Checklist for Male Infertility

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Men concerned about their fertility often look for easy alternatives to improve their sperm count. Often times men try to improve their sperm count by researching over-the-counter vitamins, minerals, herbs and dietary supplements. Scientific data regarding many of these alternatives are either lacking or unconvincing. But a few of them do show some promise in improving a man’s fertility potential. Excessive amounts of any nutrient can have detrimental effects upon health and fertility. Consult your doctor before taking any substance in excess of the Recommended Dietary Allowance (RDA).

Rating Nutritional Supplements: Vitamin C (for sperm agglutination only) Zinc (for deficiency) Arginine L-Carnitine Selenium Vitamin B12 Asian Ginseng Acetyl-L-Carnitine Coenzyme Q10 SAMe Vitamin E

What are the symptoms of infertility? The inability of a couple to become pregnant after one year of regular, unprotected sex may indicate infertility of one or both sexual partners. Low sperm count in the semen, decreased sperm motility, or abnormal shape of the sperm are responsible for infertility in about 40% of these couples.

Conventional treatment options: Initial treatments may include timing sexual activity for ovulation (usually during the second week of the menstrual cycle), avoiding drugs that may reduce sperm count, and limiting intercourse to no more than every three days, except during ovulation. Artificial insemination can also be used to place sperm directly in the cervix or uterus. Another more advanced procedure is called “in vitro fertilization” (IVF), wherein the man’s sperm and the woman’s egg (collected from the ovary in a surgical procedure) are combined under controlled conditions in a laboratory. The fertilized embryo is then implanted into the woman’s uterus.

Dietary changes that may be helpful: In a study of men with poor sperm quality, excessive alcohol consumption was associated with a decrease in the percentage of normal sperm.(1) In a study of Danish greenhouse workers, an unexpectedly high sperm count was found among organic farmers, who grew their products without the use pesticides or chemical fertilizers. The sperm count was more than twice as high in these men as in a control group of blue-collar workers.(2) Although these findings are not definitive, they suggest that consuming organically grown foods may enhance fertility.

Lifestyle changes that may be helpful: Some conventional medications can interfere with fertility. If in doubt, men taking prescription drugs should consult their physician.

The optimal temperature of the testes for sperm production is slightly lower than body temperature, which is why the testes hang away from the body in the scrotum. Men with low sperm counts are frequently advised to minimize lifestyle factors that may overheat the testes, such as wearing tight (e.g., “bikini-style”) underwear or frequently using spas and hot baths.

Environmental exposures (e.g., formaldehyde), smoking, and use of recreational drugs (e.g., marijuana, cocaine, hashish) may reduce sperm count or cause abnormal sperm morphology (shape).(3,4) Smoking adversely affects the semen quality of infertile men.(5)

Nutritional supplements that may be helpful: Vitamin C protects sperm from oxidative damage.(6) Supplementing vitamin C improves the quality of sperm in smokers.(7) When sperm stick together (a condition called agglutination), fertility is reduced. Vitamin C reduces sperm agglutination,(8) and supplementation with 200–1,000 mg per day increased the fertility of men with this condition in a controlled study.(9,10)

Many doctors recommend 1 gram of vitamin C per day for infertile men, particularly those diagnosed with sperm agglutination. However, a double-blind trial studying the effects of combined vitamin C and vitamin E supplementation found no improvements in semen quality among men with low sperm motility.(11)

Zinc deficiency leads to reduced numbers of sperm and impotence in men.(12) The correlation between blood levels of zinc and sperm quality remains controversial. Infertile men have been reported to have lower levels of zinc in their semen, than do men with normal fertility.(13) Similarly, men with normal sperm density tend to have higher amounts of zinc in their semen, than do men with low sperm counts.(14)

However, other studies have found that a high concentration of zinc in the semen is related to decreased sperm motility in infertile men.(15,16) A few studies have shown that oral zinc supplementation improves both sperm count(17,18) motility,(19,20) and the physical characteristics of sperm in some groups of infertile men.(21)

For infertile men with low semen zinc levels, a preliminary trial found that zinc supplements (240 mg per day) increased sperm counts and possibly contributed to successful impregnation by 3 of the 11 men.(22) However, these studies all included small numbers of volunteers, and thus the impact of their conclusions is limited. In a controlled trial, 100 men with low sperm motility received either 57 mg of zinc twice daily or a placebo.(23) After three months, there was significant improvement in sperm quality, sperm count, sperm motility, and fertilizing capacity of the sperm. The ideal amount of supplemental zinc remains unknown, but some doctors recommend 30 mg two times per day. Long-term zinc supplementation requires 1–2 mg of copper per day to prevent copper deficiency.

Arginine, an amino acid found in many foods, is needed to produce sperm. Research, most of which is preliminary shows that several months of L-arginine supplementation increases sperm count, quality,(24-26) and fertility.(27,28) However, when the initial sperm count was extremely low (such as less than 10 million per ml), L-arginine supplementation produced little or no benefit.(29,30) While some pregnancies have been attributed to arginine supplementation in preliminary reports,(31) no controlled research has confirmed these claims. For infertile men with sperm counts greater than 10 million per milliliter, many doctors recommend up to 4 grams of L-arginine per day for several months.

In a double-blind study of infertile men with reduced sperm motility, supplementation with selenium (100 mcg per day for three months) significantly increased sperm motility, but had no effect on sperm count. Eleven percent of 46 men receiving selenium achieved paternity, compared with none of 18 men receiving a placebo.(32)

Vitamin B12 is needed to maintain fertility. Vitamin B12 injections have increased sperm counts for men with low numbers of sperm.(33) These results have been duplicated in double-blind research.(34) In one study, a group of infertile men were given oral vitamin B12 supplements (1,500 mcg per day of methylcobalamin) for 2 to 13 months. Approximately 60% of those taking the supplement experienced improved sperm counts.(35) However, controlled trials are needed to confirm these preliminary results. Men seeking vitamin B12 injections should consult a physician.

L-Carnitine is a substance made in the body and also found in supplements and some foods (such as meat). It appears to be necessary for normal functioning of sperm cells. In preliminary studies, supplementing with 3–4 grams per day for four months helped to normalize sperm motility in men with low sperm quality.(36,37) While the majority of clinical trials have used L-carnitine, one preliminary trial found that acetylcarnitine (4 grams per day) may also prove useful for treatment of male infertility caused by low quantities of immobile sperm.(38)

Coenzyme Q10 (CoQ10) is a nutrient used by the body in the production of energy. While its exact role in the formation of sperm is unknown, there is evidence that as little as 10 mg per day (over a two-week period) will increase sperm count and motility.(39) In one study, men with low sperm counts were given CoQ10 (60 mg per day for about three months). No significant change was noted in most sperm parameters, but a significant improvement was noted in in-vitro fertilization rates.(40)

Vitamin E deficiency in animals leads to infertility.(41) In a preliminary human trial, 100–200 IU of vitamin E given daily to both partners of infertile couples led to a significant increase in fertility.(42)

Vitamin E supplementation may enhance fertility by decreasing free-radical damage to sperm cells. In another preliminary study, men with low fertilization rates in previous attempts at in vitro fertilization were given 200 IU of vitamin E per day for three months.(43) After one month of supplementation, fertilization rates increased significantly, and the amount of oxidative stress on sperm cells decreased. However, the evidence in favor of vitamin E remains preliminary. A review of research on vitamin E for male infertility concluded that there is no justification for its use in treating this condition.(44) Controlled trials are needed to validate these promising preliminary findings.

Preliminary research suggests that oral SAMe (S-adenosyl-L-methionine), in amounts of 800 mg per day, may also increase sperm activity in infertile men.(45)

Calcium is a key regulator of human sperm function.(46) The concentration of calcium in semen determines sperm motility (i.e., the ability of sperm to move spontaneously).(47,48) However, calcium deficiency has not been confirmed as a cause of male infertility nor is there any evidence that calcium supplementation improves male infertility.

Are there any side effects or interactions? Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful: Asian Ginseng may prove useful for male infertility. One preliminary study found that 4 grams of Asian ginseng per day for three months led to an improvement in sperm count and sperm motility.(49)

Are there any side effects or interactions? Refer to the individual herb for information about any side effects or interactions.

Other integrative approaches that may be helpful: Acupuncture may be helpful in the treatment of some cases of male infertility due to impairment of sperm function. A controlled study of men with reduced sperm function found that one measure of sperm function significantly improved in the men treated with acupuncture (two times per week for five weeks) compared to controls.(50) Similar results have been reported in other studies.(51,52) Nevertheless, double-blind trials are needed to determine conclusively whether acupuncture is a useful treatment for male infertility.

References: 1. Goverde HJM, Dekker HS, Janssen HJG, et al. Semen quality and frequency of smoking and alcohol consumption - an explorative study. Int J Fertil 1995;40:135–8. 2. Abell A, Ernst E, Bonde JP. High sperm density among members of organic farmers’ association. Lancet 1994;343:1498. 3. Hruska KS, Furth PA, Seifer DB, et al. Environmental factors in infertility. Clin Obstet Gynecol 2000;43:821–9. 4. Wang SL, Wang XR, Chia SE, et al. A study on occupational exposure to petrochemicals and smoking on seminal quality. J Androl 2001;22:73–8. 5. Zhang JP, Meng QY, Wang Q, et al. Effect of smoking on semen quality of infertile men in Shandong, China. Asian J Androl 2000;2:143–6. 6. Fraga CG, Motchnik PA, Shigenaga MK, et al. Ascorbic acid protects against endogenous oxidative DNA damage in human sperm. Proc Natl Acad Sci 1991;88:11003–6. 7. Dawson EB, Harris WA, Teter MC, Powell LC. Effect of ascorbic acid supplementation on the sperm quality of smokers. Fertil Steril 1992;58:1034–9. 8. Dawson EB, Harris WA, McGanity WJ. Effect of ascorbic acid on sperm fertility. Fed Proc 1983;42:531

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