Nutritional supplements not a Holy Grail solution for male infertility, but worth considering
A variety of nutritional supplements are available on the market touted to reverse male infertility by improving sperm count, health and morphology. But do they really?
Physicians and patients alike want to use therapies proven both effective and safe to use. Many studies have been conducted on several supplements to evaluate whether they are, in fact, safe and effective.
The problem with some of these studies is that there is no standard dose for many of the supplements, and few of the studies attempted to assess whether there was any deficiency in patients before initiating therapy. Also, keep in mind that a well-balanced diet will already include many of these supplements.
So how do we interpret such mixed results? When there are contrary results from different, well–designed, randomized studies, it raises questions such as:
- Was there a different patient population being studied?
- How long was the population studied?
- Was there a deficiency in this substance prior to enrolling in the study?
- Are there are other variables that are not being adequately controlled?
When in doubt, ask the expert urologist
Urologists specializing in male infertility can help the male and his partner achieve a pregnancy in many ways. Most studies on nutritional supplements include patients with idiopathic issues (i.e. without any identifiable cause). It is therefore imperative to work closely with a physician with this expertise to look for and correct any other underlying issues before self-treating with a supplement.
Regardless of what supplement you choose to take, it is important to limit the amount ingested. Even if the supplement is beneficial, consuming excessive amounts of over-the-counter supplements may be detrimental to sperm production and can have serious adverse effects, ranging from gastrointestinal upset to effects on the central nervous system (fatigue, irritability, headache, vision changes). It is important to work closely with your infertility specialist to identify which supplements are appropriate at what dosages.
Physicians Ko and Sanbanegh and Zini and Al-Hathal recently reviewed the medical literature to see if supplements are helpful or not. The following represents a partial list of supplements that have been purported to be helpful.
Supplements: some work, some don’t
Selenium supplementation has been studied mostly in combination with other vitamins. The results in these studies have largely been positive, once again suggesting that selenium supplementation may be beneficial, particularly in those who had low selenium levels.
Carnitine is an energy source for cells in general, and in particular for sperm. Some studies have shown it to be effective in improving sperm count, motility (ability to properly move through the female reproductive tract) and pregnancy rates. While in other studies, no significant benefit was observed. Given the demonstrated benefit in at least some of the studies, it is possible that carnitine supplements will be beneficial with those patients who have an abnormal semen analysis.
Coenzyme Q-10 protects cells from oxidative stress, so in theory it would seem beneficial for damaged sperm. Unfortunately, the data supporting its use are contradictory, with some studies showing improvement in sperm quality and other studies showing no improvement whatsoever. Given this fact, the conclusion that can best be drawn is that coenzyme Q-10 may be beneficial.
Vitamins A, C and E, generally regarded as the main antioxidant vitamins, have been studied largely in combination to assess for any benefit in male fertility. Once again, the data are confusing, with some studies showing some benefit and others showing no benefit at all.
N-acetylcysteine decreases free radical levels, and thus may decrease oxidative injury to cells. Several studies have demonstrated improvement in semen analysis parameters. However, due to high risk of significant side effects and the difficulty of absorbing adequate amounts into the bloodstream from oral supplementation, this supplement is seldom used.
Zinc supplements, taken in the presence of zinc deficiency, have shown to be beneficial. However, with a well-balanced diet, zinc deficiency is quite rare. Given the low incidence of zinc deficiency and the potential side effects of zinc supplementation, it is seldom recommended.
Arginine has an important role in preventing oxidative injury in cells. So in theory, this would be a useful supplement to improve sperm quality. No randomized clinical trials have demonstrated efficacy, so the use of arginine cannot be recommended.
Remember, there is no magic bottle or potion that will ensure a pregnancy. But taking steps, such as working with a urologist to identify possibly beneficial fertility supplements, will put you in the best possible position to conceive.