Exercise improves sperm quality and pregnancy outcome by attenuating oxidative stress: a systematic review and meta-analysis

Background: Male fertility contributes to the life quality of couples. Although exercise has been reported to mitigate the declining trend in sperm quality, the available reports are conflicting, and the precise influence on male fertility indices warrants further investigation. Hence, this study evaluated the effect of exercise on sperm quality, pregnancy outcomes, sex hormones, and markers of oxidative stress and inflammation in men. Methods: This is a systematic review and meta-analysis that evaluated exercise interventions, including aerobic, resistance, and combined modalities, on conventional and advanced semen parameters, and pregnancy and live birth rates. Results: Exercise considerably improved ejaculate volume, sperm count, motility, morphology, and sperm DNA integrity. Also, exercise enhanced seminal total antioxidant capacity (TAC) and decreased seminal reactive oxygen species, malondialdehyde, and pro-inflammatory cytokines levels. More so, pregnancy and live birth rates increased in the exercise group when compared with the control. Nonetheless, exercise did not show any considerable effect on testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) levels. The observed effects varied by exercise type and duration, with moderate aerobic exercise showing beneficial effects. Moderate aerobic exercise enhances sperm quality and improves pregnancy outcomes by attenuating oxidative stress and inflammation. Conclusions: These findings show that moderate aerobic exercise is a promising non-pharmacological strategy in male infertility management. However, more clinical trials are required to optimize exercise protocols for reproductive benefits. The PROSPERO Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024622166, CRD42024622166.

Exercise; Infertility; Live birth; Male infertility; Pregnancy; Testosterone

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