, nutrition and lifestyle may support reproductive health.
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Coenzyme Q10: Powering Fertility
Coenzyme Q10 (CoQ10) plays a key role in energy production and antioxidant protection, both essential for reproductive health.Emerging evidence highlights its potential to support egg quality, sperm function, and overall fertility outcomes.
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Sleep and Fertility: Why Rest Matters When Trying to Conceive
Sleep plays a vital role in fertility, influencing hormones, ovulation, and sperm health.Simple changes to sleep habits can support better reproductive outcomes for both men and women.
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Myo-Inositol vs Metformin for PCOS
Myo-inositol and metformin are both used to support PCOS, particularly insulin resistance and hormonal balance. This guide compares how they work, their effectiveness, and why tolerability is a key consideration.
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Why 3-in-1 Fertility Supplements Fall Short & Why Stage-Specific Support Matters
Preconception, pregnancy and after pregnancy each have distinct nutritional needs. We explore why stage-specific fertility supplements matter.
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Oxidative Stress & Fertility
Oxidative stress plays an important role in fertility, influencing egg and sperm quality, hormonal balance and implantation. This article explores where oxidative stress comes from and outlines practical, evidence-based ways to support reproductive health through nutrition and lifestyle.
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The Effect of Age on Men’s Fertility
For Healthcare Professionals OnlyUnlike women, men do not have a clear end point to their fertility. They continue to produce new sperm throughout their lives and can father children at any age. However, research shows that male fertility does decline gradually with age, particularly after the age of 40. In reality, a typical 45-year-old man is less fertile than a man 10 years younger, with sperm quality beginning to decline as early as 35. Sperm quality and age As men get older, the quality of their sperm changes. Semen volume tends to decrease, and there are often fewer moving (motile) sperm and fewer normally shaped (morphologically normal) sperm. Studies also show that sperm from older men are more likely to have DNA damage, with DNA fragmentation in sperm roughly doubling between ages 30 and 45. This can make it harder to achieve a pregnancy and is thought to be linked to increased oxidative stress in the body over time. Lower testosterone levels in older men may also contribute to reduced libido and erectile difficulties, which can affect a couple’s chances of conceiving naturally. The role of health and lifestyle Many health conditions that become more common with age - such as obesity, high blood pressure and type 2 diabetes - can have a negative impact on male fertility. These conditions can alter hormone levels, damage blood vessels, and increase oxidative stress, all of which may affect sperm production and quality. Lifestyle factors play a big part too. Smoking, drinking excess alcohol, eating a poor diet, or being inactive can all worsen age-related fertility decline. The good news is that these are modifiable factors. Supporting men to maintain a healthy weight, exercise regularly, stop smoking, and limit alcohol can have a positive impact on sperm health. Fertility outcomes and risks This age-related decline in male fertility is often overlooked. While many older men do father children, studies show that conception can take longer as paternal age increases. There is also a higher likelihood of needing fertility treatment. Some research suggests a small increase in the risk of pregnancy loss or certain health conditions in children of older fathers, but it’s important to note that the overall risk remains low. For couples trying to conceive, it’s important that both partners’ health and age are considered during any fertility assessment. Supporting male fertility Its not all bad news - research shows that some of this decline can be prevented, or at least slowed, with the right diet and lifestyle. Nutrition plays an important role in sperm production and protection against oxidative stress. Key nutrients such as zinc, selenium, vitamin C, vitamin E, and L-carnitine contribute to normal sperm development and help protect cells from oxidative damage. These nutrients can be obtained through a healthy, balanced diet or through a targeted preconception supplement. Key takeaways for healthcare professionals Male fertility does decline with age, particularly from around 40 onwards. Sperm quality (motility, morphology, DNA integrity) decreases gradually over time. Health conditions and lifestyle factors can accelerate this decline. Encouraging healthy habits and good nutrition can help optimise sperm quality. It’s important to assess and support both partners, not just the woman, when couples present with fertility concerns. References Siddighi S, Chan CA, Patton WC, Jacobson JD, Chan PJ. Male age and sperm necrosis in assisted reproductive technologies. Urol Int. 2007;79(3):231-4. doi: 10.1159/000107955. PMID: 17940355. Singh NP, Muller CH, Berger RE. Effects of age on DNA double-strand breaks and apoptosis in human sperm. Fertil Steril. 2003 Dec;80(6):1420-30. doi: 10.1016/j.fertnstert.2003.04.002. PMID: 14667878. Moskovtsev SI, Willis J, Mullen JB. Age-related decline in sperm deoxyribonucleic acid integrity in patients evaluated for male infertility. Fertil Steril. 2006 Feb;85(2):496-9. doi: 10.1016/j.fertnstert.2005.05.075. PMID: 16595239. Wyrobek AJ, Eskenazi B, Young S, Arnheim N, Tiemann-Boege I, Jabs EW, Glaser RL, Pearson FS, Evenson D. Advancing age has differential effects on DNA damage, chromatin integrity, gene mutations, and aneuploidies in sperm. Proc Natl Acad Sci U S A. 2006 Jun 20;103(25):9601-6. doi: 10.1073/pnas.0506468103. Epub 2006 Jun 9. PMID: 16766665; PMCID: PMC1480453.
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The Emerging Role of CoQ10 in Fertility Support
For Professional Use Only Coenzyme Q10 (CoQ10) is a naturally occurring molecule found in almost every cell of the body, including female egg cells. In recent years, research has increasingly highlighted its vital role in energy production and reproductive health. For healthcare professionals supporting patients on their fertility journey, understanding CoQ10’s function and potential benefits for egg quality can help optimise outcomes particularly for women over 35 or those with a diminished ovarian reserve. CoQ10 & Mitochondrial Energy Production CoQ10 is a key component in the mitochondria (the “powerhouses” of our cells) where it supports the process of energy generation. It acts as an electron carrier in the electron transport chain, helping to produce adenosine triphosphate (ATP), the body’s main source of energy. By enabling efficient ATP production, CoQ10 powers energy-intensive processes across the body, including muscle activity, brain function and the development and maturation of egg cells. In addition to its role in energy metabolism, CoQ10 is a powerful antioxidant. It protects cells from oxidative stress and regenerates other antioxidants such as vitamin E. However, its function within the mitochondria is particularly relevant when it comes to improving egg quality. Mitochondria & Egg Quality Healthy mitochondrial function is essential for high-quality eggs. As women age, mitochondrial performance naturally declines - fewer mitochondria are present, and those that remain become less efficient at producing energy. Research has shown that: · Eggs from women over 40 show more structural damage to mitochondria. · Aging eggs accumulate mitochondrial DNA damage. · Impaired mitochondrial function is also seen in younger women experiencing fertility challenges, such as poor response to ovarian stimulation or premature ovarian failure. This reduction in energy has significant consequences. The process of egg maturation and chromosome separation is extremely energy-demanding. Without sufficient ATP, chromosomes may not align or divide correctly, increasing the risk of chromosomal abnormalities, failed implantation, and early miscarriage. Mitochondria & Embryo Development The effects of reduced mitochondrial energy extend beyond the egg itself. Once fertilised, the developing embryo relies on energy from the egg to fuel its early growth. If the mitochondria within the egg are not functioning optimally, the resulting embryo may struggle to reach the blastocyst stage or implant successfully. Studies suggest that poor mitochondrial activity and reduced ATP production can contribute to early embryo arrest or miscarriage. The Role of Supplementation Although the body produces CoQ10 naturally, levels decline with age and oxidative stress. It’s also difficult to obtain meaningful amounts from food, making supplementation the most effective way to support optimal levels. Studies suggest that CoQ10 supplementation can: · Support mitochondrial energy production in aging eggs · Improve egg maturation rates · Enhance fertilisation and embryo quality · Potentially reduce age-related decline in reproductive outcomes Given its excellent safety profile, CoQ10 is a valuable nutrient to consider as part of fertility support, particularly for women over 35 or those undergoing assisted reproduction. Proceive® Max Women provides 70 mg of CoQ10 per daily dose, helping to support mitochondrial energy production in developing eggs. For additional support, a standalone CoQ10 supplement can be added if needed. Emerging Clinical Evidence The potential benefits of CoQ10 for egg and embryo quality are supported by a growing body of clinical research. In recent years, several controlled studies have explored the impact of CoQ10 supplementation on fertility outcomes. Two trials published in 2018 demonstrated that supplementing with CoQ10 for one to two months before IVF treatment improved egg quality, fertilisation rates, and embryo development. Women who took CoQ10 produced more mature eggs and a higher proportion of high-quality embryos compared with control groups. Notably, treatment cycles were less likely to be cancelled due to poor egg response (8% versus 23% in controls), and a greater proportion of participants had embryos suitable for freezing (18% versus 4%). In a separate double-blind, placebo-controlled study, Bentov and Casper observed fewer chromosomal abnormalities in embryos from women supplemented with CoQ10, suggesting improved mitochondrial function and chromosomal stability during egg maturation. Together, these findings provide clinical support for CoQ10’s role in enhancing egg competence and improving IVF outcomes, particularly in women with age-related or diminished ovarian function. Conclusion Mitochondrial energy production is one of the most important factors influencing egg quality and embryo development. CoQ10 plays a central role in this process, and supplementation has been shown to help support reproductive outcomes, particularly where egg quality or ovarian function may be suboptimal. For healthcare professionals, recommending a high-quality formulation that includes CoQ10 is an evidence-based way to help improve egg health, fertilisation potential, and ultimately, patient success rates. References Tatone C, Amicarelli F, Carbone MC, Monteleone P, Caserta D, Marci R, Artini PG, Piomboni P, Focarelli R. Cellular and molecular aspects of ovarian follicle ageing. Hum Reprod Update. 2008 Mar-Apr;14(2):131-42. doi: 10.1093/humupd/dmm048. Epub 2008 Jan 31. PMID: 18239135. Wilding M, Dale B, Marino M, di Matteo L, Alviggi C, Pisaturo ML, Lombardi L, De Placido G. Mitochondrial aggregation patterns and activity in human oocytes and preimplantation embryos. Hum Reprod. 2001 May;16(5):909-17. doi: 10.1093/humrep/16.5.909. PMID: 11331637. de Bruin JP, Dorland M, Spek ER, Posthuma G, van Haaften M, Looman CW, te Velde ER. Age-related changes in the ultrastructure of the resting follicle pool in human ovaries. Biol Reprod. 2004 Feb;70(2):419-24. doi: 10.1095/biolreprod.103.015784. Epub 2003 Oct 15. PMID: 14561658. Bentov Y, Casper RF. The aging oocyte--can mitochondrial function be improved? Fertil Steril. 2013 Jan;99(1):18-22. doi: 10.1016/j.fertnstert.2012.11.031. PMID: 23273985. Bonomi M, Somigliana E, Cacciatore C, Busnelli M, Rossetti R, Bonetti S, Paffoni A, Mari D, Ragni G, Persani L; Italian Network for the study of Ovarian Dysfunctions. Blood cell mitochondrial DNA content and premature ovarian aging. PLoS One. 2012;7(8):e42423. doi: 10.1371/journal.pone.0042423. Epub 2012 Aug 3. PMID: 22879975; PMCID: PMC3411770. Dumollard R, Carroll J, Duchen MR, Campbell K, Swann K. Mitochondrial function and redox state in mammalian embryos. Semin Cell Dev Biol. 2009 May;20(3):346-53. doi: 10.1016/j.semcdb.2008.12.013. PMID: 19530278. Van Blerkom J. Mitochondrial function in the human oocyte and embryo and their role in developmental competence. Mitochondrion. 2011 Sep;11(5):797-813. doi: 10.1016/j.mito.2010.09.012. Epub 2010 Oct 7. PMID: 20933103. Eichenlaub-Ritter U, Vogt E, Yin H, Gosden R. Spindles, mitochondria and redox potential in ageing oocytes. Reprod Biomed Online. 2004 Jan;8(1):45-58. doi: 10.1016/s1472-6483(10)60497-x. PMID: 14759287. Ge H, Tollner TL, Hu Z, Dai M, Li X, Guan H, Shan D, Zhang X, Lv J, Huang C, Dong Q. The importance of mitochondrial metabolic activity and mitochondrial DNA replication during oocyte maturation in vitro on oocyte quality and subsequent embryo developmental competence. Mol Reprod Dev. 2012 Jun;79(6):392-401. doi: 10.1002/mrd.22042. Epub 2012 Apr 16. PMID: 22467220. Xu Y, Nisenblat V, Lu C, Li R, Qiao J, Zhen X, Wang S. Pretreatment with coenzyme Q10 improves ovarian response and embryo quality in low-prognosis young women with decreased ovarian reserve: a randomized controlled trial. Reprod Biol Endocrinol. 2018 Mar 27;16(1):29. doi: 10.1186/s12958-018-0343-0. PMID: 29587861; PMCID: PMC5870379. Bentov Y, Hannam T, Jurisicova A, Esfandiari N, Casper RF. Coenzyme Q10 Supplementation and Oocyte Aneuploidy in Women Undergoing IVF-ICSI Treatment. Clin Med Insights Reprod Health. 2014 Jun 8;8:31-6. doi: 10.4137/CMRH.S14681. PMID: 24987272; PMCID: PMC4071761.
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Supporting Female patients: Enhancing Egg Quality Through Nutrition, Lifestyle, and Supplementation
For Healthcare Professionals Only Age is the strongest factor influencing egg quality, but it is not the only one. Nutrition, lifestyle, and targeted supplementation can all impact oocyte development and because eggs take around three months to mature before ovulation, this window offers an opportunity for meaningful intervention. Why Egg Quality Matters Egg quality is central to fertility, affecting fertilisation, embryo development, and the likelihood of a healthy pregnancy. With age, eggs naturally become more prone to oxidative damage and chromosomal errors. While age itself cannot be modified, optimising the environment in which eggs mature can make a difference to outcomes. Nutrition and Lifestyle Interventions Balanced diet with a focus on low GI foods Stabilising blood glucose and insulin is important, even outside of PCOS. A diet rich in wholegrains, vegetables, legumes, lean proteins, and healthy fats helps keep insulin levels steady and supports hormone balance. Antioxidant-rich foods Eggs are sensitive to oxidative stress, which can impair DNA and mitochondrial function. Encourage patients to eat a wide variety of colourful fruits and vegetables, along with nuts and seeds, to boost antioxidant intake. Exercise Regular physical activity helps improve insulin sensitivity and circulation, which may benefit ovarian health. A combination of aerobic and strength-based activity is recommended. Stress and sleep High stress levels and poor sleep can affect the hypothalamic–pituitary–ovarian axis, disrupting hormone regulation. Support patients to prioritise good sleep hygiene and consider stress-reduction techniques such as mindfulness or yoga. Lifestyle risks Smoking, excessive alcohol, and high caffeine intake can negatively impact egg quality. Reducing or eliminating these exposures can improve the overall reproductive environment. The Role of Supplementation Alongside diet and lifestyle, specific supplements may support egg quality and overall reproductive health: Folic acid – essential for DNA synthesis and universally recommended preconception. At Proceive we use the methylated form, L-methylfolate for increased absorption. Vitamin D – important for reproductive health and immune function; deficiencies are very common. Omega-3 fatty acids – help reduce inflammation and support cell membrane function. Coenzyme Q10 (CoQ10) – may support mitochondrial energy production, particularly relevant for egg development. Antioxidants (vitamins C & E, selenium, zinc) – help reduce oxidative stress, which is a key contributor to egg ageing. Practical Takeaway for HCPs Egg quality is strongly influenced by age, but it is also shaped by nutrition, lifestyle, and supplementation. With a 90-day maturation period before ovulation, women have a window to make meaningful changes that can positively influence reproductive outcomes. Guiding patients towards a balanced diet, regular activity, stress management, and appropriate supplementation can help create a healthier environment for egg development and improve their chances of conception.
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The Role of Selenium in Male Fertility: A HCP Perspective
For Healthcare Professionals Only Fertility discussions often begin with a focus on female reproductive health, yet it is now well established that male factors contribute to approximately 50% of all infertility cases. Male fertility is not a static metric; it can fluctuate based on a variety of biological and environmental influences. As healthcare professionals, it’s essential to recognise the dynamic nature of spermatogenesis and the critical role that nutrition, particularly selenium, can play in supporting sperm health. Sperm Health Is Not Fixed Sperm is produced in a continuous cycle, with a full spermatogenic cycle taking approximately 74 days. This means the sperm profile can vary significantly over time. While a semen analysis might show normal parameters at one point, a new cohort of sperm formed in the following months may present differently, especially if there are ongoing lifestyle or environmental challenges. Semen analysis typically assesses concentration, motility, morphology, and DNA integrity. Even when basic parameters appear within normal ranges, subclinical oxidative stress can still impair sperm function and compromise fertility outcomes. Moreover, studies have shown a correlation between abnormal semen parameters and an increased risk of miscarriage, highlighting the importance of sperm quality in early embryonic development and pregnancy viability [1]. The Impact of Stress and Lifestyle Psychological stress is another important variable. It is now understood that stress can negatively affect both male and female fertility, and its impact on male reproductive hormones and spermatogenesis is well documented [2]. Modifiable lifestyle factors including diet, smoking, alcohol intake, body weight, and exposure to environmental toxins are all critical considerations when supporting men trying to conceive. Nutrition and Sperm Health: The Role of Selenium Selenium is an essential trace mineral with powerful antioxidant properties, and it plays a particularly important role in male reproductive physiology. It is required for the formation and function of selenoproteins, many of which are involved in protecting sperm from oxidative damage during spermatogenesis. Key Mechanisms of Action Antioxidant protection: Sperm membranes are rich in polyunsaturated fatty acids, making them especially vulnerable to oxidative stress. Selenium is a cofactor for glutathione peroxidase, an enzyme that helps prevent lipid peroxidation in sperm cells. Spermatogenesis: Selenium supports the differentiation and maturation of spermatogonia into motile, morphologically normal sperm. Deficiency has been linked to reduced sperm count, poor motility, and impaired morphology [3]. Environmental protection: Selenium may also offer protection against reproductive toxicity induced by heavy metals such as cadmium and lead, which are known to disrupt testicular function. Dietary Sources and Supplementation Selenium is found in a range of foods including seafood, lean meats, grains, onions, garlic, and Brazil nuts. Brazil nuts are especially rich in selenium, with just 4–6 nuts daily providing well over the recommended daily intake. While food-first strategies are ideal, supplementation may be appropriate for men with documented deficiency or those undergoing fertility treatment. Combining selenium with other antioxidants, most notably vitamin E, has shown synergistic effects in improving sperm motility and reducing DNA fragmentation in several clinical studies. Clinical Recommendations Preconception timing: Encourage men to optimise their nutrition at least 3 months prior to conception attempts to support the full cycle of spermatogenesis. Dietary intake: Advise the inclusion of selenium-rich foods in the daily diet, particularly Brazil nuts (with attention to portion control to avoid excess intake). Supplementation: Consider supplementation in those with inadequate dietary intake, especially when semen parameters are suboptimal or oxidative stress is suspected. Lifestyle support: Address smoking cessation, stress management, and environmental toxin avoidance alongside nutritional interventions. Conclusion Sperm health is a dynamic and sensitive marker of male reproductive function. Optimising preconception nutrition, particularly through adequate selenium intake, is a simple but impactful strategy to support male fertility. For HCPs, integrating nutritional assessment and advice into fertility care can significantly enhance patient outcomes improving not only the chances of conception but also the health of the future child. References Aitken RJ, Smith TB, Jobling MS, Baker MA, De Iuliis GN. Oxidative stress and male reproductive health. Asian J Androl. 2014 Jan-Feb;16(1):31-8. doi: 10.4103/1008-682X.122203. PMID: 24369131; PMCID: PMC3901879. Janevic T, Kahn LG, Landsbergis P, Cirillo PM, Cohn BA, Liu X, Factor-Litvak P. Effects of work and life stress on semen quality. Fertil Steril. 2014 Aug;102(2):530-8. doi: 10.1016/j.fertnstert.2014.04.021. Epub 2014 May 23. PMID: 24856463; PMCID: PMC4382866. Hawkes WC, Turek PJ. Effects of dietary selenium on sperm motility in healthy men. J Androl. 2001 Sep-Oct;22(5):764-72. PMID: 11545288.
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Supporting Male Patients: Optimising Sperm Quality Through Nutrition, Lifestyle, and Supplementation
For Healthcare Professionals Only While fertility discussions often focus on women, male reproductive health is just as critical especially given that sperm take approximately 74 days to develop. This provides a three-month window for meaningful dietary and lifestyle intervention (Agarwal et al., 2014). 1. Adopt a Mediterranean-Style Dietary Pattern Numerous studies have linked a Mediterranean-style dietary pattern with improved sperm quality. This diet is rich in vegetables, fruits, whole grains, legumes, fish, olive oil, and nuts, and has been shown to enhance sperm concentration, motility, morphology, and total count (Karayiannis et al., 2018; Salas-Huetos et al., 2018). A systematic review published in Human Reproduction Update confirmed that adherence to this dietary pattern correlates with better semen parameters, likely due to its antioxidant and anti-inflammatory properties (Salas-Huetos et al., 2018). 2. Minimise Alcohol and Ultra-Processed Foods Excessive alcohol consumption has been associated with reduced testosterone levels and impaired spermatogenesis (Jensen et al., 2014). Additionally, diets high in ultra-processed foods such as refined snacks, sugary drinks, and processed meats are linked to inflammation and poorer semen quality (Chavarro et al., 2009; Nassan et al., 2018). Encouraging patients to reduce intake of these foods and prioritise whole, nutrient-dense options may yield measurable improvements in sperm parameters over time. 3. Reduce Oxidative Stress Through Antioxidant Support Oxidative stress is a leading cause of sperm dysfunction, contributing to DNA fragmentation, poor motility, and reduced fertilisation potential (Agarwal et al., 2014). Antioxidants such as vitamins C and E, selenium, zinc, CoQ10, and glutathione are known to mitigate oxidative damage to sperm. A meta-analysis of antioxidant supplementation in men with subfertility found significant improvements in sperm motility and DNA integrity (Showell et al., 2014). These nutrients can be obtained from both food and supplementation, depending on the patient's baseline diet and needs. 4. Address Weight, Stress, and Lifestyle Habits Obesity is associated with hormonal imbalances, increased scrotal temperature, and elevated oxidative stress, all of which negatively affect sperm quality (Palmer et al., 2012). Supporting patients in achieving a healthy weight through diet and exercise can improve reproductive outcomes. Stress may also play a role by disrupting the hypothalamic–pituitary–gonadal axis, leading to altered testosterone levels and reduced sperm production (Eskiocak et al., 2006). Incorporating sleep hygiene, physical activity, and stress management techniques may support overall hormonal health. Smoking cessation is another crucial intervention. Tobacco exposure is directly associated with reduced sperm count and increased DNA fragmentation (Sharma et al., 2016). 5. Consider Targeted Supplementation While diet forms the foundation of fertility health, supplementation may help optimise nutrient intake, particularly for nutrients shown to support sperm development and function. A well-formulated male fertility supplement should include key antioxidants (vitamins C and E, selenium), zinc, L-carnitine, CoQ10, and essential amino acids. Randomised controlled trials have shown that supplementation with these nutrients may improve sperm count, motility, morphology, and reduce DNA fragmentation (Gual-Frau et al., 2015; Buscemi et al., 2019). Conclusion With a three-month spermatogenesis cycle, men have a clear opportunity to positively influence their fertility outcomes. Healthcare professionals can support male patients by recommending evidence-based diet and lifestyle changes, addressing modifiable risk factors, and guiding supplement use where appropriate. Small, consistent changes can yield significant reproductive benefits and may also contribute to overall health and wellbeing. References Agarwal, A., Mulgund, A., Hamada, A., & Chyatte, M. R. (2015). A unique view on male infertility around the globe. Reproductive Biology and Endocrinology, 13(1), 37. Buscemi, L., et al. (2019). Effect of antioxidant therapy on sperm quality: meta-analysis of clinical trials. Andrology, 7(4), 446–456. Chavarro, J. E., et al. (2009). Diet and lifestyle in the prevention of ovulatory disorder infertility. Obstetrics and Gynecology, 113(5), 1050–1056. Eskiocak, S., et al. (2006). Effect of psychological stress on the L-arginine-nitric oxide pathway and semen quality. Brazilian Journal of Medical and Biological Research, 39(5), 581–588. Gual-Frau, J., et al. (2015). Antioxidant treatment and assessment of sperm DNA fragmentation in infertile men. Journal of Assisted Reproduction and Genetics, 32(4), 465–472. Jensen, T. K., et al. (2014). Habitual alcohol consumption associated with reduced semen quality and changes in reproductive hormones. BMJ Open, 4(9), e005462. Karayiannis, D., et al. (2018). Adherence to the Mediterranean diet and IVF success rate among non-obese women. Human Reproduction, 33(3), 494–502. Nassan, F. L., et al. (2018). Dietary patterns and semen quality in young men. Human Reproduction, 33(1), 120–131. Palmer, N. O., et al. (2012). Diet and exercise in the management of obesity-related male infertility. Human Fertility, 15(4), 245–253. Salas-Huetos, A., Bulló, M., & Salas-Salvadó, J. (2018). Dietary patterns, foods and nutrients in male fertility parameters and fecundability: a systematic review of observational studies. Human Reproduction Update, 24(1), 100–123. Sharma, R., Biedenharn, K. R., Fedor, J. M., & Agarwal, A. (2016). Lifestyle factors and reproductive health: taking control of your fertility. Reproductive Biology and Endocrinology, 11(1), 66. Showell, M. G., Brown, J., Yazdani, A., Stankiewicz, M. T., & Hart, R. J. (2014). Antioxidants for male subfertility. Cochrane Database of Systematic Reviews, (12).
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