Highlights from Fertility and Sterility

Male Depression Decreases Likelihood of Conception; Semen Quality Is Associated with Dietary Patterns

May’s issue of Fertility and Sterility features a study showing the effects of depression and antidepressant use on male and female fertility treatment and another demonstrating an association between dietary patterns and semen quality.

The first is a large, multi-center cohort study evaluating the effects of depression and antidepressant use on treatment outcomes for couples pursuing non-IVF fertility treatment, researchers found that currently active major depression in male partners led to a lower likelihood of pregnancy, but the same condition in female partners, not taking antidepressants, did not.

Couples participating in two randomized trials were included in the study. In one trial, female partners with PCOS underwent ovulation induction with either clomiphene citrate or letrozole; in the other trial-of couples with unexplained infertility- female partners were treated for ovulation induction with gonadotropins, clomiphene citrate, or letrozole, then underwent intrauterine insemination.

Female (1,650) and male (1,608) partners completed a patient health questionnaire (PHQ-9) that scored criteria defining currently active major depression.  Information on female use of antidepressant medication was collected. Information on male medication use was not collected.

Currently active major depression in women not using an antidepressant was not associated with poorer fertility outcomes; on the contrary, it was associated with a slightly increased likelihood of pregnancy. However, maternal antidepressant use was associated with an increased risk of miscarriage in the first trimester, particularly when the antidepressant was NOT an SSRI. The researchers noted that further studies are needed to confirm this finding.

Male partners with currently active major depression were less likely to achieve conception.

Evans-Hoeker et al, Major depression, antidepressant use and male and female infertility, Fertility and Sterility, Volume 109, Issue 5, May 2018.


In the second study, which is the first of its kind, Israeli researchers evaluated and compared the association between semen quality parameters in infertility patients and dietary indexes applied to the patients’ food consumption.  This study did not focus on specific nutrients or food groups, but instead looked at the full range of foods the patients consumed and scored patients’ food intake according to well-studied dietary patterns. They found that the more closely a man’s food consumption could be correlated to one of four diets, the better his semen analysis was going to be.

The researchers used whole dietary pattern indexes, measures of dietary quality which reflect real-world eating patterns and different combinations of food as they are consumed. The indexes, Healthy Eating Index (HEI); Alternate Mediterranean Diet Score (aMED); Alternative Healthy Eating Index (AHEI); and Dietary Approaches to Stop Hypertension (DASH), have all previously been studied in relation to health and various diseases.

Patients- 280 men seen at the Rabin Medical Center fertility clinic in Israel between 2012 and 2015- filled out the Food Frequency Questionnaire (FFQ), a tool to record the frequency of consumption and portion sizes of various foods over time. Statistical analyses were performed to apply the four dietary indexes to each patient’s consumption patterns.

The men, between the ages of 18 and 55 (average age 33.5), had either normal or poor semen analyses. They neither had medical conditions known to jeopardize testis function or sperm quality, nor were they taking medications that would affect their sperm.

For each of the index diets, the men scoring in the highest quartiles, whose diets most closely adhered to the standard, had significantly higher averages of sperm concentration, normal sperm morphology, total sperm count and sperm motility than men in the lowest quartile of adherence.

While more closely following any of the four diets was associated with improvements in semen quality, the improvement seen between the first and fourth quartiles in the AHEI was the most dramatic.  Men in the highest quartile of AHEI had a sperm concentration 45% higher than their compatriots in the lowest quartile; higher normal sperm morphology by 21%; and a 29% higher sperm count.

Efrat et al, Dietary patterns are positively associated with semen quality, Fertility and Sterility, Volume 109, Issue 5, May 2018.


Peter Schlegel, MD, President-elect of ASRM commented, “Overall health, physical and mental, plays a large part in baseline fertility. Psychological screening and nutritional advice are tools physicians can use to match patients with the most appropriate treatments, as well as help them achieve their own optimal natural fertility.” Dr. Schlegel noted, “Although not directly evaluated in this study, male use of SSRI antidepressants has been previously linked to impaired sperm quality, without necessarily affecting standard semen parameters.  Practitioners should consider male medication assessment for couples being evaluated for infertility.”


ASRM is a multidisciplinary organization dedicated to the advancement of the science and practice of reproductive medicine. The Society accomplishes its mission through the pursuit of excellence in education and research and through advocacy on behalf of patients, physicians, and affiliated health care providers. The Society is committed to facilitating and sponsoring educational activities for the lay public and continuing medical education activities for professionals who are engaged in the practice of and research in reproductive medicine.

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