Life’s Essential 8 Score and Male Reproductive Health: Insights from the Led-Fertyl Cohort on Sperm Quality

Highlights

• Higher Life’s Essential 8 (LE8) adherence correlates with enhanced sperm concentration and motility in healthy reproductive-aged men.
• Positively associated sperm parameters include total sperm count, total motility, and progressive motility with each 10-point increment in LE8 score.
• Men with the highest LE8 adherence are substantially less likely to present with abnormal seminogram results per WHO 2010 criteria.
• Findings underscore the importance of integrated cardiovascular health behaviors and factors in male reproductive potential.

Background

Male infertility is a growing public health concern worldwide, with declining sperm quality contributing significantly to reproductive challenges. While individual lifestyle and cardiovascular risk factors such as smoking, obesity, and physical inactivity have been implicated in impaired sperm parameters, comprehensive evaluation using an integrative cardiovascular health framework remains limited. Life’s Essential 8 (LE8) is an updated construct from the American Heart Association, encompassing four health behaviors (diet, physical activity, nicotine avoidance, sleep health) and four health factors (body weight, blood lipids, blood glucose, blood pressure), serving as a composite measure of ideal cardiovascular health (CVH). The Led-Fertyl cohort offers novel insights linking LE8 adherence with semen quality in healthy men of reproductive age.

Key Content

Study Design and Population

The Led-Fertyl study was a cross-sectional analysis conducted in Reus, Catalonia, Spain, involving 223 healthy men aged 18–40 years recruited from February 2021 to December 2024. This cohort was rigorously characterized for cardiovascular health (via LE8 score) and conventional sperm parameters. The LE8 score ranges from 0 to 100, calculated as the mean of eight component metrics reflecting health behaviors and clinical factors. This comprehensive approach allows for assessment of the cumulative effect of cardiovascular health on seminal outcomes.

Associations Between LE8 Score and Sperm Quality

Comparative analyses revealed that men in the highest LE8 tertile exhibited significantly better sperm concentration (β = 1.11; 95% CI: 0.12, 2.09), total motility (β = 6.05; 95% CI: 0.44, 11.65), and progressive motility (β = 5.84; 95% CI: 0.19, 11.48) relative to those in the lowest tertile. Continuous modeling further showed that each 10-point increase in LE8 score was associated with improvements in total sperm count (β = 0.88; 95% CI: 0.13, 1.63), sperm concentration (β = 0.45; 95% CI: 0.03, 0.86), and motility parameters. The odds of presenting an abnormal seminogram, according to WHO 2010 thresholds, were reduced by 68% among men with the highest LE8 adherence (OR: 0.32; 95% CI: 0.15, 0.67).

Integration with Existing Literature

Existing literature documents the detrimental effects of individual cardiovascular risk factors on male fertility. For instance, smoking is widely recognized to reduce sperm motility and concentration; obesity has been linked with altered hormonal milieu impairing spermatogenesis; and physical inactivity correlates with poorer semen quality. However, prior studies often evaluated these factors in isolation. The LE8 composite score captures synergistic effects of multiple lifestyle and clinical parameters, offering a more holistic understanding of male reproductive health. While data on LE8 are emerging, the Led-Fertyl cohort substantiates its relevance in reproductive-aged men.

Mechanistic Insights

The positive association between LE8 and sperm quality may be explained via several interconnected biological pathways. Healthy diet and physical activity reduce oxidative stress and inflammation, which are key contributors to sperm DNA damage. Adequate sleep supports hormonal regulation including testosterone secretion, essential for spermatogenesis. Maintaining healthy body weight and metabolic parameters optimizes endocrine function and testicular microenvironment, promoting sperm production and function. Avoidance of nicotine eliminates exposure to toxicants known to impair sperm parameters. Collectively, these factors enhance overall testicular health and function.

Limitations and Considerations

The cross-sectional design limits causal inference; reverse causality cannot be excluded. The relatively homogeneous population from a single Spanish geographical area restricts broader generalizability. Unmeasured confounders, such as environmental exposures or psychosocial stressors, may influence outcomes. Future prospective and interventional studies are warranted to confirm these associations and clarify temporal sequences.

Expert Commentary

The Led-Fertyl findings reinforce a critical clinical paradigm: cardiovascular health and reproductive function are closely intertwined. This integration moves beyond traditional siloed approaches, emphasizing lifestyle optimization as a potential avenue for simultaneously improving heart and reproductive health in men. LE8 provides a practical, standardized tool for clinicians and researchers to quantify cardiovascular wellness and its reproductive correlates.

The study underscores the importance of comprehensive lifestyle counseling in reproductive-age men, incorporating diet, exercise, tobacco cessation, sleep hygiene, and metabolic control. These factors collectively enhance sperm quality, with implications for fertility potential and offspring health. Furthermore, the results may inform public health strategies focused on male preconception care.

Biological plausibility is strong given that spermatogenesis is sensitive to systemic oxidative stress, inflammation, and hormonal milieu, all modifiable through LE8 components. Moreover, these findings may stimulate exploration of LE8 as a metric in fertility clinics and research, aiding risk stratification and targeted interventions.

Conclusion

The Led-Fertyl cohort study compellingly demonstrates that higher adherence to the Life’s Essential 8 cardiovascular health score is associated with favorable sperm quality parameters in healthy reproductive-aged men. Specifically, enhanced sperm concentration, total and progressive motility, and reduced odds of abnormal semen analyses were observed with greater LE8 adherence. These findings highlight the interdependence of cardiovascular and reproductive health, advocating for integrated lifestyle-focused approaches to improve male fertility outcomes. Nonetheless, prospective studies are needed to establish causality and evaluate the impact of LE8-targeted interventions on sperm quality and clinical fertility.

References

• Davila-Cordova E, Salas-Huetos A, Fernández de la Puente M, et al. Life’s Essential 8 score and its association with sperm quality parameters in reproductive-aged men: evidence from the Led-Fertyl cohort. Hum Reprod Open. 2025;2025(4):hoaf059. doi:10.1093/hropen/hoaf059. PMID: 41063806; PMCID: PMC12501419.
• Centers for Disease Control and Prevention. Life’s Essential 8: AHA’s new cardiovascular health metrics. [Internet]. Available from: https://www.cdc.gov/heartdisease/geriatric/lifes-essential-8.html
• Esteves SC. Novel perspectives on male infertility and oxidative stress: The mitochondria connection. Andrology. 2017;5(4):695-707. doi:10.1111/andr.12366
• Du Plessis SS, Cabler S, McAlister DA, Sabanegh ES, Agarwal A. The effect of obesity on sperm disorders and male infertility. Nat Rev Urol. 2010;7(3):153-161. doi:10.1038/nrurol.2010.5
• WHO Laboratory Manual for the Examination and Processing of Human Semen. 5th ed. Geneva: World Health Organization; 2010.