Nutritional Recommendations for Male Infertility Patients
Barrett Cowan MD, Urology Associates, Englewood, CO
It is estimated that one in eight couples have difficulty with conception. Of those who have difficulty, approximately 50% of the time, there is an issue with the male partner (i.e., male factor). Fortunately, it is relatively easy to assess whether there is a male factor present or not by having the male collect a semen sample and have it analyzed in a laboratory. This is called a semen analysis. When performing a semen analysis, there are four main variables which are evaluated, including the semen volume, sperm count (how many sperm are present), motility (what percentage of the sperm are swimming) and morphology (what percentage of sperm look “normal” by very strict criteria).
When a male infertility specialist evaluates a patient with an abnormal semen analysis, the initial goal is to identify any reversible causes and correct them in order to improve the semen analysis, and thus facilitate conception. In this process, patients will frequently inquire what they can do as individuals to improve their semen analysis and therefore their chances of successful conception. Exposure to toxic substances may have an adverse on sperm production, thus patients are encouraged to avoid exposure to tobacco products, toxic chemicals, testosterone supplements, alcohol in excess, marijuana and to exogenous sources of heat (hot tub, steam room, sauna, etc.). As well as avoiding negative exposure, patients are interested to know if there are positive interventions that that they can do to improve their situation, such as taking nutritional supplements.
When sperm are damaged, frequently it occurs through an oxidative injury process. When this is the case, it has been postulated that the addition of anti-oxidant supplements may minimize this oxidative injury and thus be beneficial. However, what happens in theory, may be not turn out to be the case in reality.
There are a variety of nutritional supplements which have been touted to improve sperm count, motility and morphology, but do they? Physicians and patients alike want to use therapies which have been proven to both effective and safe to use. To sort this out, many studies have been done on several supplements to find out if they are in fact safe and effective, with some of them better designed than others to answer that question. The problem with some of these studies is, 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. 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 which have been purported to be helpful.
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 and pregnancy rates, while in other studies, no significant benefit was seen. So how do we interpret such mixed results? When there are contrary results from different, well designed, randomized studies, it raises the question of whether there is a different patient population being studied, whether the study population was followed for sufficient time, whether a deficiency in this substance existed or not prior to enrolling in the study or whether there are other variables which are not being adequately controlled. 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 Q10 protects cells from oxidative stress, so once again, in theory it would be beneficial for damaged sperm. Unfortunately, the data supporting its use is contradictory, with some studies showing improvement in sperm parameters, 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 are generally regarded as the main antioxidant vitamins, and have been studied largely in combination to assess for any benefit in male fertility. Once again, the data is confusing, with some studies showing some benefit, and others showing no benefit at all.
N-Acetylcysteine decreases the levels of free radicals, 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 to the bloodstream from oral supplementation, this supplement is seldom used.
In the present of zinc deficiency, zinc supplements have been 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 rarely recommended.
Selenium supplementation has been studied as well, but mostly in combination with other vitamins. The results in these studies has largely been positive, once again suggesting that selenium supplementation may be beneficial, particularly in those who had low selenium levels.
Arginine has an important role in preventing oxidative injury in cells. So in theory, this would be a useful supplement to use to improve sperm quality. Yet, no randomized clinical trials have demonstrated efficacy, so the use of arginine cannot be recommended.
Please note that a well balanced diet will include many of these supplements.
Regardless of the supplement being taken, it is important to limit the amount ingested. Even if the supplement is beneficial, consuming increased amounts of the supplement will not necessarily be better. In fact, taking 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). For this reason, it is important for the patient to work closely with his infertility specialist to which supplements are appropriate for him and at what dosages.
There are many ways that a urologist with an expertise in male infertility can help an individual with achieving a pregnancy. Most studies looking at the use nutritional supplements include patients with idiopathic (i.e. without any identifiable cause). For this reason, it is imperative to work closely with a physician with this expertise to look for and correct other underlying issues, before self-treating with supplement. Ultimately, he or she will work with you to improve the chances of having a successful pregnancy.
Ko and Sabanegh J. Androl 2013 33(3)292-308.
Zini and Al-Hatha Asian J. Androl 2011 13(3) 374-381.