+ Coenzyme Q10

In sperm cells, Coenzyme Q 10 is concentrated in the mitochondrial mid-piece, where it is involved in energy production. It also functions as an antioxidant, preventing lipid peroxidation of sperm membranes. Many studies support Coenzyme Q 10 helps to increase in sperm count and motility. Clearly, additional studies will be evaluate the possible role of Coenzyme Q 10 in the treatment of male infertility.

+ L-Carnitine

The main function of carnitine in the epididymis is to provide an energetic substrate for spermatozoa. Carnitine contributes directly to sperm motility and may be involved in the successful maturation of sperm. This is especially important since epididymal sperm use fatty acid oxidation as their main source of energy metabolism and thus tend to concentrate carnitine while in the epididymis, as carnitine is necessary for transport of fatty acids into the mitochondria. Low levels of carnitine reduce fatty acid concentrations within the mitochondria, leading to decreased energy production and potential alteration in sperm motility.

+ L-Arginine

The amino acid arginine is a biochemical precursor in the synthesis of putrescine, spermidine, and spermine, which are thought to be essential to sperm motility. In 1973, Schachter et al published a study in which arginine was given to 178 men with low sperm count. Seventy-four percent of the subjects had significant improvement in sperm count and motility after taking 4 g/day for three months.29 More recently, researchers in Italy evaluated the clinical efficacy of arginine in 40 infertile men. All the men had a normal number of sperm ( > 20 million/ml) but had decreased motility which was not due to immunological disorders or infections. Subjects were given 80 ml of a 10-percent arginine HCl solution for six months. Arginine supplementation significantly improved sperm motility without any side effects.

+ Vitamin E

Vitamin E is a well-documented antioxidant and has been shown to inhibit freeradical-induced damage to sensitive cell membranes. In one study, lipid peroxidation in the seminal plasma and spermatozoa was estimated by malondialdehyde (MDA) concentrations. Oral supplementation with vitamin E significantly decreased MDA concentration and improved sperm motility, resulting in a 21- percent pregnancy occurrence during the study.1 In one randomized, cross-over, controlled trial, 600 mg/day vitamin E improved sperm function in the zona binding assay, therefore enhancing the ability of the sperm to penetrate the egg in vitro. Nine men with low sperm count and alterations in sperm motility were given vitamin E with the antioxidant trace mineral selenium for six months. Compared to the baseline pre-supplementation period of four months, the combination of vitamin E and selenium significantly increased sperm motility and the overall percentage of normal spermatozoa.

+ Vitamin D

Vitamin D promotes calcium absorption in the gut and maintains adequate serum calcium and phosphate concentrations to enable normal mineralization of bone and to prevent hypocalcemic tetany. It is also needed for bone growth and bone remodeling by osteoblasts and osteoclasts . Without sufficient vitamin D, bones can become thin, brittle, or misshapen. Vitamin D sufficiency prevents rickets in children and osteomalacia in adults. Together with calcium, vitamin D also helps protect older adults from osteoporosis. Vitamin D has other roles in the body, including modulation of cell growth, neuromuscular and immune function, and reduction of inflammation. Many genes encoding proteins that regulate cell proliferation, differentiation, and apoptosis are modulated in part by vitamin D.

+ Vitamin B12

Vitamin B12, in its various forms, has been studied for its effect on male infertility. Vitamin B12 is important in cellular replication, especially for the synthesis of RNA and DNA, and deficiency states have been associated with decreased sperm count and motility. Methylcobalamin (1,500 mcg/day) was given to a group of infertile men for a period of 8-60 weeks. They were evaluated periodically by semen analysis, and standard sperm parameters were increased by 60 percent.In another methylcobalamin study, 1,500 mcg/ day was given to 26 infertile men for a period of 4-24 weeks. Sperm analysis was conducted eight weeks into the study. Sperm concentration increased in 38.4 percent of the cases and total sperm count increased in 53.8 percent of the men. Sperm motility increased in 50 percent of the participants. Serum LH, FSH, and testosterone levels were unchanged.55 When 6000 mcg/day was given to men with low sperm count, it resulted in a 57-percent improvement.56 Vitamin B-12 (1000 mcg/day) was administered to men with a sperm count less than 20 million/ml. By the end of the study, 27 percent of the men had a sperm count over 100 million/ml.

+ Vitamin C

Studies have shown the concentration of ascorbic acid in seminal plasma directly reflects dietary intake, and lower levels of vitamin C may lead to infertility and increased damage to the sperm’s genetic material. Fraga et al demonstrated this by reducing ascorbic acid intake in healthy men from 250 mg to 5 mg per day. Seminal plasma levels of vitamin C decreased by 50 percent, with a concomitant 91-percent increase in sperm with DNA damage. Cigarette smoking has been documented as having deleterious effects on sperm quality. Smokers, 75 men were divided into three supplementation groups; one was given placebo, the other groups received 200 mg or 1000 mg ascorbic acid. While the placebo group showed no improvement, the ascorbic acid groups showed significant improvement in sperm quality, with the greatest improvement occurring in the 1000 mg group.38 In perhaps one of the best studies on vitamin C and male infertility, 30 infertile but otherwise healthy men were given a placebo, 200 mg, or 1000 mg vitamin C daily. After one week, the group receiving 1000 mg/day had a 140-percent increase in sperm count, while there was no change in the placebo group. The 200 mg/day group had a 112-percent increase in sperm count, while both groups demonstrated significant reductions in the number of agglutinated sperm. Most importantly, by the end of the 60-day study every participant in the vitamin C group had impregnated their partner, while no pregnancies occurred in the placebo group.

+ Zinc

Zinc is a trace mineral essential for normal functioning of the male reproductive system. Numerous biochemical mechanisms are zinc dependent, including more than 200 enzymes in the body. Zinc deficiency is associated with decreased testosterone levels and sperm count. An adequate amount of zinc ensures proper sperm motility and production. Zinc levels are generally lower in infertile men with diminished sperm count, and several studies have found supplemental zinc may prove helpful in treating male infertility.In one trial, the effect of zinc supplementation on testosterone, dihydrotestosterone, and sperm count was studied. Thirty-seven patients with idiopathic infertility of more than five-years duration and diminished sperm count received 24 mg elemental zinc from zinc sulfate for 45-50 days. The results were dramatic in the 22 subjects with initially low testosterone levels; a significant increase in testosterone levels and sperm count (from 8 to 20 million/ml) was noted, along with nine resulting pregnancies. Fourteen infertile males with idiopathic oligospermia were supplemented with 89 mg zinc from oral zinc sulfate for four months. Serum zinc levels were unaffected, but seminal zinc levels significantly increased. There were also improvements in sperm count and in the number of progressively motile and normal sperm. Three pregnancies occurred during the study.Zinc supplementation appears warranted in the treatment of male infertility, especially in cases of low sperm count or decreased testosterone levels.

+ Antioxidants

Polyunsaturated fatty acids and phospholipids are key constituents in the sperm cell membrane and are highly susceptible to oxidative damage. Sperm produce controlled concentrations of reactive oxygen species, such as the superoxide anion, hydrogen peroxide, and nitric oxide, which are needed for fertilization; however, high concentrations of these free radicals can directly damage sperm cells.35 Disruption of this delicate balance has been proposed as one of the possible etiologies of idiopathic male infertility.