Why Are Women Told to Stop Drinking, But Men Aren't?

So how many of you attended your IVF consultation and were told that women must not drink alcohol whilst trying to conceive, but men need not adjust their drinking habits?

How many of you simply accepted that to be true?

I'd hazard a guess and say almost all of you.

By the time couples arrive in my clinic, I often find that women haven't touched alcohol in years since their first IVF cycle, whilst their partners have continued drinking throughout. Nobody has ever questioned it. Not the couple. Not the GP. Not the fertility clinic.

What I find fascinating is how readily accepted this advice has become when the evidence isn't nearly as clear-cut as many people assume.

In fact, when you start digging into the research, a rather different picture begins to emerge.

What Does the Research Say About Women and Alcohol?

A 2016 Danish study, considered one of the largest of its kind, followed more than 6,000 women trying to conceive and looked at how alcohol intake affected their time to pregnancy.

The researchers found that low-to-moderate alcohol consumption (1–7 drinks per week) did not appear to significantly reduce fertility.

The signal for reduced fertility only started appearing at higher levels of consumption (14 or more drinks per week).

A later Danish study looking specifically at fertility treatment found similar results, with low-to-moderate alcohol intake during IVF and ICSI not being significantly associated with lower pregnancy or live birth rates.

Now before anyone rushes out to order a bottle of prosecco, that's not what I'm saying.

We know alcohol exposure during pregnancy can be harmful to a developing baby. Once pregnant, the advice is clear.

But fertility advice and pregnancy advice seem to have become bundled together.

Historically, most women would have consumed alcohol as normal, conceived naturally, discovered they were pregnant, and then stopped drinking. Yet women undergoing IVF are often advised to avoid alcohol entirely, sometimes for years on end, whilst carrying a considerable burden of guilt if they occasionally stray from the rules.

Why I Still Advise Women to Be Cautious

This is where things get slightly awkward for me.

From a Chinese Medicine perspective, alcohol isn't something I recommend when trying to conceive.

And from a practical perspective, I still tend to advise women to minimise alcohol intake where possible.

Not because I think a single glass of wine will ruin an IVF cycle, but because fertility treatment is often emotionally and financially significant, and many people feel more comfortable knowing they've done everything they reasonably can.

So yes, I still encourage moderation.

But this is where I differ from many fertility clinics.

What About Men?

This is the one thing I feel much more strongly about.

If a man is trying to conceive naturally, preparing for IVF, or hoping to improve embryo quality and reduce miscarriage risk, I think alcohol deserves far more attention than it currently receives.

And that opinion isn't based on folklore.

It's based on the growing body of evidence linking alcohol with:

Poorer semen quality
Oxidative stress
Hormonal disruption
Reduced antioxidant capacity
Sperm DNA damage

A large study involving more than 27,000 couples undergoing fertility treatment found that men consuming around one alcoholic drink per day had approximately a 9% lower live birth rate compared with non-drinkers.

Does that prove that every drink damages sperm?

No.

But it does challenge the idea that alcohol is irrelevant to male fertility.

And that's the point.

The uncomfortable reality is that we still don't know exactly where the "safe" threshold lies for sperm health.

The Bit We Rarely Talk About

One of the biggest problems in male fertility is that we often assess sperm very superficially.

A semen analysis tells us about:

Count
Motility
Morphology

What it doesn't tell us is whether the DNA inside those sperm is intact.

This is where sperm DNA fragmentation becomes important.

Lifestyle factors such as alcohol, smoking, vaping, obesity, poor sleep and oxidative stress may affect sperm at the DNA level long before they show up on a standard semen analysis.

A man can therefore have a "normal" semen analysis and still have significant DNA damage.

This is one of the reasons we offer sperm DNA fragmentation testing within the clinic.

The Hidden Burden on Women

There's another side to this conversation that often gets overlooked.

A fertility journey can already feel incredibly one-sided.

Women are expected to modify their diet, avoid alcohol, take supplements, attend appointments, inject medications, undergo scans, endure egg collections and embryo transfers.

Meanwhile many men are given the impression that they can simply carry on as normal and show up when needed.

Over time, this can create a feeling of isolation for women.

Many of my patients describe feeling as though they're carrying the entire responsibility for the outcome, whilst their partner's role is treated as secondary.

Yet fertility is a couple's issue.

And if we're asking women to make sacrifices in pursuit of a healthy pregnancy, perhaps it's reasonable to ask men to make some too.

It's Not Just About Fertility

There is increasing interest in the role paternal health plays in offspring health.

Emerging research suggests that sperm contribute much more than half of a child's DNA. Environmental exposures, lifestyle factors and sperm DNA integrity may all influence embryo development and potentially long-term health outcomes.

Whilst this area of science is still evolving, one thing is becoming increasingly clear:

Male preconception health matters.

Conclusion

I'm not suggesting women should drink heavily during IVF.

But I do think it's worth asking why we scrutinise every glass of wine consumed by the female partner whilst often paying relatively little attention to the lifestyle factors affecting sperm quality.

If I had to choose one partner to focus on reducing alcohol consumption before IVF, it probably wouldn't be the one most fertility clinics focus on.

If we're serious about improving fertility outcomes, perhaps it's time we stopped focusing on just half the equation.

References

Mikkelsen EM, Riis AH, Wise LA, et al. Alcohol consumption and fecundability: prospective Danish cohort study.BMJ Open. 2016. Study of 6,120 women trying to conceive found that consumption below 14 drinks per week appeared to have no discernible effect on fertility, with reduced fecundability mainly observed at higher levels of intake.
Lyngsø J, Ramlau-Hansen CH, Bay B, et al. Low-to-moderate alcohol consumption and success in fertility treatment: a Danish cohort study. Human Reproduction. 2019. Found that low-to-moderate alcohol consumption during IVF/ICSI was not significantly associated with lower pregnancy or live birth rates.
Finelli R, Sansone A, Piazzolla CR, et al. Impact of Alcohol Consumption on Male Fertility Potential. Andrology. 2021. Review highlighting associations between chronic alcohol consumption, oxidative stress, poorer semen quality, hormonal disruption and DNA integrity damage.
Nguyen-Thanh T, et al. Investigating the Association Between Alcohol Intake and Male Reproductive Function.2023. Review finding evidence that alcohol consumption affects semen volume, antioxidant status and reproductive hormones, negatively influencing male reproductive health.
Trautman A, et al. Effects of Alcohol Use on Sperm Chromatin Structure. 2023. Study exploring the relationship between alcohol intake and sperm DNA integrity/chromatin structure.
Rao W, et al. Association Between Alcohol Consumption and IVF/ICSI Outcomes: Systematic Review and Meta-analysis. 2022. Found that male alcohol consumption above 84g/week was associated with decreased live birth rates following IVF/ICSI treatment.
Klonoff-Cohen H, Lam-Kruglick P, Gonzalez C. Effects of Maternal and Paternal Alcohol Consumption on IVF and GIFT Outcomes. Fertility and Sterility. 2003. Early study linking paternal alcohol consumption with poorer assisted reproduction outcomes.
Amor H, et al. Impact of Heavy Alcohol Consumption and Cigarette Smoking on Sperm DNA Integrity. 2022. Found significantly higher sperm DNA fragmentation in heavy alcohol users.
Sengupta P, et al. Oxidative Stress Affects Sperm Health and Fertility. 2024. Review discussing oxidative stress, sperm dysfunction and DNA damage as key mechanisms in male infertility.
Romano M, et al. High Sperm DNA Fragmentation: Do We Have Robust Evidence? 2023. Review discussing lifestyle factors, including alcohol, oxidative stress and sperm DNA fragmentation.

Truth Fertility