| Summary: | The influence of individual lifestyle factors is widely described in studies on semen quality. However, their synergistic effect is often neglected. The aim of the study was to examine the association between semen quality and dietary approaches to stop hypertension (DASH) diet, physical activity (PA), and the two separately and in combination. A cross-sectional study was carried out among 207 men aged 20−55. Dietary data were collected by a food frequency questionnaire (FFQ) and analysed according to the DASH scoring index. Physical activity was evaluated by the International Physical Activity Questionnaire. Semen parameters were assessed via the computer-aided semen analysis (CASA). Adherence to the DASH diet was associated with higher sperm count (Δ<i><sub>T3-T1</sub></i> = 82.1 mln/ej) and concentration (Δ<i><sub>T3-T1</sub></i> = 24.6 mln/mL). Higher PA was related to higher sperm count (Δ<i><sub>T3-T1</sub></i> = 69.4 mln/ej), total (Δ<i><sub>T3-T1</sub></i> = 11.9%), and progressive motility (Δ<i><sub>T3-T1</sub></i> = 8.5%) and morphology (Δ<i><sub>T3-T1</sub></i> = 2.8%) in the crude model and remained significant after adjustment. The combination of the DASH diet and PA, was significantly positively associated with sperm count (Δ<i><sub>T3-T1</sub></i> = 98.1 mln/ej), sperm concentration (Δ<i><sub>T3-T1</sub></i> = 17.5 mln/mL), total (Δ<i><sub>T3-T1</sub></i> = 11.8%), and progressive motility (Δ<i><sub>T3-T1</sub></i> = 10.0%) and morphology (Δ<i><sub>T3-T1</sub></i> = 3.3%) in both models. Adherence to the DASH diet was related to higher sperm count and concentration, whereas after its combination with physical activity it was also positively correlated with sperm motility and morphology.
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