Trimester 0: Optimising Male Fertility in the 90 Days Before Conception Blog - Read More

Trimester 0: Optimising Male Fertility in the 90 Days Before Conception

9 minute read in Professional Education

For Healthcare Professionals Only

This article explores why the approximately 90 days before conception, described by Proceive as Trimester 0, are particularly relevant to male preconception health. It examines sperm development, oxidative stress and DNA integrity, alongside the role of nutrition and lifestyle during this period, and considers how healthcare professionals can bring men into the preconception conversation from the outset.

Preconception support is not only relevant to the 1 in 6 couples who experience fertility difficulties. It is relevant to 6 in 6 couples trying to conceive. This principle sits at the heart of Proceive’s approach to Trimester 0: recognising the three months before conception as an important window in which both prospective parents can support their health and nutritional status before pregnancy begins. It underpins a simple Proceive message: it takes twelve months, not nine, to make a baby.

For men, this period has particular biological relevance. Spermatogenesis – the process through which sperm cells develop within the testes – takes approximately 74 days, followed by further maturation within the epididymis.¹ The sperm present at conception therefore reflect biological processes and exposures occurring over the preceding months. Rather than waiting until conception difficulties arise, Trimester 0 provides healthcare professionals with a practical framework for bringing men into the preconception conversation from the outset.

Why Male Preconception Health Matters

Every conception involves contributions from both partners. At fertilisation, sperm contributes half of the embryo’s nuclear genetic material, making male reproductive health an important consideration for every couple planning a pregnancy – not only those experiencing fertility difficulties.

The importance of male reproductive health is also increasingly difficult to overlook. A large meta-analysis examining data collected between 1973 and 2018 reported that mean sperm concentration among unselected men declined from approximately 101 million/mL to 49 million/mL – a fall of more than 50%. The rate of decline also appeared to accelerate after 2000.² The reasons behind this decline are likely to be complex and multifactorial, but the findings reinforce the importance of considering male reproductive health as an integral part of preconception care.

Why the 90 Days Before Conception Matter for Male Fertility

Spermatogenesis is a continuous and highly coordinated process involving cell division, genetic replication, cellular differentiation and maturation. Because the development and maturation of sperm spans approximately two and a half to three months, sperm quality at any given point reflects processes occurring over the preceding weeks and months.¹ During this period, developing sperm may be influenced by factors including nutritional status, smoking, alcohol consumption, heat exposure, illness, environmental exposures, sleep and metabolic health.

This gives the 90 days before conception particular relevance. While not every influence on male fertility is modifiable, this window provides an opportunity to consider nutrition and lifestyle before the sperm that may ultimately be involved in conception has completed its development and maturation. Importantly, this principle applies whether a couple conceives quickly, takes longer than expected or ultimately requires fertility treatment. Male preconception care does not need to begin with a diagnosis of infertility.
Oxidative stress and sperm health

Oxidative Stress and Sperm Health

Oxidative stress is an important area of research within male fertility. Reactive oxygen species (ROS) are naturally produced within the male reproductive tract and have physiological roles in sperm maturation, capacitation and other processes required for fertilisation. However, when ROS production exceeds antioxidant defences, oxidative stress can occur.³

Sperm cells are particularly susceptible to oxidative damage due in part to the high proportion of polyunsaturated fatty acids within their plasma membranes and their relatively limited antioxidant capacity. Excessive oxidative stress can contribute to lipid peroxidation, impaired sperm function and sperm DNA fragmentation.³ This provides one potential biological link between the preconception environment and sperm quality and has contributed to considerable research interest in nutrition and antioxidant status in male fertility.

Sperm DNA Integrity & Male Fertility 

Conventional semen analysis provides important information on sperm concentration, motility and morphology, but these parameters do not provide a complete picture of sperm function. Sperm DNA fragmentation has therefore become an increasing area of interest within reproductive medicine. Higher levels of sperm DNA fragmentation have been associated with a reduced likelihood of natural conception and poorer outcomes following assisted reproduction, including impaired embryo development and pregnancy loss.⁴

Sperm DNA fragmentation may be increased by several factors, including smoking, advancing paternal age, infection, hormonal abnormalities and varicocele.⁴ Oxidative stress is also recognised as an important contributor to sperm DNA damage.³ Routine sperm DNA fragmentation testing is not indicated for every man. However, awareness of DNA integrity reinforces an important principle for preconception care: male reproductive health is about more than sperm count alone.

Nutrition for Male Fertility During Trimester 0

Adequate nutrition provides nutrients involved in the cell division, DNA synthesis, energy metabolism and antioxidant defence required during spermatogenesis. A number of nutrients and compounds have been investigated in relation to male fertility, including zinc, selenium, folate, vitamins C and E, coenzyme Q10, carnitine and omega-3 fatty acids.⁵ Rather than viewing these nutrients in isolation, healthcare professionals can encourage a nutrient-dense dietary pattern providing good-quality protein, vegetables and fruit, wholegrains, nuts and seeds, healthy fats and oily fish. Dietary patterns rich in many of these foods have been associated with better semen quality parameters.⁶

The 90-day window also provides a practical timeframe for considering nutritional supplementation. Where possible, establishing appropriate nutritional support around three months before conception allows supplementation to coincide with the development and maturation of the sperm that may ultimately be involved in conception.

Proceive Men provides comprehensive, high-strength nutritional support for men under 40 who are beginning their trying-to-conceive journey and have no known fertility concerns. This reflects an important principle of Trimester 0: preconception nutritional support does not need to wait until fertility difficulties arise. Where additional nutritional support may be appropriate – including for men over 40, those who have been trying to conceive for more than 12 months, those preparing for IVF or ICSI, or where male-factor fertility concerns have been identified – Proceive Max Men provides advanced nutritional support for male fertility. For men who consume little or no oily fish, Proceive Conception Omega 3 can be taken alongside either preconception formulation to provide an additional source of EPA and DHA.

Putting Trimester 0 into practice

Trimester 0 gives healthcare professionals a simple way to shift the male fertility conversation upstream. For a couple beginning their trying-to-conceive journey, the conversation can start before there is any reason to suspect a fertility problem. The three months before conception provide an opportunity to consider nutrition, lifestyle and other relevant aspects of male preconception health as part of a couple’s wider preparation for pregnancy.

For couples preparing for assisted conception, the same principle applies. Where time allows, male preconception support can begin before an IVF or ICSI cycle rather than being introduced only once treatment is underway. Importantly, the 90-day window should not be presented as a guarantee that lifestyle or nutritional changes will improve fertility outcomes, nor should preconception optimisation delay appropriate investigation where indicated. Instead, it provides a biologically relevant period in which to support male reproductive health as part of a couple’s wider preparation for pregnancy. Preconception care is therefore not simply for the 1 in 6 who experience fertility difficulties. It is an opportunity to support all couples preparing to conceive – and to include men in that preparation from the beginning.

Key Takeaways for Healthcare Professionals

  • Trimester 0 describes the approximately three-month period before conception and provides a practical framework for preconception care.
  • Male preconception health is relevant to all couples trying to conceive, not only those experiencing fertility difficulties.
  • Spermatogenesis takes approximately 74 days, followed by further maturation within the epididymis, meaning sperm present at conception have developed over the preceding months.
  • Sperm contributes half of the embryo’s nuclear genetic material, making sperm health and DNA integrity important considerations alongside conventional semen parameters.
  • Nutrition, lifestyle and other relevant exposures during spermatogenesis may influence male reproductive health.
  • Where possible, male preconception nutrition and lifestyle support can begin approximately three months before conception.
  • Proceive Men provides nutritional support from the beginning of the trying-to-conceive journey, with Proceive Max Men providing advanced nutritional support where additional considerations are present.

Frequently Asked Questions

  1. What is Trimester 0?

    Trimester 0 describes the approximately three-month period before conception and provides a practical framework for preconception care. It recognises this period as an important window in which both prospective parents can support their health and nutritional status before pregnancy begins.

  2. Why are the 90 days before conception important for male fertility?

    Spermatogenesis takes approximately 74 days, followed by further maturation within the epididymis. This means the sperm present at conception reflect biological processes and exposures occurring over the preceding months.

  3. Why does male preconception health matter?

    Every conception involves contributions from both partners. At fertilisation, sperm contributes half of the embryo's nuclear genetic material, making male reproductive health an important consideration for every couple planning a pregnancy.

  4. How can oxidative stress affect sperm health?

    When reactive oxygen species production exceeds antioxidant defences, oxidative stress can occur. Excessive oxidative stress can contribute to lipid peroxidation, impaired sperm function and sperm DNA fragmentation.

  5. What factors may influence sperm health during Trimester 0?

    During sperm development, factors including nutritional status, smoking, alcohol consumption, heat exposure, illness, environmental exposures, sleep and metabolic health may influence developing sperm.

  6. When should male preconception nutritional support begin?

    Where possible, establishing appropriate nutritional support around three months before conception allows supplementation to coincide with the development and maturation of the sperm that may ultimately be involved in conception.

References

  1. Griswold MD. Spermatogenesis: the commitment to meiosis. Physiol Rev. 2016;96(1):1–17. doi:10.1152/physrev.00013.2015.
  2. Levine H, Jørgensen N, Martino-Andrade A, Mendiola J, Weksler-Derri D, Jolles M, et al. Temporal trends in sperm count: a systematic review and meta-regression analysis of samples collected globally in the 20th and 21st centuries. Hum Reprod Update. 2023;29(2):157–176. doi:10.1093/humupd/dmac035.
  3. Agarwal A, Parekh N, Panner Selvam MK, Henkel R, Shah R, Homa ST, et al. Male oxidative stress infertility (MOSI): proposed terminology and clinical practice guidelines for management of idiopathic male infertility. World J Mens Health. 2019;37(3):296–312. doi:10.5534/wjmh.190055.
  4. European Association of Urology. EAU Guidelines on Sexual and Reproductive Health: Male Infertility. Arnhem: EAU Guidelines Office; 2025.
  5. Salas-Huetos A, Rosique-Esteban N, Becerra-Tomás N, Vizmanos B, Bulló M, Salas-Salvadó J. The effect of nutrients and dietary supplements on sperm quality parameters: a systematic review and meta-analysis of randomized clinical trials. Adv Nutr. 2018;9(6):833–848. doi:10.1093/advances/nmy057.
  6. 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(4):371–389. doi:10.1093/humupd/dmx006.
Charlotte Grand

Written by Charlotte Grand

Charlotte is a Registered Nutritionist and the Training and Education Manager at Proceive, where she leads the brand's clinical education and professional training programmes across the UK and Ireland. Specialising in fertility and prenatal nutrition, Charlotte is a recognised industry expert, author, and champion of evidence-based practice in reproductive healthcare.

Tags: Conception Lifestyle Nutrition
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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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The Effect of Age on Men’s Fertility

The Effect of Age on Men’s Fertility

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