Reproductive Sciences

https://doi.org/10.1007/s43032-022-01040-8

REVIEW

The Association Between Lipid Serum and Semen Parameters:

a Systematic Review
Cennikon Pakpahan1,2   · Andri Rezano1,3   · Ria Margiana1,4   · Bella Amanda1,2 · Agustinus Agustinus1,2   ·
Darmadi Darmadi5 

Received: 21 April 2022 / Accepted: 12 July 2022

© The Author(s), under exclusive licence to Society for Reproductive Investigation 2022

Abstract
Increased lipid levels sometimes not only affect sexual function but also are considered to harm semen quality. It is often a
suspicion that elevated lipids are a factor in infertility. We conduct a systematic review. Articles that met the criteria were
identified according to The Preferred Reporting Items for Systematic Review and Meta-analysis of recommendations in the
PubMed, ProQuest, EBSCO, Web of Science Wiley Online, Springer Link, Scopus, and Science Direct databases with no
time restriction for publication. Seven studies are eligible for qualitative analysis from nine studies that have the potential to
be assessed. These studies measure the correlation of serum lipids (VLDL, HDL, LDL, triglycerides, total cholesterol, free
cholesterol, phospholipids, free fatty acids) with semen parameters (concentration, motility, morphology, DNA fragmentation
index). Although not all studies consistently report that lipids impact semen quality, this review suspects that lipids have a
significant impact on sperm quality. This study implies that it is necessary to maintain lipid levels to maintain sperm quality
and quality of life. However, further investigation with an observational cohort study design needs to be carried out to assess
the effect of lipids on semen quality more precisely for the promotion of reproductive health care.

Keywords  Lipid serum · Sperm motility · Sperm morphology · Sperm concentration · Reproductive health care · Male
infertility

Introduction of infertility becomes aware of other underlying diseases

Infertility affects about 15% of all couples and around 50%
of cases have a male factor [1]. Previous studies revealed that
fertility might be disturbed by several diseases such as such
as cancer, obesity, and diabetes [2–7]. Furthermore, in some
conditions, the male who comes with the chief complaint
* Cennikon Pakpahan
cennikon.pakpahan@fk.unair.ac.id
1
Andrology Study Program, Faculty of Medicine, Universitas
Airlangga, Surabaya, Indonesia
2
Department of Biomedical Science, Faculty of Medicine,
Universitas Airlangga, Jl. Mayjen Prof. Dr. Moestopo 47,
Surabaya 60131, Indonesia
3
Department of Biomedical Science, Faculty of Medicine,
Universitas Padjadjaran, Sumedang, Indonesia
4
Department of Anatomy, Faculty of Medicine, Universitas
Indonesia, Jakarta, Indonesia
5
Department of Internal Medicine, Faculty of Medicine,
Universitas Sumatera Utara, Medan, Indonesia
after getting a fertility examination. Therefore, infertility,
defined as a disease, can be a marker of general health,
especially in males. The exact etiology is still unknown,
but likely involves some genetic, epigenetic, developmen-
tal, and health/lifestyle factors [8]. Recent linkage studies
report various associations between male factor infertility
and overall survival [9–11].
The data regarding male infertility-related illness is still
inadequate. Several fertilities center more focus more to
the main outcome, pregnancy and limit the male fertility
evaluation to semen analysis only. In many cases, primary
treatment focuses solely on pregnancy outcomes using
assisted reproductive technology, with little consideration
to men’s general health. In fact, not only male infertility can
be caused by a variety of etiologies and semen parameter
merely represents the endpoint of different pathophysiologi-
cal mechanism [12].
Interestingly, the increase of lipid serum levels, which
is not rarely found in obese males, is often used as a
“scapegoat” for infertility. Numerous studies indicated

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that decreasing semen quality is associated with increased
obesity. A cohort study performed in France showed that
increased body mass index was not only associated with
reduced semen quality, but also affecting volume, concentra-
tion, and motility [13]. Another study in the Asian popula-
tion indicated increased body fat was associated with lower
sperm concentration and lower normal sperm morphology
[14]. Higher consumption of saturated fat and processed
meat was found to be inversely related to semen quality in
studies conducted in the USA [15], Spain [16] as well as in
Asian countries [17].
The potential role of lipids in human fertility is hypoth-
esized because cholesterol is the main source for sex steroid
hormone synthesis [18] and a determinant role in steroido-
genesis and spermatogenesis [19]. Studies in animal models
have shown the association between cholesterol, steroido-
genesis, and male fertility [20–22]. In addition, cholesterol
fed to male rats and rabbits for 120 days reduced spermatid
cell numbers, reduced seminiferous tubules’ diameters, and
lower Leydig cell nuclear dimensions [23]. Even in mild
hyperlipidemic rats exhibited significantly reduced sperm
motility and density in the cauda epididymis and testis [24].
The relationship between lipids and sperm production is
complex and unclear. In humans, the amount of cholesterol
in sperm varies considerably, even among ejaculates; [25]
meanwhile, the amount of cholesterol present within sperm
membranes is directly related to the normal sperm mor-
phology [26] and fertility potential [25]. However, studies
exploring the detailed associations between lipid profiles and
semen parameters are limited.
The aim of this study was to analyze available studies
regarding the semen quality and lipid profiles of male fac-
tor infertility to elucidate the association between semen
abnormalities and serum lipid levels.
Materials and Methods
Database Searching Strategy
To generate an adequate report on this systematic review,
we compiled data using the Preferred Reporting Items for
Systematic Reviews and Meta-Analyzes (PRISMA) guide-
line [27]. The research protocol was submitted into the
PROSPERO database, which is a worldwide prospective
register of systematic reviews. The registered number is
CRD42022306433.
In this systematic review, we will investigate all research
from any year that studied the association between lipid serum
and semen parameters. At least one or more lipid and semen
parameters are assessed. Semen parameters were investigated
still using WHO guideline 2010. We used the MeSH terms
“lipid serum” or “lipid levels” and “semen parameters or
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Reproductive Sciences
“semen analysis” or “sperm analysis” or “sperm parameters”
on database such as PubMed, ProQuest, EBSCO, Web of Sci-
ence Wiley Online, Springer, Scopus, and Science Direct.
Criteria for Study
All studies must meet the following requirements: (1) Obser-
vational analytic design (case–control, cohort, or cross-sec-
tional); (2) Written in English; (3) Assessing the association
between one or more lipid serum and semen parameters; (4)
Presents the value of statistical analysis either odds ratio
(OR), relative risk (RR) or correlation coefficient (r); (5) the
complete text of the study was available. The studies that met
the following criteria were excluded: (1) The study design
was not in the form of observational analytic; (2) Duplicate
studies; (3) Studies that are not available in full text or main
data or data specific about lipid serum and sperm parameters
cannot be obtained; (4) non-English language; (5) Study not
in human; (6) Abstract proceedings or literature review.
Study Selection
Two people (CP and BA) conducted separate computer-
ized searches and retrieved data that matched the terms we
needed. Any issues that arose throughout the search that
caused confusion were addressed in a conversation with all
authors (AA, AR, and RM). The first author's name, year of
publication, study design, country origin, sample size, sam-
ple criteria, age (mean ± SD or median (IQR)), lipid serum
parameters being assessed (mean ± SD or median (IQR)),
semen parameters being assessed (mean ± SD or median
(IQR)), statistical analysis or association value (RR, OR, or
correlation coefficient (r)) with p-value between parameter
or group. All these data were collected from each study. If
the required information is missing, we will contact the arti-
cle's related author. We do not perform quantitative analysis
because the statistical analysis between studies is different.
Quality and Risk of Bias Assessment
The Newcastle–Ottawa quality evaluation scale was used to
assess the quality of the studies that were included (NOQS).
This scale is designed to evaluate the quality of observa-
tional studies to produce a decent systematic review result.
The included studies were rated as high (9 stars), medium
(7–8 stars), or low (less than 7 stars) in terms of quality [28].
Results
We searched on eight databases, including PubMed,
EBSCO, ProQuest, Wiley Online, Web of Science, Springer
Link, Scopus, and Science Direct, using the PRISMA
Reproductive Sciences

flowchart (Fig. 1). We found 564 studies that were relevant
to the keywords. After then, four studies were found to be
duplicates. We chose nine possibly relevant papers after
screening them for written in English, on human studies,
obtain lipid serum and semen parameters study, and obser-
vational analytic study. Two of the nine research did not
match our criteria. These two papers did not provide in full
text and no information of statistical analysis of lipid serum
and sperm parameters value.
Finally, seven studies were eligible for qualitative anal-
ysis by recruiting 14.363 participants. The articles were
published from 2014 to 2020. Each study had a sample
size ranging from 17 to 7601 participants. Of all the stud-
ies included in this systematic review, three studies from

Records idenfied through database

searching
PubMed = 367, EBSCO = 38, Wiley = 52,
Springer = 76, Scopus = 17, ProQuest = 11,
Idenficaon

Web of Science = 3
n =564

Records aer duplicates removed

(n = 560)

Records excluded
Screening

(n = 551)
Not in English = 24, Not in human =
Records screened 192, Not lipid serum and sperm
(n = 560) study = 294, Literature Review =
28, Abstract preceding = 13

Records excluded (n = 2)
Full-text arcles assessed Non-Full-text arcles excluded = 1,
Eligibility

for eligibility No informaon of stascal lipid

(n = 9) serum value and sperm parameter
value = 1

Studies included in
qualitave synthesis
Included

(n = 7)

Fig. 1  PRISMA flowchart for study search

13

Europe, one from France, one from Russia, one from Italy.
Three studies were from Asia, one from Japan, one from
China, and one from Taiwan. And the rest from USA. The
age of the participants included in this study varied from
young adults to the elderly.
From seven studies, one cross-sectional study, two
case–control, and the rest cohort study (Table 1). The results
association of between lipid serum and semen parameters
are shown in Table 2. We also checked the quality of the
studies using NOQS. We found that two studies had high
quality, while five studies had medium quality.
Outcomes
We wanted to analyze each serum lipid parameter to the
semen parameter quantitatively (Table 2). However, the type
of statistical analysis and the design used in each study were
different. Three studies reported serum lipid levels associ-
ated with sperm morphology [29–31]. Schisterman et al.’s
study reported that two lipid parameters (triglycerides, free
cholesterol) affected sperm morphology [29]. The study by
Hagiuda et al. said that the sperm morphology of patients
with hypertriglyceridemia and normal triglycerides differed
significantly [30]. In contrast, the hypertriglyceridemia
group reported having average sperm counts that tended
to be higher than those in the normal group. Meanwhile,
research by Liu et al. said that all serum lipid profiles affect
sperm morphology [32].
Another parameter that was found to be significant was
motility; this was reported in one study [31] and then in
one significant study of semen volume [30]. One study
by Dupont et al. did not perform semen analysis but only
compared lipid levels in the fertile and infertile groups; the
results reported that HDL levels were different in these two
groups; the fertile group had lower HDL levels (1.25 (1.18,
1.13)) than the infertile group [32]. While the rest of the
study reported that there was no significant relationship
between serum lipids and semen parameters [33, 34].
Discussion
Lipids serum are laboratory parameters that are easy to
check and available in almost all centres. Lipid serum pro-
files are measures when predicting cardiovascular risks and
are now part of most routine tests. Many studies revealed
that abdominal obesity or metabolic syndrome harmed
sperm parameters [35–37]. Along with the increase in obe-
sity rates and cardiovascular risks, infertility in men also
increases. What is interesting to investigate is the significant
correlation between these serum lipid parameters and male
infertility (in this case, semen parameters). This systematic
13
Reproductive Sciences
review has compiled the search results for studies investigat-
ing this question.
Lipid is a chemicals that have been classified together due
to their lack of interaction with water. Some lipids, such as
steroid hormones, act as chemical messengers between tis-
sues, cells, and organs, while others signal that a single cell's
biochemical systems have a variety of functions and impor-
tance in the body; as a result, lipids are one of the blood
parameters linked to fertility and obesity [38]. Increased
triglycerides and fatty acids in seminal plasma have been
linked to sperm characteristics alterations. Gamete matura-
tion negatively affects in this lipid-rich environment [38].
Abnormalities in lipid metabolism have been observed in
various patients who are obese [39, 40]. According to Fein-
gold, 60 to 70% of individuals with obesity have dyslipi-
daemia [39]. Male fertility parameters are affected by lipid
plasma and lipid serum. Spermatozoa have a greater propor-
tion of neutral lipids with insignificant diacylglycerol levels
[41]. Cholesterol is present in seminal plasma of species like
humans; hence the synthesis and metabolism of lipids can
affect their reproduction.
The correlation between triglycerides level to seminal
plasma and sperm quality exists. The non-esterified fatty
acids in seminal plasma and sperm suggest then male infer-
tility can be affected by lipid metabolism [30]. Lipids play
a significant role in molecular processes for reproduction;
for example, cholesterol is the primary substrate for ster-
oid synthesis and affects the hormonal steroidogenesis and
milieu in both women and men [31, 42]. However, when
sperm parameters are changed due to elevation of fatty acids
and triglycerides. Hence, gamete maturation within a lipid-
rich environment impacts oocytes and spermatozoa, conse-
quently affecting fertility in men.
Five of all the studies analyzed reported a significant
relationship between lipid levels and semen parameters.
Three sperm parameters that are always attentive to are
sperm count, motility, and normal morphology. Dupont
et al. reported that HDL levels differed in the sub fertile and
fertile groups without examining semen parameters in the
two groups [32]. This report has many weaknesses though
significant. However, it remains to be considered that HDL
contributes to a male’s fertility profile. The research sample
of Dupont et al. reported having a history of self-reporting
tobacco consumption which is sometimes underestimated.
So this self-reporting tends to cause a bias in the research
results.
Along with HDL, Ferlin et al. also reported that HDL
affects the number of spermatozoa. In addition to HDL
parameters, LDL and triglycerides were also reported to give
different results on the number of spermatozoa [43]. Against
sperm count parameters, triglycerides and very-low-density
lipoprotein were also positively correlated with sperm con-
centration [34].
 Table 1  Characteristics of included studies
Author, year Study Country origin Sample size Sample criteria Age (mean ± SD or Lipid serum parameters Semen parameters Quality
median (IQR)) of study

Dupons et al., 2019 Case Control France Fertile = 100 Infertile: primary Infertile: 33.3 (32.2, Total cholesterol NR 9
Infertile = 96 idiopathic infertil- 34.3) HDL
Reproductive Sciences

ity, age < 45 years, Fertile: 34.4 (33.7, LDL

no severe oligozoo- 35.1) Triglycerides
spermia (< 5 million/
ml), no history of
undescended testis,
varicocele, or infec-
tion, no female
factors, female part-
ner < 38 years old
Fertile: volunteers, a
spontaneously con-
ceived Childs, time to
pregnancy less than
12 months, a female
partner < 38 years old
Schisterman et al., 2014 Cohort Prospective USA 501 The male who discon- 31.8 ± 4.9 Cholesterol Semen Volume 8
tinuing contraception, Free Cholesterol Sperm Concentration
not medically or Phospholipids Total Motility
surgically sterile, aged Triglycerides Morphology
18–51 years old Total Lipid DNA fragmentation
index
Osadchuk et al., 2020 Case–control Russia Normal semen = 55 Male volunteers aged 37.8 ± 10.9 Total cholesterol Semen volume 7
Impaired semen = 35 23–63 years old, Triglycerides Sperm concentration
absent from alcohol HDL Total motility
2–3 days, excluded LDL Progressive motility
for chronic or acute Vitality
disease history and
infection
Hagiuda et al., 2012 Cohort prospective Japan 167 Males who were sus- 36.5 ± 5.73 Triglyceride Sperm concentration 7
pected infertile with Total motility
aged 22–46 years old Morphology
Lu et al., 2016 Cohort Prospective China 631 Male fertile aged 29.37 ± 4.48 Total cholesterol Sperm concentration 9
18–55 years old, Triglycerides Progressive motility
stopping use con- HDL Morphology
traception, excluded LDL
for alcohol drink- Free fatty acid
ers, heavy smokers,
chronic disease infec-
tion of urogenital,
varicocele, or other
andrology histories

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 Reproductive Sciences

The interaction between lipids and sperm production has

of study
Quality
a complex and uncertain mechanism. The first mechanism
that impacts spermatogenesis is decreased testosterone levels
8

7
(hypogonadism) which leads to disturbances in spermatogen-

Sperm concentration
Progressive motility
esis so that the number of sperm formed decreases. Intrates-
Lipid serum parameters Semen parameters

ticular testosterone is indispensable in the process of sper-

Total motility
Sperm count

Morphology
matogenesis. Decreased testosterone in the case of increased
lipids can occur in several ways. One of them is the involve-
ment of leptin. Leptin levels elevation in hypogonadotropic
hypogonadism suggesting possible leptin resistance [44, 45].
In addition, in the case of obesity, where there is an increase
in the lipid profile, there is also an increase in the cytokine
Total cholesterol

Total cholesterol

TNF-alpha. TNF-alpha will elevate IL-6, IL-8, and COX2

Triglycerides

Triglycerides

expression in the hypothalamus and a macrophage infiltration

associated with a decrease in circulating gonadotropins that
VLDL
HDL

HDL
LDL

LDL

may lead to impaired spermatogenesis [46].

Other mechanism is an increase in oestrogen is also
suspected, but this is more common in the obese dyslipi-
Age (mean ± SD or

daemia group. There is an aromatization of testosterone

median (IQR))

into excess oestrogen: adipose tissue increases circulating

oestrogens and exaggerated feedback inhibition of GnRH-
31.7 ± 7.9

31(18,70)

gonadotropin secretion [47]. The last mechanism involved

in hypogonadism on dyslipidaemia is insulin resistance.
Dyslipidaemia can be another potential risk for metabolic
lem, smoking history
pituitary or testicular
of testicular cancer,
Male with no history

drug use that affect

function, no record

syndrome; nevertheless, dyslipidaemia is also associated

of andrology prob-

over 18 years old

Healthy male aged
orchiectomy, no

with insulin resistance [48]. GnRH neurons and kisspeptin

Sample criteria

neurons express insulin receptors [49, 50], and mice with a

selective neuronal knockout for insulin receptors show an
increased body mass and hypogonadotropic hypogonadism
[51]. However, the question that is difficult to answer is the
lipid parameters that impact sperm parameters.
Liu et al. reported that increased cholesterol such as tri-
glycerides and very-low-density lipoprotein would positively
Country origin Sample size

correlate with sperm motility [31]. In addition, the study

by Hagiuda et al. reported that there were significant dif-
5177

7601

ferences in sperm morphology between the hypertriglyc-

eridemia group and the normal group [30]. However, the
unique thing is that the hypertriglyceridemia group was said
to have a higher normal sperm morphology than the normal
Taiwan

triglyceride group. Liu et al. reported that all lipid profiles

Italy

correlated with sperm morphology, especially very-low-den-

sity lipoprotein [31]. Meanwhile, Schisterman et al. said that
Cross-sectional

lipid parameters such as triglycerides negatively correlate

Retrospective

with sperm morphology [29].

The involvement of lipids in sperm differentiation is still
Study

debated. The assumption is that lipids in the serum will

transport to the seminal plasma so that an increase in serum
lipids will cause an increase in lipids in the plasma seminal.
Table 1  (continued)

Lipids are needed in sperm differentiation to a certain extent.

Ferlin et al., 2019

Liu et al., 2016

The amount of cholesterol in sperm varies enormously in

Author, year

humans, even among ejaculates [25]; conversely, the fraction

of cholesterol present within sperm membranes is widely
linked to sperm morphology [26] and fertility potential [25].

13
 Table 2  Qualitative analyses of included study
Author, Year Results Conclusion

Dupont et al., 2019 Total Cholesterol Total Cholesterol Infertile: 5.2 (5.02,5.38) There is HDL has a sig-
fertile: 5.2 HDL: 1.38 (1.32, 1.44) none nificant difference
(5.01,5.40) LDL: 3.24 (3.06, 3.41) infor- between fertile and
Reproductive Sciences

HDL: 1.25 (1.18, Triglycerides: mation infertile groups

1.13) 1.20 (1.06, 1.33) about (p < 0.008)
LDL: 3.28 (3.09, semen
3.47) param-
Triglycerides: 1.42 eters
(1.23, 1.62)
Schisterman et al., Spearmen correlation between Cholesterol and semen volume (r = -0.004), total lipid and semen volume (r = -0.001), triglycerides and bicephalic morphology There is a nega-
2014 (r = -0.001), free cholesterol and sperm head with acrosome (r = -0.043), sperm head area (r = -0.008), sperm head perimeter (r = -0.005), phospholipids and tive correlation
sperm head with acrosome (r = -0.014), sperm head area (r = -0.002) between several
lipids and semen
parameters, espe-
cially morphology
Osadchuk et al., Lipid param- Lipid parameters impaired semen group (mmol/l) (mean (SD)) Overall No reliable cor-
2020 eters normozoo- Triglycerides: 1.40 (0.81) semen relation was found
spermia group Total cholesterol: 4.55 (1.24) param- between serum
(mmol/l) (mean HDL: 1.21 (0.42 eters total cholesterol,
(SD)) LDL: 2.70 (1.15) (mean triglyceride, high
Triglycerides: 1.31 (SE)) and low-density
(0.64) Semen lipoprotein choles-
Total cholesterol: volume: terol, and semen
4.40 (0.88) 3.3 parameters
HDL: 1.14 (0.36) (1.8)
LDL: 2.69 (0.92) Sperm
concen-
tration:
55.81
(45.77)
Progres-
sive
motil-
ity: 45.0
(26.5)
Normal
mor-
phol-
ogy:
6.95
(2.98)

13


Table 2  (continued)
Author, Year Results Conclusion

13
Hagiuda et al., Semen parameters in normal triglycerides (mean ± SD) Semen parameters in hyper triglycerides (mean ± SD) There is a signifi-
2012 Sperm concentration: 12.6 ± 8.60, Sperm concentration: 13.4 ± 7.87, cant difference in
Motility: 39.9 ± 18.0 Motility: 41.9 ± 15.8 morphology
Normal morphology: 10.1 ± 5.50 Normal morphology: 12.2 ± 5.82 between the
normal and
hypertryglic-
erides group
(p = 0.0386)
Lu et al., 2016 Overall Lipid serum (mmol/L) (Mean (SD)) Overall Semen parameters (mean (SD)) There was no
Triglycerides: 1.75 (1.67) Sperm concentration (­ 106/ml): 57.15 (44.67) significant cor-
Total cholesterol: 4.54 (1.00) Progressive motility (%): 33.14 (13.06) relation between
LDL: 2.55 (0.74) Total motility (%): 45.61 (18.42) serum lipids
HDL: 1.26 (0.29) Normal sperm morphology (%): 4.31 (1.69) levels and semen
parameters
Ferlin et al., 2019 Lipid parameters (mean ± SD) Semen parameters (mean ± SD) There is a sig-
Triglycerides (mg/dl): 111 ± 46 Sperm concentration: 30.1 ± 38.7 nificant difference
HDL: 51 ± 14 Progressive motility: 28.3 ± 21.0 between lipid
LDL: 110 ± 41 Normal morphology: 15.1 ± 12.7 levels (HDL,
Total cholesterol: 183 ± 38 LDL, and triglyc-
erides) and sperm
count (p = 0.01,
p = 0.008,
p = 0.019, respec-
tively)
Liu et al., 2017 There is a positive correlation between sperm concentration with triglyceride and very-low-density lipoprotein (adjusted p = 0.001 and p = 0.005, The men with
total sperm motility and progressive motility was increased with increasing low‐density lipoprotein and cholesterol levels (both adjusted p = 0.008 increased total
and p < 0.001), lipid profile and normal sperm morphology, especially low‐density lipoprotein and cholesterol with statistical significance (adjusted cholesterol were
p = 0.017 and p = 0.021) positively corre-
lated with sperm
motility. There
is a correlation
between all lipid
profiles and sperm
morphology
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Reproductive Sciences
However, small number study looks into the specific rela-
tionships between serum cholesterol or other lipid profiles
and sperm quality. Testicular cholesterol composed 26.50%
of total lipid, glycerides 28.50%, and phospholipids 45%
[52]. The lipid content of the sperm membrane altered dra-
matically throughout spermatogenesis, sperm maturation,
capacitation, and acrosome reaction [53]. These changes
presumably depended on the transfer of cholesterol and
phospholipids between sperm and seminal plasma [54].
Several investigations have identified a connection
between sperm membrane lipid composition and seminal
plasma [55] and increased phospholipid levels in seminal
plasma in oligozoospermia and azoospermia patients [56].
However, Liu et al. also suggested it's possible that the lipids
in seminal plasma aren't derived from blood [31]. Epithe-
lial cells in the male reproductive tract could be the source.
This raises how lipids in seminal plasma are regulated and
where they come from [56]. But what is certain is that the
increase of lipids levels in the seminal plasma will affect
sperm quality.
The mechanism involved in sperm abnormalities is an
increase in reactive oxygen species (ROS), which ulti-
mately causes disturbances in spermatogenesis such as
sperm count, sperm motility, and morphology. ROS also
even affects DNA damage. ROS can disrupt DNA integrity
by causing deletions, cross-links, frameshifts, and chromo-
somal rearrangements by modifying nucleic bases [57]. All
these because their plasma membranes contain huge lev-
els of polyunsaturated fatty acids (PUFA) [58], and their
cytoplasm contains deficient concentrations of scavenging
enzymes [59], spermatozoa are particularly sensitive to the
damage produced by excessive ROS. These intracellular
antioxidant enzymes cannot protect the plasma membrane
that surrounds the acrosome and tail, leaving spermatozoa
to rely on the seminal plasma for protection. The increase in
ROS can occur because ­H2O2 peroxidation the lipid compo-
nent. Actually, lipids are part of the sperm. However, if the
lipids in the seminal plasma are too excessive, peroxidation
will cause an excess of ROS [60]. Excess ROS will lead to
sperm damage and apoptosis (abortive).
Other reports have reported otherwise, Liu et al. and
Osadchuk et al. said no significant correlation between
serum lipid parameters and sperm parameters [31, 33].
This is in line with the statement of Liu et al. that it is very
likely that the selection of participants who are members
of the study tends to be biased and not random, especially
with a cross-sectional design [31]. If you want to see the
effect of exposure, lipids with sperm parameters, a cohort
design with a baseline sperm examination would be better
and prioritized. The sampling place for ejaculation col-
lection also needs to be considered because it can affect
(bias) sperm results. In addition, genetic risk factors such
as familial hypercholesterolemia or ApoE genotype should
be excluded. Many studies measure semen parameters such
as sperm count, motility, and morphology, but not many
have investigated sperm DNA.
The relationship between serum lipids and sperm
parameters may remain unanswered. However, obesity
was linked to higher serum lipid levels, leading to higher
seminal plasma lipid levels. Therefore we concluded that
lipid serum might impact sperm quality primarily through
aberrant lipid metabolism in the male reproductive system.
It's likely that unusual lipid levels in the male reproduc-
tive system directly cause poor semen quality. In addition,
research with similar objectives should also analyse exer-
cise habits and dietary patterns in the future.
Male with metabolic diseases, particularly dyslipidae-
mia, may be prescribed statins, which can lower testos-
terone levels and interfere with reproduction [61]. A pilot
study about the use of atorvastatin in healthy men revealed
that at least one altered semen parameter in 35% of the
subjects during atorvastatin treatment, and in 65% of the
subjects after withdrawal [41]. Contrary, a large-scale ret-
rospective study suggested that there are no deleterious
effects from statin use on conventional semen parameters
[62]. We assume that normal lipid level is required for
a good semen parameters, but excess or deficiency will
worsen them. Apart from that, controlling hyperlipidaemia
not only improves sperm but also maintains the overall
quality of life expectancy [63].
Conclusion
The association between serum lipids and semen param-
eters is still unclear. However, five of seven studies that
researched these two variables reported that serum lipids
have the potential to influence the quality of semen param-
eters. A study with a more appropriate design and suffi-
cient length of time is needed to confirm the correlation
between these two variables. While waiting, there is no
harm in providing an intervention to stabilize blood lipid
levels to improve sperm quality and a more decent quality
of life.
Author Contribution  CP: conceptualizing a systematic review study;
CP and BA: perform study searches in database; CP and BA: selecting
and extracting data from each eligible study; RM, AR, and AA: validate
the results of the selection and extraction of data that has been col-
lected; CP, AR, and RM: wrote the manuscript; AA and DD: reviewing
the manuscript; and all authors: finalized the manuscript.
Data Availability  There is no data support this article.
Code Availability  No code was used nor generated in this study.
13

Declarations  13. Belloc S, Cohen-Bacrie M, Amar E, et  al. High body mass
Ethics Approval  This study did not involve human participants, their
data or biological material, and therefore no ethics approval was
needed.
14. Tsao C-W, Liu C-Y, Chou Y-C, et al. Exploration of the associa-
Consent to Participate  This study did not involve human participants,
their data or biological material, and therefore no consent to participate
was needed.
15. Attaman JA, Toth TL, Furtado J, et al. Dietary fat and semen
Consent for Publication  This study did not involve human participants,
their data or biological material, and therefore no consent to publica-
16. Mendiola J, Torres-Cantero AM, Moreno-Grau JM, et al. Food
tion was needed.
Conflict of Interest  The authors declare no competing interests.
17. Liu C-Y, Chou Y-C, Chao JC-J, et al. The association between
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