When it comes to fertility and difficulties with conceiving, the focus is often placed squarely on reproductive health -- and more often than not, through a female-centric lens.
But for the one in six couples in Ireland who experience infertility, that tells only part of the story. In fact, up to 50% of infertility cases involve a male factor, according to nutritional therapist Amy Swan, who specialises in fertility.
'It's a huge percentage, and the reality is that many people just aren't aware,' says Amy, noting that global sperm counts have fallen by around 50% since the 1970s.
'This decline is predominantly down to lifestyle factors and the foods we are eating.'
Amy, a mum of two, has heavily researched the decline in male sperm health and previously presented her findings at the World Health Congress.
She explains that while fertility clinics often assess whether sperm are present, swimming in the right direction and moving fast enough, fertility is far more complex than that.
'There's something called sperm DNA fragmentation, which increases over time when oxidative stress in the body is high,' she explains.
'Oxidative stress is a natural process, but it's made far worse by lifestyle factors and nutrition. When you address those, you can clean up oxidative stress and significantly improve sperm quality. There's actually a lot that men can do.'
And one of her most practical pieces of advice is also one of the simplest.
'Change your underwear type if you're wearing tight-fitting underwear. Testes need to be cool -- you need to let them 'hang out' -- heat damages sperm. Saunas, excessive cycling and prolonged heat exposure can all have a big impact on fertility.'
Alcohol intake, smoking or vaping, ultra-processed foods, nutrient-poor diets and chronic stress all play a role too.
'Both sperm and egg quality decline with age,' Amy says. 'So antioxidants, a nutrient-dense diet and reducing toxin exposure are really important for men and women alike.'
As a nutritional therapist, Amy -- who has a clinic in Blackrock, Co Dublin - works strictly from an evidence-based perspective, creating tailored plans that work with a client's existing lifestyle rather than against it.
'It's about small, easy, achievable tweaks,' she says. 'But I always remind clients that these changes aren't just for fertility -- they're part of a healthspan strategy. We're living longer, but not necessarily healthier.Making lifestyle changes now also supports how well you live later in life.'
Amy, who is married to David and has a daughter, Riley and son, Cooper, was previously involved in project management, and segued into this line of work for deeply personal reasons, having herself faced significant fertility challenges due to type 1 diabetes and thyroid issues.
'We had a very difficult journey trying to conceive,' she says. 'We became pregnant initially, somewhat unexpectedly, and sadly had a miscarriage at our wedding in Ibiza,' she reveals, adding that after that heartbreak, she had several rounds of IVF.
'We did become pregnant again, but our baby had Edwards' syndrome, and I had to undergo a medical termination,' she says.
That tragedy ultimately led Amy to retrain as a nutritional therapist, later specialising in fertility, training and working with Sandra Greenbank at the Fertility Nutrition Centre in London. Today, Amy runs her own clinic in Blackrock, Co Dublin, supporting clients with fertility issues, PCOS, endometriosis, IVF preparation and general reproductive health.
'I understand how lonely and overwhelming this journey can feel,' she says, adding that in fact, stress can be one of the biggest and most overlooked factors in a couple's fertility.
'Mental stress creates physical stress throughout the body, affecting sleep, mood, weight and cortisol. When the body is in that state, it's not functioning at its full potential, affecting sleep, mood, cortisol levels,' she says.
For couples preparing for IVF, Amy often uses a simple analogy.
'You wouldn't send your car straight for an NCT if you knew something was wrong -- you'd service it first. I say the same about fertility. Don't spend thousands on IVF until you understand what's going on and optimise egg and sperm health first.
'It takes at least three months for egg and sperm quality to improve once you make diet and lifestyle changes,' she says. 'That's why I encourage couples to prepare in advance where possible.'
Her programmes are highly personalised, based on detailed health histories, family background, medications, supplements and test results. 'The plan for the man will be completely different to the female's," she explains. 'Identifying lifestyle barriers and supporting behavioural changes and hugely important steps.'
Basic nutrition, of course, is foundational: three balanced meals a day, a protein-rich breakfast to stabilise blood sugar, and as much colour on the plate as possible. 'Sometimes people are just lost and need help getting back on track,' she says. 'That support can make a real difference -- not just for fertility,but for long-term health.'
Amy's life-enhancing recipes
PRAWN, AVOCADO and FETA SALAD
Prawns are packed with protein, low in fat, a great source of selenium, iodine (great for thyroid health) and vitamin B12.
Serves 2.
Ingredients:
- 50g feta/cottage cheese
- 200g cooked prawns, responsibly sourced.
- 1 avocado, peeled and chopped
- 20 cherry tomatoes, halved
- 2 spring onions, finely sliced
- Salad leaves (include spinach for an iron & folate boost)
- 1 tbsp olive oil
- 1 tbsp lemon juice
- 2 tsp dried oregano
- Salt and pepper to taste
Method:
- Make the dressing by mixing the lemon juice, olive oil and oregano.
- Mix up the rest of the ingredients in a bowl, pour over the dressing, season and serve.
BERRY BREAKFAST SMOOTHIE
This quick and easy smoothie is a good way to support your energy across the day whilst supporting those short on time.
Serves 1
Ingredients:
- 1/2 small banana (frozen or fresh)
- 2 tsp of essential seed mix(flaxseed/chai/ pumpkin/ sunflower seeds)
- 1 small handful of blueberries (or other berries) - fresh or frozen
- Juice of 1/2 lemon
- I ÷ tablespoon of Greek yoghurt
- Plus enough water or milk of your choice to give an easy-to-drink consistency
Method:
- Place all the ingredients in a blender, add desired amount of water or milk and blend to make your perfect smoothie.
MEDITERRANEAN FRITTATA
Eggs are such a versatile food packed with protein, choline, Vitamin D, B12, and selenium, supporting brain, eye, bone, reproductive and muscle health.
Serves 2
Ingredients:
- 200g baby spinach
- 10 cherry tomatoes
- 1 tbsp olive oil/coconut oil
- 1 red onion, thinly sliced
- 40g black olives, pitted and halved
- 6 free-range eggs, lightly beaten and seasoned with salt and pepper
- 115g feta cheese, cubed
Method:
- wilt the spinach in a covered saucepan for 2 to 3 minutes, or steam (preferable). Once cooked, squeeze out any excess water.
- Heat the oil in an ovenproof frying pan and fry over a gentle heat until the onion is soft.
- Pre-heat the grill to medium heat while the onions are cooking.
- Spread the onion, spinach and olives over the base of the pan.
- Pour the eggs over the mixture and scatter the feta on top.
- Set the base by cooking over a low to moderate heat for about 5 minutes.
- Cook the top of the frittata under the grill for about 3 minutes, until golden. Serve with a fresh green salad seasoned with lemon juice and olive oil.
CELERIAC & FENNEL SOUP
Eating in season is often more financially viable but also seasonal produce tend to be more nutritious - this recipe is great for this time of year. Top with cottage cheese for an added protein boost.
Ingredients:
- 300g fresh fennel, finely chopped (including the green part)
- 230g celeriac, peeled and finely chopped
- 1 garlic clove, finely chopped
- 2 tbsp olive oil
- 1 tsp coriander seeds
- ¼ tsp ground nutmeg
- 850ml water
- 1 good-quality vegetable stock cube
- 140g butter
- Juice of a lemon
- Salt and ground black pepper, to season
- Handful of fresh dill or fresh coriander, to garnish
- Sunflower and pumpkin seeds to garnish
Method:
- Fry all the vegetables in oil in a large pan for a few minutes, over a low heat to avoid burning. Stir occasionally to prevent sticking.
- When the vegetables have softened, add the coriander seeds and nutmeg, stir and fry for another minute.
- Add the stock cube to boiling water and dissolve, then add to the pot.
- Bring to a boil and lower the heat, simmering for about 10 mins or until everything is soft.
- Add the butter and lemon juice and stir.
- Remove from the heat and bend to the desired consistency. Season to taste.
- Garnish with a dessert spoon of sunflower and pumpkin seeds, and a sprinkling of fresh herbs.
LENTIL BOLOGNESE
Lentils are a great source of protein, iron, folate and fibre and this is an easy way to include them in your diet.
Serves 4
Ingredients:
- 120g red lentils, rinsed
- 1 onion, finely chopped
- 2 garlic cloves, minced
- 2 celery sticks, finely chopped
- 2 carrots, grated
- 6 mushrooms, finely chopped -->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->-->