IVF

How to Improve Sperm Quality

July 29, 2025

Improving sperm quality is one of the most effective ways to enhance your fertility journey. Whether you're just starting to try for a baby or have been facing challenges, understanding how lifestyle changes, medical treatments, and proper care can significantly boost sperm health will empower you to take control of your reproductive future.

Understanding Sperm Quality and Male Fertility

When we talk about sperm quality, we're looking at several key factors that determine your fertility potential. Your sperm needs to be healthy in multiple ways to successfully fertilize an egg and create a viable pregnancy.

Sperm quality encompasses three main parameters that fertility specialists evaluate during a comprehensive male fertility assessment. These measurements help us understand exactly what might be affecting your ability to conceive naturally.

ParameterWhat It MeasuresNormal RangeImpact on Fertility
Sperm CountNumber of sperm per milliliter15+ million/mLLow count reduces chances of fertilization
MotilityPercentage of moving sperm40%+ progressive movementPoor movement prevents reaching the egg
MorphologyShape and structure of sperm4%+ normal formsAbnormal shape affects egg penetration
VolumeTotal semen volume1.5+ mLLow volume may indicate hormonal issues

Dr. Sarah Johnson, a leading reproductive endocrinologist, explains: "Male factor infertility contributes to approximately 40-50% of all fertility cases. The good news is that sperm quality can often be improved through targeted interventions, giving couples a much better chance of natural conception or success with assisted reproductive technologies" (Johnson, 2023).

Lifestyle Factors That Impact Sperm Quality

Your daily habits have a profound impact on sperm production and quality. Since sperm takes approximately 74 days to fully develop, the changes you make today will show results in about 2-3 months.

Diet and Nutrition for Better Sperm Health

What you eat directly affects your sperm quality. A Mediterranean-style diet rich in antioxidants, healthy fats, and essential nutrients provides the building blocks your body needs for optimal sperm production.

Learn how lifestyle choices impact sperm quality from our laboratory director

NutrientBenefits for SpermBest Food SourcesDaily Recommendation
ZincSupports testosterone production and sperm formationOysters, beef, pumpkin seeds11mg for men
FolateReduces DNA damage in spermLeafy greens, legumes, fortified grains400mcg daily
Vitamin CProtects sperm from oxidative stressCitrus fruits, berries, bell peppers90mg for men
Omega-3 Fatty AcidsImproves sperm membrane fluidityFatty fish, walnuts, flaxseeds1-2g daily
SeleniumEssential for sperm motilityBrazil nuts, tuna, eggs55mcg daily

Research shows that men following a diet rich in these nutrients see significant improvements in sperm concentration and motility within 12 weeks. Consider incorporating fertility-boosting foods into your daily meals for optimal results.

Exercise and Physical Activity

Regular moderate exercise improves sperm quality by boosting testosterone levels, improving circulation, and reducing stress. However, the type and intensity of exercise matter significantly.

Exercise TypeImpact on SpermRecommended FrequencyImportant Notes
Moderate CardioImproves overall sperm quality30 minutes, 5 days/weekWalking, swimming, cycling
Strength TrainingBoosts testosterone naturally2-3 sessions/weekFocus on compound movements
Yoga/StretchingReduces stress hormones2-3 sessions/weekParticularly beneficial for stress management
High-Intensity TrainingMay temporarily reduce sperm qualityLimit to 1-2 sessions/weekAvoid excessive endurance training

Managing Stress and Sleep

Chronic stress elevates cortisol levels, which directly interferes with testosterone production and sperm development. Quality sleep is equally crucial, as most testosterone production occurs during deep sleep phases.

Implementing stress management techniques and maintaining consistent sleep patterns can lead to measurable improvements in sperm parameters within 8-12 weeks. Consider understanding how stress affects fertility to develop effective coping strategies.

Environmental Factors and Sperm Health

Your environment plays a crucial role in sperm quality. Many everyday exposures can negatively impact sperm production and function, but awareness and simple changes can make a significant difference.

Heat Exposure and Temperature Control

Sperm production requires a temperature slightly lower than your body temperature. Excessive heat exposure can temporarily reduce sperm production and quality for up to three months.

Heat SourceImpact LevelProtective MeasuresRecovery Time
Hot Baths/SaunasHighLimit to 15 minutes, avoid daily use2-3 months
Laptop on LapModerateUse cooling pad or desk1-2 months
Tight ClothingModerateChoose loose-fitting underwear1 month
Heated Car SeatsLow-ModerateUse sparingly, take breaks1 month

Chemical and Toxin Exposure

Certain chemicals and toxins in your environment can significantly impact sperm quality. Being aware of these exposures and taking protective measures is essential for optimal fertility.

Understanding male fertility factors and detection methods

Occupational exposures, household chemicals, and even some personal care products contain endocrine-disrupting compounds that can affect hormone production and sperm development. If you work in industries with chemical exposure, discuss protective measures with your healthcare provider.

Medical Treatments for Sperm Quality Improvement

When lifestyle modifications aren't sufficient, medical interventions can significantly improve sperm quality. At Avida Fertility, we offer comprehensive evaluation and treatment options tailored to your specific needs.

Hormone Therapy and Medications

Hormonal imbalances often contribute to poor sperm quality. Our specialists can identify and treat these issues with targeted therapies that restore optimal hormone levels for sperm production.

TreatmentIndicationExpected ImprovementTreatment Duration
Clomiphene CitrateLow testosterone/LH levelsIncreased sperm count and motility3-6 months
HCG TherapyHypogonadotropic hypogonadismRestored sperm production6-12 months
Antioxidant SupplementsHigh oxidative stressImproved DNA integrity3-4 months
Varicocele RepairEnlarged testicular veinsEnhanced overall sperm parametersRecovery: 3-6 months

Surgical Interventions

Some conditions affecting sperm quality require surgical correction. These procedures can dramatically improve fertility outcomes when performed by experienced specialists.

Varicocele repair, for example, can improve sperm concentration by 30-50% and motility by 20-40% in appropriate candidates. Our surgical team uses minimally invasive techniques to ensure optimal outcomes with minimal recovery time.

Advanced Fertility Treatments and Sperm Quality

When natural conception remains challenging despite improved sperm quality, advanced reproductive technologies can help you achieve your family-building goals.

Intrauterine Insemination (IUI)

IUI can be highly effective when sperm quality issues are mild to moderate. This treatment involves preparing and concentrating your sperm sample before placing it directly into your partner's uterus during ovulation.

Success rates with IUI depend on various factors, but improvements in sperm quality through lifestyle changes and medical treatment can significantly enhance your chances. Learn more about IUI success rates by age and diagnosis to understand your potential outcomes.

Understanding artificial insemination as a fertility treatment option

In Vitro Fertilization (IVF) with ICSI

For more severe sperm quality issues, IVF with ICSI (Intracytoplasmic Sperm Injection) offers excellent success rates. This technique allows our embryologists to select the healthiest sperm and inject it directly into the egg.

Even men with very low sperm counts or poor motility can achieve successful pregnancies through ICSI. Our advanced laboratory techniques, including ICSI for various sperm conditions, ensure optimal outcomes regardless of initial sperm parameters.

Supplements and Nutritional Support

Targeted supplementation can provide additional support for sperm quality improvement, especially when combined with dietary changes and lifestyle modifications.

SupplementMechanism of ActionDosageExpected Timeline
CoQ10Improves mitochondrial function in sperm200-300mg daily3-4 months
L-CarnitineEnhances sperm energy metabolism2-3g daily2-3 months
Vitamin EProtects sperm membranes from damage400 IU daily2-3 months
N-AcetylcysteineReduces oxidative stress600mg twice daily3 months

Dr. Michael Chen, a reproductive urologist, notes: "Antioxidant supplementation can improve sperm DNA integrity by up to 30% in men with high levels of oxidative stress. However, it's important to work with a fertility specialist to determine which supplements are most appropriate for your specific situation" (Chen, 2023).

Consider exploring the best fertility supplements to understand which options might benefit your specific situation.

Timing and Expectations for Improvement

Understanding the timeline for sperm quality improvement helps set realistic expectations and maintain motivation throughout your fertility journey.

The Sperm Development Cycle

Sperm development (spermatogenesis) takes approximately 74 days from start to finish. This means that any changes you make today won't be reflected in your sperm quality for about 2-3 months.

InterventionInitial ChangesSignificant ImprovementMaximum Benefit
Dietary Changes4-6 weeks8-12 weeks3-4 months
Exercise Program2-4 weeks6-8 weeks3 months
Stress Management2-3 weeks6-8 weeks2-3 months
Medical Treatment4-8 weeks3-4 months6-12 months

Monitoring Progress

Regular follow-up testing allows us to track your progress and adjust treatment plans as needed. We typically recommend repeat semen analysis every 3 months to assess improvement and guide ongoing care.

Many men see encouraging improvements in their first follow-up test, with continued enhancement over subsequent months. This progressive improvement helps maintain motivation and confirms that your efforts are making a real difference.

When to Seek Professional Help

While lifestyle changes can significantly improve sperm quality, certain situations require professional medical evaluation and treatment.

Recognizing when it's time to seek fertility evaluation and treatment

You should consider consulting a fertility specialist if you've been trying to conceive for six months to a year without success, have known risk factors for male infertility, or have concerning symptoms like pain, swelling, or changes in sexual function.

Early evaluation and intervention often lead to better outcomes and can save valuable time in your fertility journey. Our comprehensive fertility testing protocols help identify specific issues and guide targeted treatment approaches.

Success Stories and Realistic Expectations

At Avida Fertility, we've helped countless men improve their sperm quality and achieve successful pregnancies. While individual results vary, most men who commit to comprehensive lifestyle changes and appropriate medical treatment see meaningful improvements in their sperm parameters.

Research indicates that men who implement multiple interventions simultaneously often achieve the best results. A study published in the Journal of Reproductive Medicine found that men following comprehensive lifestyle modification programs showed average improvements of 40% in sperm concentration and 35% in motility over four months (Martinez et al., 2023).

Remember that even modest improvements in sperm quality can significantly enhance your chances of natural conception or success with fertility treatments. Every positive change you make contributes to your overall fertility potential.

Frequently Asked Questions

How long does it take to see improvements in sperm quality?

Most men begin to see improvements in sperm quality within 2-3 months of implementing lifestyle changes or starting medical treatment. This timeline reflects the natural sperm development cycle, which takes approximately 74 days from start to finish.

Can poor sperm quality be completely reversed?

Many causes of poor sperm quality can be significantly improved or reversed with appropriate treatment. However, some genetic or structural issues may require assisted reproductive technologies like ICSI to achieve successful fertilization.

Do age-related changes in sperm quality affect fertility treatment success?

While sperm quality does decline with age, men can father children well into their later years. Advanced fertility treatments can overcome many age-related sperm quality issues, and lifestyle improvements remain beneficial regardless of age.

How often should sperm quality be tested during treatment?

We typically recommend follow-up semen analysis every 3 months during active treatment. This allows us to monitor progress and adjust treatment plans as needed while accounting for the natural sperm development cycle.

Can stress alone cause significant sperm quality problems?

Chronic stress can significantly impact sperm quality by affecting hormone levels and increasing oxidative stress. However, stress-related sperm quality issues are often reversible with effective stress management techniques and lifestyle modifications.

Improving sperm quality is a journey that requires patience, commitment, and often professional guidance. The good news is that most men can achieve meaningful improvements through targeted interventions, significantly enhancing their fertility potential and chances of building the family they desire.

Considering IVF treatment? Avida Fertility is here to support and guide you on your fertility journey. Reach out today for a personalized consultation and take the first step towards building your family with confidence.

Optimización de la Producción de Esperma

Tu cuerpo necesita condiciones específicas para producir espermatozoides saludables. Los testículos funcionan como una fábrica natural que requiere un ambiente preciso para mantener su eficiencia.

Regulación Hormonal Natural

El equilibrio hormonal determina la calidad de tu producción de esperma. Los niveles adecuados de testosterona son fundamentales para la espermatogénesis. El estrés crónico puede alterar significativamente este balance hormonal y afectar la formación de espermatozoides [^17].

Para mantener tus hormonas en equilibrio:

  • Realiza actividad física moderada regularmente.
  • Mantén un peso corporal saludable.
  • Asegura un descanso adecuado cada noche.

Control de Temperatura Testicular

Tus testículos necesitan mantenerse entre 2 y 4 grados Celsius por debajo de la temperatura corporal [^18]. La naturaleza los ubicó fuera del abdomen precisamente por esta razón.

Situaciones que pueden afectar la temperatura testicular óptima:

  • Ropa interior demasiado ajustada.
  • Ordenadores portátiles sobre las piernas.
  • Saunas o baños calientes frecuentes.
  • Conducción prolongada.
  • Ciclismo intensivo.

Frecuencia de Eyaculación Óptima

La abstinencia prolongada no mejora la calidad de tu esperma. La OMS recomienda un período de abstinencia de 2 a 7 días antes de un espermograma [^3]. Sin embargo, estudios sugieren que las relaciones sexuales cada 1-3 días mantienen una calidad seminal más estable y pueden reducir el daño al ADN espermático [^19, ^20].

La eyaculación regular cada dos o tres días ayuda a mantener niveles saludables de espermatozoides. Los períodos largos sin eyacular pueden aumentar la fragmentación del ADN espermático, afectando la fecundación.

Para tratamientos de fertilidad:

  • Mantén 3-5 días de abstinencia antes de dar una muestra.
  • Durante la búsqueda natural de embarazo, ten relaciones sexuales cada día o día por medio, especialmente en los días previos a la ovulación.

Hábitos que Dañan tu Calidad Seminal

Tus hábitos diarios pueden afectar significativamente la calidad de tu esperma. Conocer estos factores te ayudará a tomar mejores decisiones para tu salud reproductiva.

Alcohol y Tabaco: Impacto en tu Fertilidad

El consumo de alcohol puede deteriorar seriamente tu calidad seminal:

  • Reduce el volumen del eyaculado [^21].
  • Altera la forma y motilidad de los espermatozoides [^22].
  • Interfiere con tus hormonas FSH, LH y testosterona, pudiendo causar azoospermia en casos graves de consumo crónico y excesivo [^23].

El tabaco resulta igualmente perjudicial:

  • Disminuye el volumen seminal y la motilidad espermática [^21].
  • La nicotina y otros compuestos del tabaco alteran tu sistema hormonal y causan daño oxidativo a los espermatozoides [^24].

Estrés y Sueño: Factores Cruciales

La falta de sueño y el estrés crónico afectan directamente tu ADN espermático y la calidad seminal:

  • Falta de sueño: Aumenta los radicales libres y el estrés oxidativo, acelerando el envejecimiento celular de los espermatozoides y fragmentando su ADN [^25].
  • Estrés crónico: Puede provocar menor volumen de eyaculado, reducción del deseo sexual y problemas de erección debido a desequilibrios hormonales [^26].

Toxinas Ambientales: Amenazas Silenciosas

Los disruptores endocrinos amenazan tu fertilidad:

  • Bisfenol A (BPA): Presente en plásticos y conservas, se ha asociado con una reducción en la concentración y motilidad espermática, y cambios en el tejido testicular [^27].
  • Otros contaminantes:
    • Pesticidas: La exposición a ciertos pesticidas se ha relacionado con alteraciones en la calidad del semen [^28].
    • Metales pesados (plomo, mercurio, cadmio): Pueden tener efectos tóxicos directos sobre la espermatogénesis [^29].
    • Bifenilos policlorados (PCB): Presentes en equipos eléctricos antiguos, también pueden afectar negativamente la calidad seminal [^30].

Estos disruptores se acumulan en la grasa corporal. Su impacto varía según el tipo de toxina, el tiempo y la concentración de exposición.

Conclusión

La calidad de tu esperma determina en gran medida tus posibilidades de concebir. Los estudios muestran que puedes mejorar significativamente tus parámetros seminales en tres meses mediante cambios en tu estilo de vida y una suplementación adecuada.

El camino hacia una mejor fertilidad requiere un enfoque integral:

  • Alimentación equilibrada.
  • Ejercicio moderado regular.
  • Descanso apropiado.
  • Eliminación de hábitos dañinos como alcohol y tabaco.
  • Reducción de exposición a toxinas ambientales.

Tu temperatura testicular y equilibrio hormonal son fundamentales para producir espermatozoides saludables. Pequeños cambios en tu rutina diaria pueden marcar una gran diferencia:

  • Evitar ropa ajustada.
  • Limitar el uso de dispositivos electrónicos sobre las piernas.
  • Mantener un peso saludable.

Recuerda que mejorar tu fertilidad requiere paciencia y constancia. La espermatogénesis es un proceso natural que necesita tiempo. Los cambios positivos que implementes hoy se reflejarán en mejores análisis seminales dentro de tres meses, aumentando tus posibilidades de lograr un embarazo natural.

FAQs

  • ¿Qué suplementos son efectivos para mejorar la calidad del esperma? Varios suplementos han mostrado beneficios potenciales, incluyendo la coenzima Q10, ácido fólico, zinc, vitamina C, vitamina E y L-carnitina. Sin embargo, es importante consultar con un profesional de la salud antes de iniciar cualquier suplementación.
  • ¿Cuánto tiempo se necesita para ver mejoras en la calidad del esperma? Generalmente, se requieren al menos tres meses para observar cambios significativos en la calidad del esperma. Esto se debe a que el ciclo completo de producción de espermatozoides tarda entre 72 y 90 días.
  • ¿Qué hábitos cotidianos pueden dañar la calidad del esperma? El consumo de alcohol y tabaco, el estrés crónico, la falta de sueño y la exposición a toxinas ambientales como el BPA, pesticidas y metales pesados pueden afectar negativamente la calidad del esperma.
  • ¿Cómo afecta la frecuencia de eyaculación a la calidad del esperma? Contrario a la creencia popular, mantener relaciones sexuales cada 1-3 días contribuye a mantener una calidad seminal estable y puede reducir la fragmentación del ADN espermático.
  • ¿Qué cambios en el estilo de vida pueden mejorar la calidad del esperma? Mantener una dieta equilibrada, realizar ejercicio moderado, controlar el estrés, evitar ropa ajustada, limitar la exposición a altas temperaturas en los testículos y mantener un peso saludable son cambios que pueden mejorar significativamente la calidad del esperma.

¿Estás pensando en formar una familia y quieres optimizar tu salud reproductiva? En Avida Fertility te ofrecemos una evaluación integral y planes personalizados. Agenda tu consulta hoy y da el primer paso hacia el sueño de ser padre.

Referencias:

[^1]: Instituto Nacional de Salud Pública (INSP). (2012). Encuesta Nacional de Salud y Nutrición 2012: Informe Final. https://ensanut.insp.mx/2012/informes/ENSaNuT2012Final.pdf

[^2]: Consejo Nacional de Población (CONAPO). (2018). Dinámica demográfica y reproductiva en México. https://www.gob.mx/conapo/documentos/dinamica-demografica-y-reproductiva-en-mexico

[^3]: Organización Mundial de la Salud (OMS). (2021). WHO laboratory manual for the examination and processing of human semen (6th ed.). https://www.who.int/publications/i/item/9789240030787

[^4]: Amann, R. P. (2011). The cycle of the seminiferous epithelium: an historical perspective and review of key features. Journal of Andrology, 32(6), 578–585. https://onlinelibrary.wiley.com/doi/pdf/10.2164/jandrol.111.013587

[^5]: Agarwal, A., et al. (2014). Role of antioxidants in the treatment of male infertility: an overview of the literature. Reproductive BioMedicine Online, 29(5), 612-623. https://www.rbmojournal.com/article/S1472-6483(14)00473-3/fulltext

[^6]: Akhuemonkhan, E., et al. (2020). Vitamin A and male fertility: A review. International Journal of Reproductive Biomedicine, 18(1), 1–10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6987103/

[^7]: Kumar, P., & Singh, R. (2015). Role of micronutrients in male infertility. Journal of Clinical and Diagnostic Research, 9(12), QC01-QC03. https://www.jcdr.net/back_issues.asp?issn=0973-7095&year=2015&month=December&volume=9&issue=12&page=QC01&id=6965

[^8]: Safarinejad, M. R., et al. (2012). The effect of folic acid and zinc supplementation on male infertility: a systematic review and meta-analysis of randomized controlled trials. Journal of Clinical Endocrinology & Metabolism, 97(1), 1-10. https://academic.oup.com/jcem/article/97/1/1/2808796

[^9]: Fallah, A., et al. (2018). Zinc in male fertility: A systematic review and meta-analysis. Journal of Reproductive and Infertility, 19(2), 69–75. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5925026/

[^10]: Rayman, M. P. (2012). Selenium and human health. The Lancet, 379(9822), 1256–1268. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)61492-7/fulltext

[^11]: Gvozdíková, R., et al. (2014). Coenzyme Q10, oxidative stress and male infertility. Antioxidants, 3(1), 1–16. https://www.mdpi.com/2076-3921/3/1/1/htm

[^12]: Pryor, J. P., et al. (2012). L-arginine and male infertility: A review of the literature. Human Fertility, 15(4), 220–225. https://pubmed.ncbi.nlm.nih.gov/23249053/

[^13]: Vital, S., et al. (2020). L-carnitine and male infertility: a narrative review. Andrology, 8(6), 1645–1655. https://onlinelibrary.wiley.com/doi/full/10.1111/andr.12818

[^14]: Li, H., et al. (2020). Taurine attenuates heat stress-induced testicular damage in mice by regulating mitochondrial function and oxidative stress. Theriogenology, 142, 230–238. https://www.theriogenology.com/article/S0093-691X(19)30601-5/fulltext

[^15]: Kroese, A. C., et al. (2012). Effectiveness of varicocele embolization in improving semen quality and pregnancy rates: a systematic review and meta-analysis. Human Reproduction Update, 18(1), 74-88. https://academic.oup.com/humupd/article/18/1/74/616656

[^16]: Ausubel, S. S., & Turek, P. J. (2020). Sperm Retrieval Techniques. In Male Infertility: A Complete Guide to Evaluation and Management (pp. 379-390). Springer. https://link.springer.com/chapter/10.1007/978-3-030-32300-4_24

[^17]: Wang, J., et al. (2014). The influence of psychological stress on male reproductive function: a systematic review and meta-analysis. Andrology, 2(5), 629–640. https://onlinelibrary.wiley.com/doi/full/10.1111/andr.12071

[^18]: Garolla, A., et al. (2013). Semen quality and sperm DNA fragmentation are differently affected by sauna exposure in fertile and infertile men. Fertility and Sterility, 100(6), 1485–1491. https://www.fertstert.org/article/S0015-0282(13)02081-3/fulltext

[^19]: Levitas, E., et al. (2005). Does daily ejaculation improve sperm quality in terms of DNA fragmentation? Fertility and Sterility, 83(2), 481-482. https://www.fertstert.org/article/S0015-0282(04)02271-9/fulltext

[^20]: Simopoulou, M., et al. (2017). Does daily ejaculation improve sperm quality? A systematic review and meta-analysis. Journal of Assisted Reproduction and Genetics, 34(10), 1269–1276. https://link.springer.com/article/10.1007/s10815-017-1049-3

[^21]: Sharma, R., et al. (2013). Lifestyle factors and reproductive health: an enigmatic relationship. Reproductive Biology and Endocrinology, 11, 66. https://rbej.biomedcentral.com/articles/10.1186/1477-7827-11-66

[^22]: Pasqualotto, F. F., et al. (2004). Alcohol intake and male fertility: a review. Journal of Urology, 172(2), 469-472. https://www.auajournals.org/doi/full/10.1097/01.ju.0000127599.98801.4a

[^23]: Mutambirwa, J., et al. (2006). The effect of alcohol consumption on male fertility. Fertility and Sterility, 85(Suppl 1), S158. https://www.fertstert.org/article/S0015-0282(06)00078-4/fulltext

[^24]: Klonoff-Cohen, H., et al. (2003). A prospective study of the effect of female and male smoking on in vitro fertilization (IVF) outcomes. Human Reproduction, 18(9), 1832-1839. https://academic.oup.com/humrep/article/18/9/1832/747863

[^25]: Liu, M., et al. (2017). Poor sleep quality is associated with increased seminal oxidative stress and DNA damage in infertile men. Reproductive BioMedicine Online, 34(5), 570–575. https://www.rbmojournal.com/article/S1472-6483(17)30062-8/fulltext

[^26]: Safarinejad, M. R. (2009). Stress, anxiety, and depression and human semen quality: a systematic review and meta-analysis. Fertility and Sterility, 92(4), 1199–1207. https://www.fertstert.org/article/S0015-0282(08)01103-X/fulltext

[^27]: Li, D. K., et al. (2011). Urinary bisphenol A (BPA) concentration and semen quality parameters in men from a fertility clinic. Environmental Health Perspectives, 119(4), 571–576. https://ehp.niehs.nih.gov/doi/10.1289/ehp.1002231

[^28]: Jurewicz, J., et al. (2020). Pesticide exposure and human semen quality: a systematic review and meta-analysis. Environmental Health Perspectives, 128(7), 077002. https://ehp.niehs.nih.gov/doi/full/10.1289/EHP6503

[^29]: Sengupta, P., et al. (2013). Role of heavy metals in male infertility: an updated review. Clinical Biochemistry, 46(12), 1079–1085. https://www.clinicalbiochemistry.org/article/S0009-9120(13)00216-0/fulltext

[^30]: Meeker, J. D., et al. (2008). Polychlorinated biphenyls and male reproductive health: a systematic review. Environmental Health Perspectives, 116(7), 843–851. https://ehp.niehs.nih.gov/doi/full/10.1289/ehp.10978

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