14

Report Author: Simran Sharma

Report Date: March 3, 2025

Table of Contents

Introduction

Male infertility is a disease, syndrome, or condition of the male reproductive system that causes failure to achieve a pregnancy. The World Health Organization (WHO) defines male infertility as “the inability of a man to impregnate a fertile woman after at least one year of frequent, unprotected sexual intercourse.” It is estimated that 20-30% of infertility cases are solely due to male factors, and men contribute to 50% of infertility cases overall. The percentage of infertile men globally ranges from 2.5% to 12%. Around 30 million men worldwide are infertile, with the highest rates in Africa and Central/Eastern Europe, that can account for up to 70% of infertility cases. In North America, male infertility rates are estimated at 4-6%, in Australia at 9%, and in Central and Eastern Europe at 8-12%.¹ In the U.S., 11.4% of men aged 15-49 and 12.8% of men aged 25-49 reported some form of infertility between 2015 to 2019.² A person with infertility is prone to emotional stress, depression, isolation, anxiety, and low self-regard because of the high social value of having a child.³

Male infertility has many causes, including lifestyle factors. Lifestyle factors that can contribute to male infertility include smoking, excessive alcohol consumption, obesity, poor diet, and excessive exercise.⁴ Diet is an essential factor that can positively or negatively impact male fertility. A healthy diet can improve semen quality and conception rates. Dietary nutrients have a great effect on male fertility. Scientific studies have indicated that specific nutrients like vitamins, minerals, essential fats, and antioxidants may protect or improve male fertility. 

This literature review comprehensively examines the interactions between diet and male fertility. An in-depth exploration of factors affecting male fertility, including lifestyle factors and unhealthy food habits, has been discussed. Considering the evidence supporting the positive effects of dietary nutrients and natural herbs on male fertility, their benefits, drawbacks, or concerns have also been discussed.

The discussion begins with an in-depth analysis of the various factors contributing to male infertility, including lifestyle, environmental, and physiological influences. This is followed by a detailed exploration of dietary nutrients and herbs, focusing on their mechanisms of action and the scientific evidence supporting their effectiveness in improving male fertility. Specific topics include dosage recommendations, natural food sources rich in these nutrients, potential side effects, interactions with common medications, and essential safety precautions to ensure proper use. Conclusively, the positions and views of worldwide governmental medical and health organizations, leading experts, and social platforms addressing the issue of male infertility have been discussed.

Significance of the Topic

Male infertility is increasingly recognized as a significant global health concern. Around 30 million men worldwide are infertile. Male infertility affects a substantial portion of the population, with causes ranging from genetic factors to lifestyle choices and medical conditions. Addressing male infertility is significant due to its prevalence and the impact it has on couples trying to conceive. Men often experience emotional distress related to infertility. Men diagnosed with male infertility often experience significant psychological distress, including symptoms of depression, anxiety, and reduced self-esteem. The emotional impact is exacerbated by societal norms that stigmatize male infertility, viewing it as a failure of masculinity and an isolating experience.⁵ Diet plays a significant role in male infertility. Dietary modifications and the inclusion of specific nutrients and antioxidants can significantly improve health.⁶ Food provides the raw materials required for the body’s metabolic processes, including the production of sperm, maintaining hormone balance, and reproductive health. The present review summarizes the evidence on the relationships between specific dietary components and fertility in men.

Potential Cause of Male Infertility

Male infertility is a complex condition that involves several factors or causes. However, up to 50% of male infertility cases are classified as unexplained or idiopathic, meaning that the cause is unknown. In the remaining 50% of cases, various non-adjustable factors (age and genetics) and adjustable factors such as environmental and lifestyle contribute to male infertility. Here are the potential causes of male infertility:

Hormonal Imbalance

A healthy reproductive system requires a balanced hormone level. The pituitary gland regulates the production of hormones like testosterone, follicle-stimulating hormone (FSH), luteinizing hormone (LH), estrogen, and prolactin. Testosterone, FSH, and LH are primary hormones and regulators of the male reproductive system.⁷ The physiological functions and normal reference range of reproductive hormones in adult men have been provided in Table 1.

Table 1 The physiological functions and normal reference range of reproductive hormones in adult men

Pituitary gland dysfunction causes hormonal imbalance, leading to male infertility. A hormone imbalance occurs when the hormone level rises above or drops below normal levels in the bloodstream. Testosterone levels above or below the normal range can negatively impact male fertility. Abnormally high or low testosterone can suppress sperm production and quality.⁸ Insufficient or overproduction of FSH and LH by the pituitary gland causes testicular dysfunction and lowers testosterone levels and sperm production.⁹ Elevated levels of prolactin (15 micrograms (μg)/L or more) can inhibit the release of FSH and LH from the pituitary gland and hinder sperm production.¹⁰ The most common causes of pituitary gland dysfunction are benign pituitary tumors, poor blood circulation, inflammation, infection, autoimmune disorders, and surgery.

Sperm Quality Issue

WHO-established normal reference values for human semen quality have been provided in Table 2.¹¹

Table 2 WHO-established normal reference values for human semen quality

Poor sperm health could be due to abnormally developed testicles, oxidative stress (an imbalance between free radicals and antioxidants), heat exposure (sauna baths and electromagnetic radiation through cell phones and laptops), inflammation of testicles, lifestyle factors, or surgery in or around the testicles¹⁴ Different types of sperm disorders or abnormalities have been listed in Table 3.

Table 3 Sperm Disorder Description

Immune Disorder

Infections or inflammation in the prostate, physical trauma to the testicles, surgery in the scrotal region, and autoimmune diseases like lupus, rheumatoid arthritis, or Type I diabetes can generate immune responses that harm sperm through antisperm antibodies (ASA). ASA can hinder spermatogenesis, affecting semen parameters like motility and causing sperm agglutination. Sperm agglutination happens when ASA binds to the sperm’s surface, forming a clump or cluster of sperm cells and hence preventing sperm cells from swimming freely and reaching an egg for fertilization. In the case of ASA, immunosuppressive therapy, artificial insemination, or in vitro fertilization are helpful.¹⁵

Oxidative Stress

Oxidative stress happens when harmful reactive oxygen species (ROS), also known as free radicals, build up to levels that the body’s natural antioxidant defenses cannot effectively manage. The increased level of ROS can result from environmental factors such as high temperature, electromagnetic waves, air pollution, insecticides, alcohol consumption, sedentary lifestyle, excessive physical exercise, obesity, and poor nutrition. The plasma membrane of sperm consists of high levels of polyunsaturated fatty acids (PUFAs), providing membrane flexibility. PUFAs are prone to oxidation by ROS. ROS negatively affects the functional and structural integrity of membrane cells, decreases sperm motility, and eventually leads to infertility. ROS also causes sperm DNA damage. Sperm DNA damage may result from diabetes-induced oxidative stress and lipid peroxidation, resulting in poor implantation, embryonic development, and low natality.¹⁶

Lifestyle Factors

The lifestyle issues that impact male fertility involve alcohol, unhealthy food habits, stress, obesity, and smoking.

Smoking: Research has correlated smoking to diminished semen parameters such as sperm count, motility, and abnormal morphology. Smoking accelerates sperm DNA fragmentation and oxidative stress. The toxins in cigarette smoke, such as nicotine, cadmium, carbon monoxide, cancer-causing metals, and ROS, impair spermatogenesis and negatively affect the overall quality of sperm. Smoking also causes a hormonal imbalance leading to lower testosterone levels and higher estrogen levels, both of which are detrimental to fertility.¹⁷ In a study, sperm samples of 63 fertile heavy smokers (20 cigarettes/day) exhibited a significant decrease in standard semen parameters in comparison to non-smokers.¹⁸ Smoking cessation can reverse the effects. In a case study, three months of smoking cessation showed a significant improvement in sperm quality due to reduced oxidative stress markers, allowing for better sperm DNA integrity.¹⁹

Excessive Alcohol Consumption: Alcohol overconsumption has been found to drastically affect male reproductive organs, hormones, and semen quality. Alcohol exerts influence on the hypothalamic-pituitary axis instigating suppression of gonadotropin production causing testicular dysfunction, hindered spermatogenesis, increase in oxidative stress and inflammation, decline in testosterone levels, and imbalance between free testosterone and free estrogen.²⁰ According to a study, moderate alcohol consumption (40 grams or less daily) displayed no adverse effects on sperm parameters. In contrast, alcohol overindulgence (80-160 grams daily) may hamper male fertility.²¹ Prolonged heavy drinking also contributes to oxidative stress, leading to sperm DNA damage and increasing the risk of infertility and stillbirth. A study of 66 men who were given ~180 ml alcohol (40-60% alcohol content) per day for 5 days/week for 1 year showed significant decrement in semen volume, sperm count, motility, and number of morphologically normal sperm as compared to control. A hormonal imbalance was also observed with significantly higher FSH, LH, and estrogen levels and significantly lower testosterone and prolactin levels.²² In a similar study, chronic alcohol consumption was found to give rise to intestinal dysbiosis that causes testicular inflammation and diminished sperm quality.²³ Moreover, a study of 1221 men revealed that even moderate alcohol consumption (5 units per week) also had a bad effect on standard semen quality.²⁴ Fortunately, studies have shown that abstinence from alcohol for several months can restore normal hormone levels and improve sperm quality, typically within three to six months demonstrating that the detrimental effects of alcohol on male fertility can often be reversed through lifestyle changes.¹⁹

Obesity: Obesity resulting from an unhealthy lifestyle is associated with male infertility as it hinders sperm quality and reproductive hormones. Obesity leads to increased levels of oxidative stress and inflammation, which harm spermatogenesis, causing low sperm count, motility, and abnormal morphology. In obese individuals, disorders on the hypothalamic-pituitary-gonadal axis are observed. The hormonal imbalances due to obesity induce elevated estrogen levels and reduced testosterone production.²⁵ Several studies have indicated that weight loss through dietary changes and increased physical activity can significantly improve sperm parameters. Weight loss helps to lower systemic inflammation, reduce oxidative stress, and restore reproductive hormone balance. Specifically, weight loss can raise testosterone levels while decreasing estrogen levels, benefiting spermatogenesis. Additionally, weight loss reduces insulin resistance, which has also been associated with impaired fertility.²⁶

Exercise has a well-documented positive effect on infertility. Regular physical activity promotes hormonal balance, leading to increased testosterone levels and improved spermatogenesis. However, the intensity and type of physical exercise play a crucial role in determining its effect on male reproductive health. A study revealed that moderate-intensity workouts had a positive impact on sperm concentration and motility. However, very high-level physical activity might potentially have the opposite effect. Moreover, some types of exercise, such as weightlifting (more than 2 hours/week) and cycling (more than 5 hours/week), were found to hamper sperm count by causing physical exertion and elevated temperatures in the pelvic area. It concludes that a balanced outlook on exercise and not overexertion helps optimize fertility.²⁷

Unhealthy Food Habits

For optimal health and fertility in men, some foods should be avoided, including: 

Highly Processed Food: Food processing is transforming raw agricultural products into food or converting one form of food into another. A food classification system called NOVA (not an acronym) categorizes all foods according to the nature, extent, and purposes of the industrial processes they undergo. It divides foods into four groups: unprocessed or minimally processed foods, processed culinary ingredients, processed foods, and ultra-processed foods.²⁸  NOVA food classification has been discussed in detail in Table 4.

Table 4 NOVA food classification system

Highly processed food or drinks are stripped of nutrients and fiber and are high in salt, sugar, bad fat (saturated fat, cholesterol, and trans-fat), harmful preservatives, and additives (artificial color and flavor) that have no nutritional value and can negatively impact sexual health. These foods increase oxidative stress and inflammation in the body, resulting in metabolic disorders that damage reproductive and immune systems, lower sperm quality, and cause an imbalance in hormones.²⁹ Studies have shown a link between dietary intake of highly processed meat and low sperm count, concentration, and morphology.³⁰ Highly-processed meat may also contain high concentrations of xenoestrogens and, in some cases, steroids that influence semen quality and reproductive hormone levels. Xenoestrogens are synthetic chemicals that disrupt hormone balances in the body by mimicking natural estrogen hormones and hindering estrogen binding to its receptors. Examples include pesticides, petrochemicals, herbicides, chlorinated pollutants, and bisphenol A.³¹ However, it should be mentioned that not every type of processed food is necessarily bad for our health. For example, minimally processed food should be preferred over processed food.³²

Seafood High in Mercury: Eating fish is good, but fish contaminated with mercury are bad for the reproductive system.³³ Mercury is a heavy metal and may act as a spermatotoxicant affecting spermatogenesis, sperm motility, and morphology.³⁴ Due to bioaccumulation, large fish with long lifespans contain more mercury like swordfish, marlin, mollusks, mackerel, tuna, and tilefish. Hence, go for lower-mercury seafood such as salmon, anchovy cod, scallops, oysters, squid, sardines, and shrimp.³⁵

Caffeine: Caffeine is a naturally occurring psychoactive chemical that has a central nervous system-stimulating effect. Frequent or excessive intake of caffeine (more than 800 mg/day) has been associated with reduced sperm count and concentration, altered spermatogenesis, and testicular function.³⁶

Refined Sugar: Excessive intake of glucose or refined sugars, in the form of cakes, fries, chocolate, confectionery, syrups, table sugar, white bread, soft drinks, sweets, processed and packaged bars and snacks, ice cream, ketchup, and sauces, harms semen quality. Regular and excessive consumption of sugar is associated with an increased risk of developing prediabetes and greater insulin resistance.³⁷ With higher insulin resistance, more oxidative stress can negatively influence testosterone levels, sperm production, and motility by disrupting the hypothalamic–pituitary–testicular axis.³⁸ Many animal-based studies revealed that a high-sugar diet may damage sperm quality permanently, with an increase in testicular weight and abnormal testosterone levels.³⁹

In a study on 2935 young men, men consuming sugar-sweetened beverages (~200 ml serving/day) showed comparatively low sperm count, concentration, and motility compared to the non-consumers who opted for water.⁴⁰ In a cross-sectional study, it was found that even a moderate intake of artificially sweetened beverages (≥ 3 days per week) could lower the number of morphologically normal sperm.⁴¹

Soy: The relationship between soy food consumption and male infertility has been a topic of interest due to the presence of phytoestrogens, such as isoflavones, in soy products. Phytoestrogens are plant-based compounds that resemble estrogen structures and have an anti-estrogenic effect. Phytoestrogens can alter the expression of estrogen and testosterone receptors, which may disrupt the hormonal regulation of the reproductive system. Some studies found a deleterious impact of high soy-based food consumption on sperm concentration in men.⁴²

Packaged food: Food packed in plastic food containers or metal cans can negatively impact male fertility due to the presence of bisphenol A (BPA). BPA is an industrial chemical that is used to make polycarbonate plastic and epoxy resins. Metal cans are mostly coated with epoxy resin to avoid corrosion and to combat the sterilization process. BPA can leach from the plastic container or cans into the food or drinks. In the body, BPA acts as an endocrine-disrupting chemical or xenoestrogen that mimics estrogen. BPA can negatively interfere with sperm motility and disturb hormone balance and mitochondrial function in the testes.⁴³ It also alters fertility-related protein levels in spermatozoa.⁴⁴ Glass jars and BPA-free cans are good alternatives.

Specific Nutrient: Vitamins

What is it

Vitamins are micronutrients required in small quantities for good health. This is due to the antioxidant capacity of vitamins and some vitamins’ role in many biological or metabolic processes as a cofactor. Specifically, some vitamins like vitamin D, vitamin E, vitamin B9 (folic acid), and vitamin C may help in improving male fertility.

How it Works

Vitamin D is a vitamin that helps the body absorb calcium. It regulates calcium homeostasis or calcium influx in the testes and spermatozoa, which is an essential process required for sperm motility.⁴⁵

Vitamin E acts as an antioxidant that protects sperm by neutralizing free radicals in the testes, protecting sperm cell membranes from oxidative damage and reducing DNA damage.⁴⁶

Vitamin C has antioxidant capacity, and it can be found in high concentrations in seminal plasma and prohibits sperm DNA damage through ROS.⁴⁷

Folic acids, also known as vitamin B9 or folates, are vitamins that act as an essential cofactor required by enzymes involved in protein synthesis, cell division, and methylation of DNA. They play a central role in spermatogenesis, stabilizing sperm count, and maintaining healthy hormone levels. Folate prevents hyperhomocysteinemia, a condition associated with low semen parameters.⁴⁸

What the Research is Telling us

Recent studies have found a positive correlation between vitamin D levels and sperm motility. The normal range of vitamin D levels in the blood for adult men is 30 nanogram/ml or more. A deficiency in vitamin D is associated with lower semen parameters like motility. A significant improvement in sperm motility was observed in 3 months of daily vitamin D supplementation (4000 IU/day) in 86 asthenozoospermia (low sperm motility) infertile men with vitamin D deficiency (serum level of vitamin D less than 30 nanogram/ml). However, no significant effect of vitamin D supplementation was observed on semen volume, sperm count, or sperm morphology.⁴⁹ More dedicated clinical studies are needed to clarify the exact role of vitamin D in male fertility, particularly regarding its effects on hormonal and seminal parameters. 

Vitamin E, mostly in combination with other nutrients, showed efficiency in treating male infertility. Vitamin E supplement (100 mg) in combination with coenzyme Q (10 mg) three times daily for 3 months was observed to be effective in enhancing sperm motility, morphology, and testosterone levels in 73 infertile men with idiopathic infertility.⁵⁰ Antioxidant supplement treatment (1 gram of vitamin C and 1 gram of vitamin E) for 2 months given to 64 men with idiopathic infertility reduced the level of DNA damage in spermatozoa.⁵¹ The efficacy of vitamin E in treating male infertility is controversial, however, with some studies showing no significant improvements in sperm parameters after vitamin E treatment alone. For instance, in a study, daily consumption of an oral synthetic vitamin E supplement (400 IU or 180 mg/day) for 2 months showed no statistically significant change in sperm volume, sperm count, motility, and morphology in 61 men with idiopathic infertility.⁵² The current body of research presents mixed results, and there is a need for more well-defined clinical studies to establish the efficacy of vitamin E in male infertility treatment. Long-term studies are required to assess the impact of vitamin E on live birth rates and to determine the most effective combinations of antioxidants for improving male fertility outcomes.

Varicocele (swollen veins in the scrotum) is one of the most common causes of male infertility. Vitamin C has been shown to improve sperm motility and morphology, particularly in men who have undergone varicocele surgery. In one study, 115 men with infertility receiving vitamin C supplements (250 mg/day) after varicocelectomy surgery (a surgical procedure to treat varicoceles) exhibited improved sperm motility and morphology, although the supplementation did not significantly affect sperm count.⁵³ Furthermore, an improved sperm parameter (sperm count, morphology, and motility) was observed in 2 months of twice-daily supplementation of vitamin C (1000 mg/day) in 13 infertile men.⁵⁴

In another study, high-dose folic acid supplementation (15 mg/day; 3 tablets 5 mg each) decreased DNA fragmentation in sperm, a positive indicator for fertility, although it did not significantly change other sperm characteristics such as concentration or motility in 162 infertile men.⁵⁵ A study has shown that daily consumption of folic acid (5 mg/day), in combination with tamoxifen citrate acid (20 mg/day) for 3 months, increased sperm concentration and motility in 68 infertile men.⁵⁶ However, a study on 2370 men seeking infertility treatment failed to show significant improvement in sperm quality when given zinc supplement (30 mg) in combination with folic acid (5 mg) for 6 months.⁵⁷ Given the mixed results of previous studies, further well-designed clinical trials are necessary to better understand the role of folic acid, both alone and in combination with other supplements in treating male infertility.

Dosage Recommendation Based on Research

Recommended dietary allowances (RDA) or minimum daily recommended intake of different vitamins for adult men (age more than 14 years) according to National Institutes of Health (NIH) include vitamin D [15 micrograms (µg)/day or 600 IU]; vitamin C (75-90 mg/day); vitamin E (15 mg/day), and vitamin B9 or folic acid (400 µg/day).⁵⁸

Recommended dosages of different vitamins for specific sperm parameters include vitamin D (4000 IU) for sperm motility; vitamin C (1000 mg/day) for improving sperm count, motility, and morphology; vitamin E (100 mg/day) for enhancing sperm motility, morphology, and testosterone levels; and vitamin B9 or folic acid (400 µg/day) for increasing sperm concentration and motility and reducing sperm DNA fragmentation.

Table 5 Dosage Recommendation of Vitamins for Adult Men (age more than 14 years)

Food Sources

Plant sources that provide Vitamin D include:⁵⁹

• Mushroom: 2300 IU/100 gram, 383% of the Daily Recommended Value (DV)

• Orange juice: 100 IU per cup, 16% of DV

• Soy Milk: 107-117 IU per cup, 19% of DV

• Fortified cereal: 85-145 IU per cup, 11-18% of DV

• Fortified orange juice: 100 IU per cup, 12% of DV

Animal sources that provide Vitamin D include:

• Tofu: 100 IU/100 gram, 16% of DV

• Canned sardines: 193 IU/100 gram, 32% of DV

• Cheese: 24 IU/100 gram, 4% of DV

• Cod liver oil: 450 IU/teaspoon, 50% of DV

Plant sources with the highest amount of vitamin C include:⁶⁰

• Guava: 125 mg per fruit, 138% of DV

• Kiwi: 56 mg per fruit, 62% of DV

• Orange: 83 mg per fruit, 92% of DV

• Raw kale: 93 mg of Vitamin C per 100 g, 103% of DV

• Black currants: 102 mg per half cup (56 g), 113% of DV

• Yellow Bell pepper(chopped): 342 mg per cup, 342% of DV

Animal sources with the highest amount of vitamin C are:

• Raw Chicken liver: 17.9 mg per 100g, 19.8% of DV

• Beef Lungs: 32.7 mg per 100 g, 36.3% of DV

Plant sources providing a good amount of vitamin E include:⁶¹

• Wheat germ oil: 150 mg/100 g, 1000% of DV

• Almond:15 mg/100 g, 100% of DV

• Dried apricot: 4 mg/100 g, 26% of DV

• Sunflower seed: 35 mg/100 g, 233% of DV

• Avocado: 3.1 mg per fruit, 20% of DV

Animal sources providing a good amount of vitamin E include:

• Goose meat: 1.7 mg/100 g, 11% of DV

• Cod: 0.8 mg/100 g, 5% of DV

• Abalone: 3.4 mg/100 g, 23% of DV

• Goose meat: 2.4 mg/100 g, 16% of DV

Plant sources that provide Vitamin B9 or folic acid include:⁶²

• Kidney beans (cooked): 131 µg per cup, 32% of DV

• Asparagus (cooked): 134 µg per half cup, 33% of DV

• Brussel sprouts (cooked): 47 µg per half cup, 11% of DV

• Broccoli (cooked): 84 µg per half cup, 21% of DV

• Raw spinach: 58.2 µg/30g, 15% of DV

Animal sources that provide Vitamin B9 or folic acid include:

• Beef liver (cooked): 212 µg per half cup, 53% of DV

• Egg: 22 µg per egg, 6% of DV

Side Effects

Common side effects: Too much (more than 4000 IU) vitamin D supplementation daily can cause side effects like itchy skin, sore eyes, stomach pain, diarrhea, or vomiting.⁶³

Side effects of high doses of vitamin C (more than 2000 mg/day) include diarrhea, stomach cramps, and nausea.⁶⁴

High doses (1000 mg/day) of vitamin E may cause side effects like headaches, nausea, fatigue, and bleeding.⁶⁵

Side effects of folic acid are uncommon but may include allergic reactions like rash, itching, and redness.⁶⁶

Drug interactions: Vitamin D supplementation may interact with medications like diuretics, antiarrhythmic drugs, blood pressure regulators, laxatives, and corticosteroids.⁶³ Vitamin C supplements might interfere with cancer treatments, such as chemotherapy and radiation therapy.⁶⁴ Vitamin E may interact with blood thinners (e.g., warfarin, aspirin).⁶⁵ Folic acid supplements may interact with alcohol and medications such as antibiotics and anticonvulsants.⁶⁶

Safety precautions: Nutrients in the form of dietary supplements should only be taken after consulting a doctor or other healthcare professional for safety. Supplements can interact with other supplements or medications, so a healthcare provider’s help is required to decide what supplement is right for you. Always remember that supplements cannot replace a well-balanced, healthy diet.

Bottom Line

Strength of recommendations: Vitamin D appears to have a positive effect on certain aspects of semen quality, particularly sperm motility, but its overall impact on male fertility and hormonal balance requires further investigation.

Vitamin E has shown significant improvements in sperm parameters and hormone levels (sperm motility, morphology, and testosterone levels) compared to vitamin E alone, indicating that combination therapies (with other nutrients) might be more effective. The current body of this research also presents mixed results, and there is a need for more well-defined clinical studies to establish the efficacy of vitamin E in male infertility treatment. Factors such as dosage and duration of treatment still need to be standardized.

Vitamin C exhibits high potential in improving certain aspects of sperm quality (sperm count, motility, and morphology). However, its direct impact on fertility outcomes such as pregnancy and live birth rates requires further investigation.

Folic acid supplementation shows some promise in improving certain sperm parameters (sperm concentration and motility) and reducing sperm DNA fragmentation. Nonetheless, more research is needed to establish clear guidelines for its use in male infertility treatment.

Specific Nutrient: Minerals

What is it

Minerals in food are inorganic nutrients that are essential, like vitamins. Minerals are required in small quantities for the variety of metabolic processes in the body. The body cannot produce minerals on its own; hence, they must be obtained through food or supplements. Minerals like zinc and selenium have a vital role in male infertility.

How it works

Zinc is the second most abundant trace element in the human body after iron. Zinc has high antioxidant potential and antibacterial effects. Zinc is an essential mineral that plays a role as a cofactor for enzymes involved in cell division required for sperm formation, hormone balance, and cell motility. Its antioxidant capacity and antibacterial properties help maintain the epithelial integrity of sperm and prevent urinary infection.⁶⁷ Selenium is an essential trace element that acts as a cofactor for antioxidant enzymes that protect sperm from oxidative damage, maintain normal sperm structure integrity, and are involved in the formation of sperm and testosterone production.⁶⁸

What the Research is Telling Us

A study involving 45 infertile men with asthenozoospermia (poor sperm motility) demonstrated that zinc supplementation improved sperm parameters by reducing oxidative stress, sperm apoptosis (programmed cell death), and sperm DNA fragmentation.⁶⁹ A daily dietary intake of 11 mg is needed, especially in males, as zinc is not stored in the body. Zinc deficiency (serum zinc level below 70 μg/dL) impedes spermatogenesis, resulting in sperm abnormalities and reduced sperm fertilization capacity. Zinc deficiency can arise due to high oxidative stress and smoking.⁶⁷ Studies have shown that zinc levels in the seminal plasma of infertile males were significantly lower than those of normal males. This suggests a potential link between zinc deficiency and male infertility.⁷⁰ However, further studies are needed to better elucidate the correlation between seminal plasma zinc and male infertility.

On the contrary, in a study on couples seeking infertility treatment, 2370 men did not show significant improvement in sperm quality when given zinc supplements (30 mg) in combination with folic acid (5 mg) for 6 months.⁷¹

While some studies support the beneficial effects of zinc on male fertility, other results are inconsistent, indicating the need for further research to clarify the relationship between zinc levels and infertility. Future studies should focus on understanding the optimal dosage and duration of zinc supplementation and its interaction with other micronutrients to maximize its benefits for male fertility.

Selenium is an essential trace element that plays a crucial role in reproductive health, particularly in male fertility. A study of 69 patients with low selenium profile showed improvement in sperm motility when given a selenium supplement alone or in combination with vitamins A, C, and E for 3 months.⁷² Another study involving 690 infertile men with idiopathic asthenoteratospermia indicated that daily supplementation of selenium (200 μg) in combination with vitamin E (400 units) for 100 days enhanced sperm morphology and motility in 352 cases.⁷³ A combined effect of selenium (200 μg) with N-acetylcysteine (a strong antioxidant medicine) (600 mg) daily oral supplement on 468 infertile men with idiopathic oligoasthenoteratospermia was observed for 26 weeks. Resulting in improved semen parameters (concentration, motility, and morphology).⁷⁴

Dosage Recommendation Based on Research

According to the National Institutes of Health (NIH), the recommended dietary allowances (RDA) or minimum daily recommended intake for adult men (age more than 14 years) for zinc is 11 mg/day and 55 µg/day for selenium.

Recommended dosages of minerals for specific sperm parameters include zinc (11 mg/day) for preventing DNA fragmentation and apoptosis of sperm cells and selenium (200 μg/day) for improving sperm concentration, motility, and morphology.

Table 6 Dosage Recommendation of Certain Minerals for Adult Men (age more than 14 years)

Food Sources

Plant sources with the most zinc are:⁷⁵

• Pumpkin seeds: 8.4 mg per half cup, 57% of DV

• Cashews: 6 mg/100 g, 54% of DV

• Hemp seeds: 3 mg/30 g, 27% of DV

Animal sources with the most zinc are:

• Lobster: 4 mg/100 g of meat, 36% of DV

• Beef chuck: 8.47 mg/100 g, 77% of DV

• Lamb shank: 8.67 mg/100 g, 78% of DV

• Raw ground beef: 4.79 mg/100 g, 44% of DV

• Alaska king crab: 7.62 mg/100 g, 69% of DV

Plant sources high in selenium include:⁷⁶

• Brazil nut: 68-91 μg per nut, 165% of DV

• Firm tofu: 17.4 μg/100 g, 31% of DV

• Whole wheat pasta (cooked): 36.3 μg per cup, 53% of DV

• Cottage cheese: 20 μg per cup, 36% of DV

• Cooked brown rice: 19 μg per cup, 35% of DV

Animal sources high in selenium include:

• Lean pork chops: 47.4 μg/100 g

• Roasted beefsteak: 33 μg/85 g, 47% of DV

• Roasted turkey: 31 μg/85 g, 44% of DV

• Beef liver (pan-fried): 28 μg/85 g, 40% of DV

• Cooked Tuna: 92 μg/85 g, 131% of DV

Side Effects

Common side effects: Taking very high doses of zinc (more than 40 mg) may cause side effects like stomach pain, diarrhea, or vomiting.⁷⁷ Common side effects of high doses (more than 400 μg) of selenium are nausea, bad breath, hair loss, tiredness, and fever.⁷⁸

Drug interaction: Zinc may interfere with medications such as antibiotics, non-steroidal anti-inflammatory drugs, blood pressure regulators, and immunosuppressants. Selenium may interact with medications like sedatives, immunosuppressants, anticoagulants, or antiplatelet drugs.

Safety Precautions: Check with your healthcare provider or dietitian before taking any supplements.

Bottom Line

Strength of recommendations: While zinc is vital for male reproductive health and can improve certain sperm parameters, its direct impact on fertility outcomes requires further investigation. More comprehensive studies are needed to establish effective supplementation strategies for treating male infertility.

Selenium supplementation shows potential in improving semen quality (sperm concentration, motility, and morphology) and addressing male infertility, particularly when combined with other antioxidants. However, further research is needed to fully understand its effects and establish standardized treatment protocols.

Specific Nutrient: Omega-3 fatty acid

What is it

Omega-3 fatty acids are essential fats or essential fatty acids. These essential fats cannot be produced in the body and have to be acquired from the diet for the proper functioning of the body.

How it Works

Studies positively correlated a diet rich in omega-3 fatty acids with better sperm quality. Omega-3 fatty acids provide structure and integrity to sperm membranes and improve sperm motility and morphology. It combats male infertility due to its anti-inflammatory properties and antioxidant potential. Excessive inflammation activates an enzyme called aromatase that converts testosterone into estrogen, causing low testosterone levels and hormone imbalance. Omega-3 fatty acids counter the effects of that aromatase enzyme. Omega-3 fatty acids protect sperm from oxidative damage. It acts as a vasodilator and widens the blood vessels, leading to increased blood circulation to the sexual organ.⁷⁹

What the Research is Telling us

According to research, omega-3 fatty acids can potentially benefit men experiencing infertility issues by improving semen quality. In an eight-month study of 238 men suffering from oligoasthenoteratospermia, omega-3 fatty acids administration (1.84 g/day) improved total sperm count and sperm concentration.⁸⁰ In another study of 119 men, an omega-3 fatty acids-rich diet comprising mixed nuts (60 g/day) for 14 weeks showed a positive effect on total sperm count, morphology, vitality, and motility. Also, sperm DNA fragmentation was significantly reduced in comparison to the control group. The mixed nuts comprised 30 g of walnuts, 15 g of almonds, and 15 g of hazelnuts.⁸¹ In cases of oligozoospermia, omega-3 fatty acids capsule supplementation (1 gram twice daily) for 3 months led to significant improvements in sperm count and total motile sperm count in 70 infertile men (age 20-45 years) with oligozoospermia. This study was limited by its small sample size due to time constraints, so generalizability is limited. Only one dose of omega-3 fatty acid was used in this study, so the effect of different doses of omega-3 on different sperm parameters could not be examined. Additionally, the side effects of taking omega-3 fatty acids were not evaluated.⁸²

There is significant variability in the results of studies on omega-3 supplementation, which may be due to differences in administration periods and dosages. More standardized research is needed to confirm the optimal conditions for omega-3 supplementation in treating male infertility.

Dosage Recommendation Based on Research

The U.S. Food and Drug Administration recommends consuming no more than 5 g/day of omega-3 fatty acids from dietary supplements. The recommended dosage for omega-3 fatty acids is 1.1-1.8 g/day for improving sperm count, morphology, motility, vitality, and sperm concentration.⁸³

Table 7 Dosage Recommendation of Omega-3 fatty acids for Adult Men (age more than 14 years)

Food Sources

Plant sources that are rich in omega-3 fatty acids are:⁸⁴

• Chia seeds: 5 g/100 g

• Walnut: 2.5 g/100 g

• Soybean: 0.67 g/100 g

• Flaxseed oil: 7.2g/tablespoon (13.6g)

Animal sources that are rich in omega-3 fatty acids are:

• Salmon: 2.2 g/100 g

• Mackerel: 4.8 g/100 g

• Cod liver oil: 2.4 g per tablespoon

• Smoked herring: 2.1g/100g

• Raw oyster: 0.32g per 6 raw eastern oysters

• Canned Atlantic sardines: 1.46 g per cup (149 g)

Side Effects

Common side effects: Side effects of omega-3 fatty acids may include stomach pain, diarrhea, burping, or nausea.

Drug interaction: Omega-3 fatty acids may interact with medications such as antidiabetics, blood pressure regulators, and blood thinners.

Safety Precautions: Consult your healthcare provider before taking supplements.

Bottom Line

Strength of recommendation: Research suggests that omega-3 fatty acids have high potential as a treatment to enhance male fertility by improving sperm quality (sperm concentration, count, morphology, vitality, and motility). This is supported by multiple studies showing that omega-3 supplementation can lead to better semen parameters in infertile men, although further research is still needed to establish its long-term effects, safety, and optimal dosing.

Specific Nutrient: Antioxidants

What is it

Antioxidants are compounds in food that scavenge and neutralize free radicals or ROS from the body’s cells and protect from damage caused by oxidation. Certain nutrients possess antioxidant properties. Lycopene is a bright red natural pigment (carotenoid) mostly found in fruits and vegetables that are red in color. Lycopene is a powerful antioxidant.

L-carnitine, or 3-aminobutyric acid, is a naturally occurring amino acid derivative or a semi-essential vitamin that acts as a cofactor in bioenergetic processes and transports long-chain fatty acids from cytosol to mitochondria for energy production from fat.⁸⁵ Coenzyme Q (CoQ10), also known as ubiquinone, is a naturally occurring lipid-soluble strong antioxidant and cofactor (co-enzyme) that participates in bioenergetic processes and converts food into energy. It is usually naturally produced by the human body.⁸⁶

How it Works

The ability of sperm to fertilize the egg is primarily dependent on sperm motility and membrane integrity. Sperm cells produce reactive oxygen species (ROS) and antioxidants in seminal plasma try to neutralize it. Excessive and uncontrolled production of ROS and oxidative stress is due to immature and damaged spermatozoa, infection, smoking, etc. This can damage sperm and impair the ability to fertilize an egg. Antioxidants help neutralize the ROS that can damage sperm. Nutrients such as lycopene, coenzyme (CoQ10), and L-carnitine are powerful antioxidants that can counteract oxidative stress, improving sperm quality.⁸⁷

What the Research is Telling us

 Studies have shown that lycopene can significantly improve male fertility. In one study, one can of tomato juice consumption (30 mg lycopene) for three months improved sperm motility. However, no significant improvement was observed with the daily consumption of one antioxidant capsule (containing vitamin C 600 mg, vitamin E 200 mg, and glutathione 300 mg).⁸⁸ Similarly, a study on 44 infertile males with oligozoospermia (low sperm count) showed significantly increased ejaculate volume, sperm count, motility, and concentration when given a lycopene supplement (25 mg/day) for 3 months.⁸⁹ While current studies show promising results, they often involve small sample sizes and short durations. Larger, long-term clinical trials are necessary to confirm the efficacy and optimal dosage of lycopene for treating male infertility. In addition, further research is needed to explore whether lycopene affects hormonal levels, such as LH, FSH, estradiol, testosterone, and prolactin, which could provide additional insights into its role in male reproductive health.

Many studies have demonstrated that L-carnitine can increase sperm motility and count, particularly in men with conditions like asthenozoospermia (low sperm motility) and oligozoospermia (low sperm count). A study on 60 infertile males with asthenozoospermia, showed significantly improved sperm motility when given L-carnitine supplement (2g/day) for 6 months.⁹⁰ In a similar study on 72 infertile men with asthenozoospermia, L-carnitine supplementation (660 mg/day) for 3 months increased sperm motility.⁹¹ Furthermore, a recent study has demonstrated that a daily dose of L-carnitine (2 g/day) for 3 months can improve sperm concentration, sperm count, percentage of actively motile sperm, and progressively motile sperm count among men (134 patients) with idiopathic oligo- and/or astheno-zoospermia (low sperm count and/or abnormal sperm motility).⁹²

 CoQ10 supplementation has been shown to improve sperm quality in several studies. A study of 65 infertile men with idiopathic oligoasthenoteratozoospermia (OAT) exhibited a notable increase in sperm concentration, progressive motility and total motility, and semen antioxidant capacity when treated with a CoQ10 oral supplement (200-400 mg/day) for 3 months.⁹³ Similar results were observed in an identical study on 212 infertile men with idiopathic oligoasthenoteratozoospermia (OAT), where a CoQ10 oral supplement (300 mg/day) for 3 months improved sperm quality (sperm motility, count, and morphology).⁹⁴ The optimal dosage of CoQ10 and its potential synergistic effects with other antioxidants remain areas for further research. 

Dosage Recommendation Based on Research

The recommended dose of lycopene supplement ranges from 2-30 mg per day for up to six months to improve sperm motility.⁹⁵ A daily dose of 2 g of L-carnitine is safe for up to 12 months to improve sperm motility.⁹⁶ Standard dosages for CoQ10 supplements range between 60 and 500 milligrams daily for 3 months to increase sperm concentration, count, morphology, and motility.⁹⁷

Table 8 Dosage Recommendation of Certain Antioxidants for Adult Men (age more than 14 years)

Food Sources

Lycopene is primarily found in plant sources. Foods high in lycopene are:⁹⁸

• Guavas: 5.2 mg/100 g

• Tomato (cooked): 7.2 mg per cup

• Watermelon: 4.5 mg/100g

• Grapefruit: 1.4 mg/100g

• Papaya: 1.8 mg/100g

• Red bell pepper: 0.513 mg per cup cooked

Plant sources rich in L-carnitine are:⁹⁹

• Cooked asparagus: 0.1 mg per half cup, 0.02% of DV

• Avocado: 2 mg per medium-sized avocado

• Animal sources rich in L-carnitine are:

• Cooked beef steak: 56-162 mg/113g, 11.2% to 32% of DV

• Cooked ground beef: 65-74 mg/85g, 13% to 15% of DV

• Cooked pork meat: 42 mg/113g, 8.4% of DV

• Milk: 8-12 mg/240 ml, 2% of DV

• Hard cheese: 3 mg/100g, 0.6% of DV

• Cooked chicken breast: 2-4 mg/85g, 0.4-0.8% of DV

Plant sources abundant in CoQ10 are:

• Boiled soybean: 1.2 mg/100g

• Pistachio: 2 mg/100g

• Peanut: 2.6 mg/100g

• Broccoli: 0.6-0.86 mg/100g

• Sesame seeds: 1.7 mg/100g

Animal sources abundant in CoQ10 are:

• Beef: 3.1 mg/100g

• Mackerel fish: 6.75 mg/100g

• Trout: 0.85mg/100g

• Chicken:1.4 mg/100g

• Pork:2.4 mg/100g

Side Effects

Common side effects: Lycopene is generally safe. A daily dose of 2 g of L-carnitine is safe but may have mild side effects like heartburn and indigestion.

CoQ10 may cause side effects like nausea, diarrhea, heartburn, and abdominal pain.

Drug interactions: Lycopene may interfere with medications such as anticoagulants or antiplatelet drugs. L-carnitine may interfere with medications such as anticoagulants and thyroid medication. CoQ10 may interfere with medications such as anticoagulants, antidiabetics, and thyroid medication.

Safety Precautions: Talk to your doctor before adding supplements to your diet.

Bottom Line

Strength of recommendations: Lycopene appears to be a promising agent for improving sperm quality (sperm motility, ejaculate volume, sperm count, and concentration). However, larger, long-term clinical trials are necessary to confirm the efficacy and optimal dosage of lycopene for treating male infertility.

L-carnitine shows promise as a treatment for male infertility by improving sperm motility and count. Likewise, CoQ10 was found to be effective in improving sperm concentration, count, morphology, and motility. However, there is a need for larger, well-designed clinical trials to better understand the clinical efficacy of L-carnitine and CoQ10 in treating male infertility and to establish standardized treatment protocols.

Specific Nutrient: Amino acids

What is it

Amino acids are organic compounds that are involved in protein synthesis, which is essential for producing sperm and reproductive hormones. D-Aspartic acid is a non-essential amino acid that is naturally produced by the human body. L-arginine is a conditionally essential amino acid that plays a crucial role in protein buildup and blood circulation. It must be obtained through diet during certain conditions such as stress or illness.¹⁰⁰

How it Works

D-aspartic acid occurs mainly in the pituitary gland and testes and regulates the synthesis and secretion of reproductive hormones like testosterone.¹⁰¹

L-arginine induces the synthesis and release of nitric oxide, leading to higher testicular blood flow and improved testosterone production by the testes. Nitric oxide has an important role in regulating sperm capacitation and the acrosome reaction, hence improving sperm’s ability to fertilize an egg.¹⁰⁰

What the Research is Telling us

D-aspartic acid plays a direct role in enhancing the capacitation process and acrosome reaction of spermatozoa, which are essential steps for successful fertilization. This effect has been particularly noted in younger mice, where D-aspartic acid treatment significantly increased these parameters. In an animal study based on a mouse model, a D-aspartic acid oral supplement for 2 weeks improved fertilizing capacity and sperm quality and increased testosterone levels.¹⁰²

A human study on 30 male patients with oligoasthenozoospermia and 30 male patients with asthenozoospermia demonstrated a notable increase in sperm concentration and motility and eventual rate of pregnancy when provided oral supplementation of sodium D-aspartate (2.6 g/day) for 3 months. In the case of oligoasthenozoospermia patients, there was a two-fold increase in sperm concentration.¹⁰³ D-aspartic acid has been shown to increase sperm motility, concentration, and testosterone levels in both animal models and human studies. However, the long-term effects and safety of D-aspartic acid supplementation need further investigation to ensure its efficacy and safety for prolonged use in fertility treatments.

Some studies have demonstrated that L-arginine supplementation can improve various parameters of sperm quality in men. L-arginine oral supplement (1000 mg/day) for 4 months showed a positive effect on sperm count, morphology, progressive motility, and ejaculate volume in a study on 15 infertile men.¹⁰⁴ In another study on 540 patients with erectile dysfunction, due to its vasodilating property, L-arginine supplement (1500-5000 mg) for 3 months helped in restoring erectile function.¹⁰⁵

Dosage Recommendation Based on Research

D-aspartic acid is possibly safe when used in doses of 2.6 to 3 grams daily for up to 3 months to increase testosterone levels, sperm concentration, and motility. L-arginine dose should be kept between 1 to 5 grams daily for up to 3 months to enhance erectile function, sperm count, sperm motility, morphology, and ejaculate volume.

Table 9 Dosage Recommendation of Certain Amino acids for Adult Men (age more than 14 years)

Food Sources

Plant sources rich in D-aspartic acid are:¹⁰⁶

• Avocado: 474 mg per fruit.

• Nectarine: 886 mg per fruit

• Asparagus: 500 mg per half cup of cooked asparagus

Animal sources rich in D-aspartic acid are:

• Beef steak (cooked): 2809 mg per 85 g,

• Chicken breast (cooked): 2563 mg per 3 ounces

• Egg (hard-boiled): 632 mg per egg

Plant sources that are naturally rich in L-arginine are:¹⁰⁷

• Peanut: 3.35 g/100g

• Pumpkin seed: 5.35 g/100g

• Soy protein concentrate: 4.64 g/100g

• Walnut: 3.62 g/100g

• Sesame: 3.25 g /100g

• Tofu: 3.19 g/100g

Animal sources that are naturally rich in L-arginine are:

• One cooked turkey breast:16 g of L-arginine

• One cooked chicken breast: 9 g of L-arginine

Side Effects

Common side effects: D-aspartic acid supplements can cause side effects such as irritability, anxiety, and headache.¹⁰⁸ L-arginine supplements can cause  stomach pain, diarrhea, low blood pressure, and bloating.¹⁰⁹

Drug interactions: D-aspartic acid may interfere with medications such as antidepressants and seizure medications. L-arginine may interact with medications like antidiabetics, sildenafil, blood pressure regulators, and anticoagulants.

Safety Precautions: Seek advice from a healthcare provider before taking supplements.

Bottom Line

Strength of recommendations: D-aspartic acid shows promise as a treatment to enhance male fertility by improving sperm quality (sperm concentration and motility) and hormonal balance (increase testosterone levels) in both animal and human models. Clinical studies have reported improvements in sperm motility and overall semen parameters (sperm count, morphology, and ejaculate volume) with the use of L-arginine.

While the benefits of D-aspartic acid and L-arginine are evident, determining the optimal dosage and treatment duration for human subjects remains a challenge. Further research is needed to establish standardized treatment protocols.

Specific Nutrient: Spermidine

What is it

Spermidine is a polyamine, or biogenic amine, found in ribosomes and living tissues. It got its name due to its isolation from seminal fluid for the first time in 1870. It is naturally present in various foods and is synthesized in the human body. Human seminal plasma contains spermidine, which is found in high concentrations within this fluid. Spermidine is considered one of the key components of seminal plasma, playing a role in sperm function and maintaining the alkaline pH of semen. The average concentration of spermidine in human seminal plasma is 31 mg/L, but it can range from 15 to 50 mg/ml. ¹¹⁰

How it Works

Spermidine is implicated in the process of spermatogenesis (the production of sperm), which is essential for male fertility. Metabolomic analyses have identified spermidine as a vital component in seminal plasma, indicating its role in the development and function of sperm cells. This suggests that spermidine could be crucial in maintaining or improving sperm quality, which is often compromised in cases of male infertility.¹¹¹ Spermidine has anti-inflammatory and antioxidant potential. Dietary intake of spermidine has a positive impact on semen parameters. Spermidine protects sperm from oxidative damage, reduces cortisol levels (stress hormone level), and increases testosterone levels.¹¹²

What the Research is Telling us

A study involving 15 healthy men with no history of infertility or sexual dysfunction showed a 48.9% significant increase in testosterone levels and a 58% reduction in cortisol levels with supplementation of spermidine (the dosage amount was not provided) for 30 days. For both fertility and sexual performance, it is important to reduce cortisol levels.¹¹²

In an animal study on diabetic mice, spermidine treatment improved spermatogenic cell proliferation and testicular function and increased testis weight and sperm count.¹¹³ Despite promising findings, the evidence on spermidine’s supplement effectiveness in improving male fertility is still emerging. Most studies emphasize the need for larger, well-designed trials to confirm these initial results and to better understand the specific role of spermidine among other nutrients.

Dosage Recommendation Based on Research

The average daily intake of spermidine in supplement form ranged from 4.8 to 17.0 mg/day.¹¹⁴ A daily dose of 5-10 mg spermidine supplement is safe to improve testosterone levels and reduce cortisol levels. No known side effects are there for high doses.¹¹⁵

Table 10 Dosage Recommendation for Spermidine

Food Sources

Plant sources high in spermidine include:¹¹⁶

• Mango: 3 mg/100g

• Wheat germ: 243 mg/100 g

• Hazelnut: 2.1 mg/100 g

• Soybean: 20.7 mg/100g

• Mushroom: 8.8 mg/100 g

Animal sources high in spermidine include:

• Chicken liver: 4.8 mg/100 g

• Beef: 3.7 mg/100 g

Side Effects

Common side effects: There are no known side effects for high doses of spermidine.¹¹⁷

Drug interaction: Spermidine may interact with medications such as antidepressants and blood thinners.

Safety Precautions: Please consult a physician before taking it.

Bottom Line

Strength of recommendation: Spermidine has shown potential in improving fertility by increasing testosterone levels and reducing stress. However, more extensive research is needed to fully understand its benefits and explore the optimal dosage and duration of spermidine supplementation for fertility benefits.

Specific Nutrient: Ashwagandha

What is it

Ashwagandha (Withania somnifera) is an aphrodisiac and adaptogenic evergreen herb found in India, northern Africa, and the Middle East. It has been used for more than 6,000 years in Ayurveda, one of the world’s oldest studies of natural healing practiced in India.

How it Works

The principal bioactive compounds of ashwagandha are triterpene lactones known as withanolides. Withanolides have antioxidant, antistress, and anti-inflammatory properties. It protects spermatozoa from oxidative stress and increases libido by lowering stress hormone (cortisol) levels. Ashwagandha increases testosterone levels and balances hormones.¹¹⁸

What the Research is Telling us

A study involving 46 male patients with oligospermia (sperm count less than 20 million/ml semen) observed a 167% significant increase in sperm count, 53% increase in semen volume, and 57% increase in sperm motility with supplementation of ashwagandha root extract (675 mg/day in three doses) for 90 days. Furthermore, a significantly greater improvement and regulation were observed in serum hormone levels. Serum testosterone level was markedly increased by 17% and LH by 34%.¹¹⁸ Research on 30 men (aged 18-45 years) with semen disorder (low sperm count or motility) showed that daily oral supplementation of one capsule (one gram of concentrated ashwagandha powder) 5 times a day for 3 months enhanced sperm concentration and motility. ¹¹⁹ These studies add to the evidence of the therapeutic value of Ashwagandha as attributed in Ayurveda for the treatment of infertility.

While Ashwagandha shows promise, more studies are needed to determine the optimal dosage and to ensure its safety as a treatment for male infertility. Current evidence suggests it is beneficial, but comprehensive toxicological studies are lacking.

Dosage Recommendation Based on Research

The recommended dosage for ashwagandha ranges from 300 mg to 600 mg/day for 1-2 months to increase semen volume, sperm count, and motility.¹²⁰

Table 11 Dosage Recommendation for Ashwagandha

Side Effects

Common side effects: Side effects of ashwagandha may include diarrhea, headache, sedation, nausea, or liver problems.¹²¹

Drug interactions: Ashwagandha may interact or interfere with medications such as antidiabetics, antihistamines, antihyperglycemic, contraceptives, thyroid hormone supplements, immunosuppressants, blood pressure regulators, and blood thinners.

Safety Precautions: Seek an opinion from your doctor before taking  this herbal supplement.

Bottom Line

Strength of recommendations: Ashwagandha appears to be a promising herbal remedy for improving male fertility by enhancing sperm quality (sperm count, motility, semen volume) and regulating hormones. However, further research is necessary to fully understand its mechanisms and to establish standardized treatment protocols.

Specific Nutrient: Maca

What is it

Maca (Lepidium meyenii), also known as Peruvian Ginseng or Ginseng Andin, is a herbaceous plant that originated in Peru.

How it Works

Maca root is rich in a unique bioactive compound known as macamides that possess antioxidant, anti-inflammatory, and libido and sperm quality-enhancing properties.¹²²

What the Research is Telling us

 Research on 20 healthy adult men men (aged 20-40 years) showed that daily oral supplementation of milled hypocotyl maca (1.75 g/day) for 3 months enhanced sperm concentration and motility with no significant change in hormone levels.¹²² Another study on 9 adult men (aged 24-44 years) showed that daily oral supplementation of maca tablets (1.5 to 3 g/day) for 4 months increased ejaculate volume, sperm count, and motility. However, no change in serum hormone levels (LH, FSH, testosterone, prolactin, and estradiol) was observed with Maca treatment.¹²³

Maca root oral supplementation capsule (2.8 g/day divided into 7 doses) for 3 months did not show significant improvement in sperm concentration and hormone levels (LH, FSH, testosterone, and estradiol) in 50 patients suffering from various reproductive-related problems. Maca root supplement was gelatinized and powdered dried bulb of yellow maca having less than 7% humidity.¹²⁴

Research indicates that maca does not significantly alter serum reproductive hormone levels in men. Studies have shown no effect on hormones such as testosterone, luteinizing hormone, and follicle-stimulating hormone when maca is administered. This suggests that any potential fertility benefits of maca are not mediated through changes in hormone levels.

Small sample sizes and methodological inconsistencies limit the current research on maca’s effects on male infertility. The evidence remains inconclusive, and more rigorous, large-scale studies are needed to determine the efficacy and safety of maca as a treatment for male infertility.

Dosage Recommendation Based on Research

The recommended daily dose of maca ranges from 1.5 to 3 g/day for 4 months to increase ejaculate volume, sperm count, and motility.

Table 12 Dosage Recommendation for Maca

Side Effects

Common side effects: Maca root has mild side effects like headaches, stomach issues, insomnia, or jitteriness.¹²⁵

Drug interactions: People taking blood thinners, high blood pressure medicine, or having thyroid problems should take the advice of their healthcare provider.

Safety Precautions: Seek an opinion from your doctor before taking herbal supplements.

Bottom Line

Strength of recommendations: While maca root shows some promise in improving semen parameters (ejaculate volume, sperm count, and motility), the scientific evidence is not yet robust enough to support its widespread use for male infertility. Further research is necessary to clarify its potential benefits and mechanisms of action.

Specific Nutrient: Red Ginseng

What is it

Red Ginseng (Panax ginseng) is a plant native to South Korea and China. Its roots have been used in traditional Chinese medicine.

How it Works

Red ginseng is one of the famous aphrodisiacs. It contains ginsenoside, a bioactive compound that has antioxidant and anti-inflammatory properties. Ginsenosides protect sperm cells from damage caused by free radicals. Ginsenosides may impact the hypothalamus-pituitary-gonadal axis, stimulating the production of hormones like testosterone and FSH required for spermatogenesis and sexual vitality.¹²⁶

What the Research is Telling us

 Red ginseng oral supplementation (1.5 g/day) for 3 months was revealed to significantly improve motility, concentrations, morphology, and viability of sperm in 80 infertile men. However, there were no significant differences in hormone levels, i.e., serum FSH, LH, and testosterone. These patients were suffering from varicocele, an enlargement of the veins in the scrotum, that caused infertility.¹²⁶

In animal studies, red ginseng has been found to protect against testicular damage induced by various stressors. In experimental rat models, red ginseng ameliorated testicular damage caused by chronic intermittent heat stress and sub-acute immobilization stress. It improved sperm kinematics, restored organ weights, and modulated the expression of antioxidant enzymes and spermatogenesis-related genes. These findings suggest that red ginseng may help mitigate stress-related male infertility.¹²⁷

Despite the promising findings, the exact mechanisms by which red ginseng improves male fertility are not fully understood, and further research is needed to determine the optimal dosage and duration of treatment.

Dosage Recommendation Based on Research

Red ginseng is safe for healthy adults to consume daily at a dose of 2 g for up to 3 months for improved motility, concentration, morphology, and viability of sperm.¹²⁸

Table 13 Dosage Recommendation for Red Ginseng

Side Effects

Common Side Effects: Side effects of red ginseng may include diarrhea, headache, increased blood pressure, nausea, or insomnia.¹²⁹

Drug Interactions: Red ginseng may interact or interfere with medications such as antidiabetics, antidepressants, antihypertensives, diuretics, and blood thinners.

Safety Precautions: Talk with your healthcare provider before taking herbal supplements.

Bottom Line

Strength of recommendations: Red ginseng shows potential as a therapeutic agent for improving male fertility by improving motility, concentrations, morphology, and viability of sperm. However, further research with a focus on larger, well-designed studies is required to fully understand its mechanisms and to validate its clinical use.

Specific Nutrient: Puncturevine

What is it

Puncturevine (Tribulus terrestris), commonly called bindii or lawnweed, is an annual herb, native to Africa, Asia, Australia, and Europe. It is an integral part of indigenous medicine.

How it Works

Puncturevine contains a strong phytochemical agent named protodioscin (steroidal saponin). Protodioscin acts on Sertoli cells, germ cell proliferation, and the growth of seminiferous tubules. Protodioscin is known to convert testosterone into dihydrotestosterone and acts as a stimulator of testosterone production, which plays an important role in male attributes. Dihydrotestosterone is a hormone that stimulates the development of male sexual characteristics (an androgen) and is involved in the growth and repair of the prostate and the penis. Almost 10% of the testosterone produced by an adult each day is converted to dihydrotestosterone. It also acts as an antioxidant to protect sperm cells from oxidative damage. ¹³⁰

What the Research is Telling us

In a study involving 65 men with abnormal semen evaluation, the oral administration of Androsten® (250 mg of puncturevine dried extract per capsule) was found to be effective in increasing testosterone levels, sperm concentration, and motility in a 90-day study. Also, a significant decrease in the percentage of body fat and an increase in lean mass were observed.¹³⁰

However, no statistically significant difference was observed in the levels of testosterone (total and free) and LH and semen parameters (sperm concentration or motility, or abnormal forms) before and after the treatment with puncturevine supplementation (750 mg/day in 3 divided doses) for 3 months in patients having idiopathic infertility. ¹³¹

In an animal study on a mouse model, the safety of puncturevine extract was evaluated for 28 days. The findings suggested that puncturevine does not adversely affect body weight, reproductive organ weights, or androgen-dependent biochemical markers. ¹³²However, further research, particularly well-designed clinical trials with large population sizes, is needed to establish its role in treating male infertility conclusively.

Dosage Recommendation Based on Research

Puncturevine extract is possibly safe when taken at a dosage of 250-1500 mg/day for up to 90 days for increasing testosterone levels, sperm concentration, and motility.¹³³

Table 14 Dosage Recommendation for Puncturevine

Side Effects

Common Side Effects: The common side effects of puncturevine may include diarrhea, constipation, headache, increased blood pressure, nausea, or insomnia.¹³³

Drug Interactions: Puncturevine may interact with medications like antidiabetics, anti-hypertensives, diuretics, and blood thinners.

Safety Precautions: Speak with your healthcare provider before taking herbal supplements.

Bottom Line

Strength of recommendations: Despite the promising results of puncturevine in improving testosterone levels, sperm concentration, and motility, its role in treating male infertility remains controversial. Some studies suggest its benefits, while others call for more rigorous, placebo-controlled trials to confirm its efficacy and better understand its mechanisms. Future research should focus on larger, well-designed studies to provide more definitive conclusions about its role in male infertility treatment.

Multi-Nutrients

A varied and balanced diet, including vegetables, fruits, fish, seafood, nuts, seeds, poultry, and low-fat dairy products, provides all the essential nutrients required for reproductive health. Fruits and vegetables are great sources of vital nutrients like antioxidants, minerals, vitamins, and other phytochemicals. A study based on a 3-day record method on 90 men suggested that men who consumed fruits and vegetables (>734 g/day) showed the highest sperm concentration, vitality, motility, and antioxidant capacity in semen and blood.¹³⁴ However, the fruits and vegetables should be organic and properly washed with water to remove pesticide residue since it has a detrimental effect on semen quality.¹³⁵

Some studies have highlighted the protective role of some fruit juices and extracts on male fertility in animal models. For instance, broccoli extract (300 mg/kg) was found to improve testicular structure, sperm count, viability, motility, and serum and testes oxidative stress biomarkers, and increase testosterone levels in a mice model.¹³⁶

Protein provides the amino acids that are the building blocks of sperm cells. A low-protein diet can reduce the size and weight of the testicles and lower testosterone levels.¹³⁷ In a study on 270 infertile men, a diet rich in plant proteins was found to improve semen parameters like concentration, motility, and morphology, whereas an animal protein-rich diet exhibited the opposite effect.¹³⁸

Multi-antioxidant supplementation is an emerging therapy for male infertility due to the synergistic effect of multi-antioxidants. A study on 32 infertile men with idiopathic oligoasthenozoospermia, demonstrated a notable increase in sperm concentration, progressive motility, and total motility when treated with a multi-antioxidant oral supplement caplet for 3 months. The capsule consisted of vitamin C (90 mg/day), vitamin E (15 mg/day), selenium (30 µg/day), coenzyme Q10 (4 mg/day), and zinc (5 mg/day).¹³⁹ Comparably, the administration of multi-antioxidant supplements (consisting of 50 mg coenzyme-Q10, 500 mg L-carnitine: 2.5 mg lycopene, and 12.5 mg zinc) for 3 months leads to a significant improvement in sperm count and total motility in 138 men with oligoastheonoteratozoospermia.¹⁴⁰ Despite some positive findings, the evidence supporting the effectiveness of antioxidants in treating male infertility is not conclusive. Further research is needed to establish standardized guidelines for multi-antioxidant use in male infertility treatment. Large, well-designed randomized controlled trials are necessary to determine the optimal combinations and dosages of antioxidants and to assess their long-term safety and efficacy.

Who are the Experts

Several renowned researchers and experts in the field of male infertility have made significant contributions to understanding its causes and treatments. Some notable names include:

Dr. Peter Schlegel – A leading expert in male infertility and microsurgery. Dr. Schlegel is an internationally recognized urologist. He has served as Chair of Urology at Weill Cornell Medicine and has authored numerous papers on male infertility and sperm retrieval techniques. Dr. Schlegel’s contributions to the field of male infertility are extensive. He has developed new genetic analyses to understand the causes of the severe form of male infertility known as non-obstructive azoospermia. His research has identified nearly 25 additional genetic causes of infertility that can lead to new treatments. He was the first to publish articles on the medical treatment of infertility with aromatase inhibitors and demonstrate the value of such treatment.

Abstract of relevant published work:

Diagnosis and treatment of infertility in men: AUA/ASRM guideline part I (American Urological Association Journal, January 1, 2021)¹⁴¹

Best practice policies for male infertility¹⁴² (Elsevier, May 6, 2002)

Diagnosis and treatment of infertility in men: AUA/ASRM guideline part II¹⁴³ (American Urological Association Journal, January 1, 2021)

Aromatase inhibitors for male infertility¹⁴⁴ (Elsevier, October 25, 2012)

Prof. Allan Pacey – Prof. Pacey is a professor of andrology who serves as deputy vice president and deputy dean of the faculty of biology, medicine, and health at the University of Manchester, United Kingdom. Prof. Pacey is known for his research on male infertility, particularly in sperm quality and the genetic factors influencing infertility. He has been awarded Honorary Membership of the British Fertility Society (BFS) for his exceptional contributions to research, scholarship, and public engagement in male infertility over the past 30 years.

Abstract of relevant published work:

Male fertility and the need for more research¹⁴⁵ (Taylor & Francis, May 6, 2019)

Sperm, human fertility and society¹⁴⁶ (Elsevier, September 8, 2009)

Dr. Ashok Agarwal – A pioneer in the field of male infertility, Dr. Agarwal is a recognized expert and Director of the Andrology Center at the Cleveland Clinic, Ohio, US. His research has focused on sperm dysfunction, oxidative stress, and advanced laboratory techniques in male infertility. Ashok is ranked in Scopus as the top-ranking author worldwide in the fields of Male Infertility/Andrology and Human Assisted Reproduction, based on his number of peer-reviewed publications, citation scores, and Hirsch index (h-index).

Abstract of relevant published work:

 Effect of antioxidant supplementation on the sperm proteome of idiopathic infertile men¹⁴⁷ (MDPI, October 16, 2019)

The role of antioxidant therapy in the treatment of male infertility¹⁴⁸ (Taylor & Francis, November 30, 2010)

Obesity and male infertility: Mechanisms and management¹⁴⁹ (Wiley, May 12, 2020)

Positions and Views of Worldwide Governmental Medical and Health Organizations

The positions and views of governmental medical and health organizations on male infertility vary by country but generally emphasize its importance as a public health issue. These organizations are concerned with male infertility for several reasons: its impact on family planning, its association with underlying health problems, and the psychological and emotional burden it can place on individuals and couples. Here is a summary of some global perspectives on male infertility:

• Positions from the Medical Community

  • Agency for Healthcare Research and Quality (AHRQ)

    • Male Infertility | Effective Health Care (EHC) Program (AHRQ 2024)¹⁵⁰

  • National Institute for Health and Care Excellence (NICE), United Kingdom

    • Fertility problems: assessment and treatment (NICE 2013)¹⁵¹

• Worldwide Governmental Websites on Male Infertility

  • WHO on male infertility and semen analysis.

    • Infertility (WHO 2014)¹⁵²

    •  WHO laboratory manual for the examination and processing of human semen for investigating male fertility status (WHO 2024)¹⁵³

  • NIH (USA) on male infertility and its diagnosis and treatment.

    • Diagnosis and treatment of infertility in men: AUA/ASRM guideline part II (NIH 2021)

    • Updates to Male Infertility: AUA/ASRM Guideline (2024) (NIH 2024)¹⁵⁴

  • NHS (UK) on male infertility and its causes

    • Low sperm count (NHS 2017)¹⁵⁵

    • Causes of infertility (NHS 2017)¹⁵⁶

  • CDC.gov (USA) on male infertility, its causes, and treatment

    • Infertility: Frequently Asked Questions | Reproductive Health (CDC 2024)¹⁵⁷

  • Public Health Agency of Canada on male infertility and assisted human reproduction.

    • Assisted human reproduction (Public Health Agency of Canada 2024)¹⁵⁸

  • Department of Health (Ireland)

    • Minister for Health announces plans to roll out a Model of Care for Infertility (Department of Health 2019)¹⁵⁹

Nonprofits and Private Organizations

There are many nonprofit and private organizations focused on male infertility, offering resources, support, and advocacy. These organizations work to raise awareness about male infertility, provide educational materials, and help individuals access treatment options. Below is a list of some of these organizations:

• Nonprofit and Private Organizations:

  • American Society for Reproductive Medicine (ASRM)

    • Purpose/Mission statement: “ASRM’s mission is to lead the advancement of reproductive medicine through evidence-based ethical practice, education, research, and advocacy”. ASRM is a professional organization that includes resources about male infertility, its causes, diagnosis, and treatment options. It provides educational materials and offers support for healthcare providers and patients alike. It provides a platform for male infertility specialists and patients to access the latest science, journals, courses, opinion documents, and networking opportunities. ASRM mission page.¹⁶⁰

Website: asrm.org

• Social media accounts: Instagram: @asrm_org // LinkedIn: https://www.linkedin.com/company/american-society-for-reproductive-medicine/ //YouTube: www.youtube.com/@ASRMEducation //Facebook: https://www.facebook.com/ASRMFB/ //Twitter: @ASRM_org

• National Infertility Association (RESOLVE)

  • Purpose/Mission statement: “RESOLVE is a nonprofit organization dedicated to ensuring that all people challenged in their family-building journey reach a resolution through being empowered by knowledge, supported by the community, united by advocacy, and inspired to act”. They provide support for individuals and couples facing infertility, including male infertility. They offer educational materials, resources for finding support groups, and advocacy efforts to improve access to fertility care. National Infertility Association (RESOLVE) mission page.¹⁶¹

Website: resolve.org

• Social media accounts: Instagram: @resolveorg // Twitter: @resolveorg // Facebook: https://www.facebook.com/resolveinfertilityorg/ // Linkedln: https://www.linkedin.com/company/resolve-the-national-infertility-association/ //YouTube: https://www.youtube.com/c/ResolveOrg

• FertilityIQ

  • Purpose/Mission statement: “FertilityIQ’s goal is to deliver critical education to people when they need it most – so they can navigate life’s most complex inflection points”.¹⁶² They offer ratings and reviews of fertility clinics, including those that treat male infertility. It provides a platform for men to research various treatments, clinics, and procedures related to infertility.

Website: fertilityiq.com

• Social media accounts: Instagram: @fertilityiq //Twitter: @FertilityIQ //Facebook: https://www.facebook.com/FertilityIQ/

Social Media Contributors

Platforms that frequently discuss the topic of male fertility, health, and wellness are:

• Michigan Medicine

  • Michigan Medicine is a premier, highly ranked academic medical center and award-winning healthcare system of the University of Michigan. Their social media accounts provide podcasts addressing male infertility, among other fertility topics. It often includes insights from doctors and individuals who have experienced infertility, offering support and education on both male and female fertility issues.

Website:uofmhealth.org

• Social media accounts: Instagram (30K+ followers): @umichmedicine// LinkedIn (92K+ Followers): https://www.linkedin.com/company/michigan-medicine/ // Youtube (200K+ Subscribers):www.youtube.com/@MichiganMedicine //Facebook (89.2K+ Followers): http://on.fb.me/michiganmedicine // Twitter (43K+ Followers):@umichmedicine

• Fertile Minds

  • The Fertile Minds platform provides the latest research, studies, and information to help you understand fertility. It is brought to you by IVF Australia, Melbourne IVF, Queensland Fertility Group, and TasIVF.

  • Social media accounts: YouTube (33.3K+ Subscribers): www.youtube.com/@FertileMinds // TikTok (137 Followers):tiktok.com/@fertileminds?is_from_webapp=1&sender_device=pc

• NutritionFacts.org

  • It is a science-based nonprofit organization founded by Michael Greger, M.D. Fellow of the American College of Lifestyle Medicine (FACLM), provides free updates on the latest research on male infertility and its link to nutrition via bite-sized videos, blogs, podcasts, and infographics.

Website: nutritionfacts.org

• Social media accounts: Instagram (1.2M+ followers):www.youtube.com/@NutritionFactsOrg //YouTube (1.21M+ Subscribers):www.youtube.com/@NutritionFactsOrg //Facebook (881K+ Followers): facebook.com/NutritionFacts.org// Twitter (153.5K+ Followers):twitter.com/nutrition_fact

• Maze Men’s Sexual & Reproductive Health

  • A channel of Dr. Michael A. Werner, MD, who is a board-certified, fellowship-trained urologist. His practice is limited to sexual dysfunction and male infertility.

Website: mazehealth.com

• Social media accounts: Instagram (20.3k+ followers)//YouTube (7.12k+ Subscribers): www.youtube.com/@mazewerner/videos //Facebook (7.9K+ Followers): facebook.com/MazeMensHealth// Twitter (1.1K+ Followers): twitter.com/mazemenshealth

Bibliography

Abdollahi, Nooshin, Mehran Nouri, Kimia Leilami, Yasser Fakri Mustafa, and Mahsa Shirani. “The Relationship between Plant and Animal Based Protein with Semen Parameters: A Cross-Sectional Study in Infertile Men.” Clinical Nutrition ESPEN 49 (June 2022): 372–77. https://doi.org/10.1016/j.clnesp.2022.03.019.

Adekunbi, D.A., O.A. Ogunsola, O.T. Oyelowo, E.O. Aluko, A.A. Popoola, and O.O. Akinboboye. “Consumption of High Sucrose and/or High Salt Diet Alters Sperm Function in Male Sprague–Dawley Rats.” Egyptian Journal of Basic and Applied Sciences 3, no. 2 (June 2016): 194–201. https://doi.org/10.1016/j.ejbas.2016.03.003.

Agarwal, Ashok, Aditi A. Mulgund, Alaa J. Hamada, and Michelle Renee Chyatte. “A Unique View on Male Infertility around the Globe.” Reproductive Biology and Endocrinology : RB&E 13 (2015). https://doi.org/10.1186/s12958-015-0032-1. 

Agarwal, Ashok, Manesh Kumar Panner Selvam, Luna Samanta, Sarah C. Vij, Neel Parekh, Edmund Sabanegh, Nicholas N. Tadros, Mohamed Arafa, and Rakesh Sharma. “Effect of Antioxidant Supplementation on the Sperm Proteome of Idiopathic Infertile Men.” Antioxidants 8, no. 10 (October 16, 2019): 488. https://doi.org/10.3390/antiox8100488.

Agarwal, Ashok, and Lucky H. Sekhon. “The Role of Antioxidant Therapy in the Treatment of Male Infertility.” Human Fertility 13, no. 4 (December 2010): 217–25. https://doi.org/10.3109/14647273.2010.532279.

Ahmadi, Sedigheh, Reihane Bashiri, Akram Ghadiri-Anari, and Azadeh Nadjarzadeh. “Antioxidant Supplements and Semen Parameters: An Evidence Based Review.” International Journal of Reproductive Biomedicine 14, no. 12 (December 2016): 729–36.https://doi.org/10.29252/ijrm.14.12.729.

Ajuogu, Peter Kelechi, Mohammed Ak Al-Aqbi, Robert A Hart, Mitchell Wolden, Neil A Smart, and James R McFarlane. “The Effect of Dietary Protein Intake on Factors Associated with Male Infertility: A Systematic Literature Review and Meta-Analysis of Animal Clinical Trials in Rats.” Nutrition and Health 26, no. 1 (March 2020): 53–64. https://doi.org/10.1177/0260106019900731.

Akmal, Mohammed, J.Q. Qadri, Noori S. Al-Waili, Shahiya Thangal, Afrozul Haq, and Khelod Y. Saloom. “Improvement in Human Semen Quality After Oral Supplementation of Vitamin C.” Journal of Medicinal Food 9, no. 3 (September 2006): 440–42. https://doi.org/10.1089/jmf.2006.9.440.

Al Tarique, Mostafa M., Jesmine Banu, Nastaran Lasker, S. M. Munira, Shahin Ara Anwary, Tandra Ghosh, Sharmin Sultana, Rawnok Laila, Asma Akter, and Makshoda Begum. “Effects of Levo-Carnitine in Infertile Men with Asthenozoospermia: A Randomized Placebo-Controlled Trial.” International Journal of Reproduction, Contraception, Obstetrics and Gynecology 13, no. 6 (May 29, 2024): 1409–14. https://doi.org/10.18203/2320-1770.ijrcog20241421.

Alahmar, Ahmed T. “Effect of Vitamin C, Vitamin E, Zinc, Selenium, and Coenzyme Q10 in Infertile Men with Idiopathic Oligoasthenozoospermia.” International Journal of Infertility & Fetal Medicine 8, no. 2 (August 2017): 45–49. https://doi.org/10.5005/jp-journals-10016-1147.

Alahmar, Ahmed T. “The Impact of Two Doses of Coenzyme Q10 on Semen Parameters and Antioxidant Status in Men with Idiopathic Oligoasthenoteratozoospermia.” Clinical and Experimental Reproductive Medicine 46, no. 3 (September 2019): 112–18. https://doi.org/10.5653/cerm.2019.00136.

Ambiye, Vijay R., Deepak Langade, Swati Dongre, Pradnya Aptikar, Madhura Kulkarni, and Atul Dongre. “Clinical Evaluation of the Spermatogenic Activity of the Root Extract of Ashwagandha ( Withania Somnifera ) in Oligospermic Males: A Pilot Study.” Evidence-Based Complementary and Alternative Medicine 2013 (2013): 1–6. https://doi.org/10.1155/2013/571420.

“Clinical Evaluation of the Spermatogenic Activity of the Root Extract of Ashwagandha ( Withania Somnifera ) in Oligospermic Males: A Pilot Study.” Evidence-Based Complementary and Alternative Medicine 2013 (2013): 1–6. https://doi.org/10.1155/2013/571420.

Amor, Houda, Yaser Alkhaled, Riffat Bibi, Mohamad Eid Hammadeh, and Peter Michael Jankowski. “The Impact of Heavy Smoking on Male Infertility and Its Correlation with the Expression Levels of the PTPRN2 and PGAM5 Genes.” Genes 14, no. 8 (August 12, 2023): 1617. https://doi.org/10.3390/genes14081617.

Argent, Emmanuelle Mathieu d’, Célia Ravel, Alexandra Rousseau, Karine Morcel, Nathalie Massin, Julie Sussfeld, Tabassome Simon, et al. “High-Dose Supplementation of Folic Acid in Infertile Men Improves IVF-ICSI Outcomes: A Randomized Controlled Trial (FOLFIV Trial).” Journal of Clinical Medicine 10 (2021).  https://doi.org/10.3390/jcm10091876 .

Bendera, Richard, and Leanna S. Wilson. “The Regulatory Effect of Biogenic Polyamines Spermine and Spermidine in Men and Women.” Open Journal of Endocrine and Metabolic Diseases 09, no. 03 (2019): 35–48. https://doi.org/10.4236/ojemd.2019.93004.

Biggs, Sarah, Jane Halliday, and Karin Hammarberg. “Psychological Consequences of a Diagnosis of Infertility in Men: A Systematic Analysis.” Asian Journal of Andrology 26 (2023): 10–19. https://doi.org/10.4103/aja202334. 

Boonyarangkul, Arthit, Nipattha Vinayanuvattikhun, Charoenchai Chiamchanya, and Pachara Visutakul. “Comparative Study of the Effects of Tamoxifen Citrate and Folate on Semen Quality of the Infertile Male with Semen Abnormality.” Journal of the Medical Association of Thailand Chotmaihet Thangphaet 98, no. 11 (November 2015): 1057–63.

Braesco, Véronique, Isabelle Souchon, Patrick Sauvant, Typhaine Haurogné, Matthieu Maillot, Catherine Féart, and Nicole Darmon. “Ultra-Processed Foods: How Functional Is the NOVA System?” European Journal of Clinical Nutrition 76, no. 9 (September 2022): 1245–53. https://doi.org/10.1038/s41430-022-01099-1.

Brannigan, Robert E., Linnea Hermanson, Janice Kaczmarek, Sennett K. Kim, Erin Kirkby, and Cigdem Tanrikut. “Updates to Male Infertility: AUA/ASRM Guideline (2024).” Journal of Urology 212, no. 6 (December 2024): 789–99. https://doi.org/10.1097/JU.0000000000004180.

Brighten, Dr Jolene. “25 Health Benefits of Omega-3 Fatty Acids.” Dr. Jolene Brighten, March 7, 2020. https://drbrighten.com/25-health-benefits-of-omega-3-fatty-acids/.

Burch, James B, Sara Wagner Robb, Robin Puett, Bo Cai, Rebecca Wilkerson, Wilfried Karmaus, John Vena, and Erik Svendsen. “Mercury in Fish and Adverse Reproductive Outcomes: Results from South Carolina.” International Journal of Health Geographics 13, no. 1 (2014): 30. https://doi.org/10.1186/1476-072X-13-30.

Canada, Health. “Assisted Human Reproduction.” Decisions, July 26, 2004. https://www.canada.ca/en/health-canada/services/drugs-health-products/biologics-radiopharmaceuticals-genetic-therapies/legislation-guidelines/assisted-human-reproduction.html.

CDC. “Infertility: Frequently Asked Questions.” Reproductive Health, November 25, 2024. https://www.cdc.gov/reproductive-health/infertility-faq/index.html.

Chavarro, Jorge E., Thomas L. Toth, Sonita M. Sadio, and Russ Hauser. “Soy Food and Isoflavone Intake in Relation to Semen Quality Parameters among Men from an Infertility Clinic.” Human Reproduction (Oxford, England) 23, no. 11 (November 2008): 2584–90. https://doi.org/10.1093/humrep/den243.

Chereshnev, Valeriy A., Svetlana V. Pichugova, Yakov B. Beikin, Margarita V. Chereshneva, Angelina I. Iukhta, Yuri I. Stroev, and Leonid P. Churilov. “Pathogenesis of Autoimmune Male Infertility: Juxtacrine, Paracrine, and Endocrine Dysregulation.” Pathophysiology: The Official Journal of the International Society for Pathophysiology 28, no. 4 (October 15, 2021): 471–88. https://doi.org/10.3390/pathophysiology28040030.

Chiu, Y.H., M.C. Afeiche, A.J. Gaskins, P.L. Williams, J.C. Petrozza, C. Tanrikut, R. Hauser, and J.E. Chavarro. “Fruit and Vegetable Intake and Their Pesticide Residues in Relation to Semen Quality among Men from a Fertility Clinic.” Human Reproduction 30, no. 6 (June 2015): 1342–51. https://doi.org/10.1093/humrep/dev064.

Choy, Christine M.Y., Queenie S.Y. Yeung, Christine M. Briton-Jones, Chi-Kwok Cheung, Christopher W.K. Lam, and Christopher J. Haines. “Relationship between Semen Parameters and Mercury Concentrations in Blood and in Seminal Fluid from Subfertile Males in Hong Kong.” Fertility and Sterility 78, no. 2 (August 2002): 426–28. https://doi.org/10.1016/S0015-0282(02)03232-6.

Cleveland Clinic. “Ginseng: Uses, Interactions & Side Effects.” Accessed November 24, 2024. https://my.clevelandclinic.org/health/drugs/19105-ginseng-capsules-or-tablets.

CNET. “15 Best Food Sources of Zinc.” Accessed November 26, 2024. https://www.cnet.com/health/nutrition/best-food-sources-of-zinc/.

Cyrus, Ali, Ali Kabir, Davood Goodarzi, and Mehrdad Moghimi. “The Effect of Adjuvant Vitamin C after Varicocele Surgery on Sperm Quality and Quantity in Infertile Men: A Double Blind Placebo Controlled Clinical Trial.” International Brazilian Journal of Urology : Official Journal of the Brazilian Society of Urology 41 (2015): 230–38. https://doi.org/10.1590/s1677-5538.ibju.2015.02.07. 

Dabbous, Zeinab, and Stephen L. Atkin. “Hyperprolactinaemia in Male Infertility: Clinical Case Scenarios.” Arab Journal of Urology 16, no. 1 (March 2018): 44–52. https://doi.org/10.1016/j.aju.2017.10.002.

Dai, Jing-Bo, Zhao-Xia Wang, and Zhong-Dong Qiao. “The Hazardous Effects of Tobacco Smoking on Male Fertility.” Asian Journal of Andrology 17, no. 6 (2015): 954–60. https://doi.org/10.4103/1008-682X.150847.

Danielewicz, Anna, Katarzyna Przybyłowicz, and Jakub Morze. “Processed Meat Intake in Relation to Semen Quality Indicators among Men Attending a Fertility Clinic.” Proceedings of the Nutrition Society 79, no. OCE2 (2020): E650. https://doi.org/10.1017/S0029665120005996.

D’Aniello, Gemma, Salvatore Ronsini, Tiziana Notari, Natascia Grieco, Vincenzo Infante, Nicola D’Angel, Fara Mascia, Maria Maddalena Di Fiore, George Fisher, and Antimo D’Aniello. “D-Aspartate, a Key Element for the Improvement of Sperm Quality.” Advances in Sexual Medicine 02, no. 04 (2012): 45–53. https://doi.org/10.4236/asm.2012.24008.

Fallah, Ali, Azadeh Mohammad-Hasani, and Abasalt Hosseinzadeh Colagar. “Zinc Is an Essential Element for Male Fertility: A Review of Zn Roles in Men’s Health, Germination, Sperm Quality, and Fertilization.” Journal of Reproduction & Infertility 19, no. 2 (2018): 69–81.

“FertilityIQ: All The Best Family Building Education.” Accessed December 5, 2024. https://www.fertilityiq.com/.

Gaia Herbs. “Ashwagandha: 10 Side Effects & Contraindications to Know.” Accessed November 24, 2024. https://www.gaiaherbs.com/blogs/seeds-of-knowledge/ashwagandha-side-effects.

Gonzales, G. F., A. Cordova, C. Gonzales, A. Chung, K. Vega, and A. Villena. “Lepidium Meyenii (Maca) Improved Semen Parameters in Adult Men.” Asian Journal of Andrology 3, no. 4 (December 2001): 301–3.

Gordetsky, Jennifer, Edwin Van Wijngaarden, and Jeanne O’Brien. “Redefining Abnormal Follicle‐stimulating Hormone in the Male Infertility Population.” BJU International 110, no. 4 (August 2012): 568–72. https://doi.org/10.1111/j.1464-410X.2011.10783.x.

Greco, Ermanno, Marcello Iacobelli, Laura Rienzi, Filippo Ubaldi, Susanna Ferrero, and Jan Tesarik. “Reduction of the Incidence of Sperm DNA Fragmentation by Oral Antioxidant Treatment.” Journal of Andrology 26, no. 3 (May 6, 2005): 349–53. https://doi.org/10.2164/jandrol.04146.

Griffin, R. Morgan. “Conenzyme Q10 (CoQ10): Should You Take Supplements?” WebMD. Accessed November 25, 2024. https://www.webmd.com/diet/supplement-guide-coenzymeq10-coq10.

Guo, Dan, Wei Wu, Qiuqin Tang, Shanlei Qiao, Yiqiu Chen, Minjian Chen, Mengying Teng, et al. “The Impact of BMI on Sperm Parameters and the Metabolite Changes of Seminal Plasma Concomitantly.” Oncotarget 8, no. 30 (July 25, 2017): 48619–34. https://doi.org/10.18632/oncotarget.14950.

Healthline. “15 Healthy Foods That Are High in Folate (Folic Acid),” March 8, 2023. https://www.healthline.com/nutrition/foods-high-in-folate-folic-acid.

Healthline. “Does Ashwagandha Make You Fertile? What the Research Says,” September 21, 2023. https://www.healthline.com/health/does-ashwagandha-make-you-fertile.

Healthline. “L-Carnitine – A Review of Benefits, Side Effects and Dosage,” March 27, 2023. https://www.healthline.com/nutrition/l-carnitine.

Healthline. “Normal Sperm Count: Understanding Your Semen Analysis,” August 29, 2018. https://www.healthline.com/health/mens-health/normal-sperm-count.

Healthline. “Should You Avoid Fish Because of Mercury?,” September 14, 2018. https://www.healthline.com/nutrition/mercury-content-of-fish.

“The Hormones That Drive Male Fertility | Legacy,” February 4, 2023. https://www.givelegacy.com/resources/the-hormones-that-drive-male-fertility/.https://www.givelegacy.com/.

“Vitamin D Rich Food- Fruits, Vegetables & Other Sources.” Accessed November 26, 2024. https://www.hdfcergo.com/health-insurance/wellness-corner/vitamin-d-rich-food-in-india.https://www.hdfcergo.com/.

I. Abbas, Yasir, Mazin A. Yadigar, and Shayma S. Khuder. “The Effect of L-Carnitine Supplement on Seminal Fluid Parameters in Males with Infertility.” Tikrit Journal of Pharmaceutical Sciences 13, no. 1 (April 26, 2023): 23–29. https://doi.org/10.25130/tjphs.2018.13.1.4.23.29.

“Infertility.” Accessed December 6, 2024. https://www.who.int/news-room/fact-sheets/detail/infertility.

Jensen, T. K., S. H. Swan, N. E. Skakkebaek, S. Rasmussen, and N. Jorgensen. “Caffeine Intake and Semen Quality in a Population of 2,554 Young Danish Men.” American Journal of Epidemiology 171, no. 8 (April 15, 2010): 883–91. https://doi.org/10.1093/aje/kwq007.

Jensen, Tina Kold, Mads Gottschau, Jens Otto Broby Madsen, Anne-Maria Andersson, Tina Harmer Lassen, Niels E Skakkebæk, Shanna H Swan, Lærke Priskorn, Anders Juul, and Niels Jørgensen. “Habitual Alcohol Consumption Associated with Reduced Semen Quality and Changes in Reproductive Hormones; a Cross-Sectional Study among 1221 Young Danish Men.” BMJ Open 4, no. 9 (September 2014): e005462. https://doi.org/10.1136/bmjopen-2014-005462.

Jiao, Shi-Ya, Yi-Hong Yang, and Su-Ren Chen. “Molecular Genetics of Infertility: Loss-of-Function Mutations in Humans and Corresponding Knockout/Mutated Mice.” Human Reproduction Update 27, no. 1 (January 4, 2021): 154–89. https://doi.org/10.1093/humupd/dmaa034.

Jihad Manssor1, Abdul Rahman, Zaid Mohammed Mubarak Al–Mahdawi1, and Azzawi Mustafa Hadi2. “The Effect of L-Arginine of Treatment for Infertile Men on Semen Parameters.” Tikrit Journal of Pure Science 24, no. 5 (September 13, 2019): 1. https://doi.org/10.25130/j.v24i5.858.

Kaltsas, Aris, Athanasios Zachariou, Fotios Dimitriadis, Michael Chrisofos, and Nikolaos Sofikitis. “Empirical Treatments for Male Infertility: A Focus on Lifestyle Modifications and Medicines.” Diseases 12, no. 9 (September 11, 2024): 209. https://doi.org/10.3390/diseases12090209.

Keohane, Patrick, Jeremy R. Everett, Rui Pereira, Chad M. Cook, Traci M. Blonquist, and Eunice Mah. “Supplementation of Spermidine at 40 Mg/Day Has Minimal Effects on Circulating Polyamines: An Exploratory Double-Blind Randomized Controlled Trial in Older Men.” Nutrition Research 132 (December 2024): 1–14. https://doi.org/10.1016/j.nutres.2024.09.012.

Kopalli, Spandana Rajendra, Kyu-Min Cha, Seock-Yeon Hwang, Min-Sik Jeong, and Si-Kwan Kim. “Korean Red Ginseng (Panax Ginseng Meyer) with Enriched Rg3 Ameliorates Chronic Intermittent Heat Stress–Induced Testicular Damage in Rats via Multifunctional Approach.” Journal of Ginseng Research 43, no. 1 (January 2019): 135–42. https://doi.org/10.1016/j.jgr.2018.06.004.

Kumari, Mrinalini, Praveen Kumar, and Poonam Jayant Singh. “Safety Evaluation of Tribulus Terrestris on the Male Reproductive Health of Laboratory Mouse.” International Journal of Pharmaceutical and Phytopharmacological Research 4 (2017): 281–87. https://api.semanticscholar.org/CorpusID:89826565.

“L-ARGININE: Overview, Uses, Side Effects, Precautions, Interactions, Dosing and Reviews.” Accessed November 25, 2024. https://www.webmd.com/vitamins/ai/ingredientmono-875/l-arginine.

“L-CARNITINE: Overview, Uses, Side Effects, Precautions, Interactions, Dosing and Reviews.” Accessed November 25, 2024. https://www.webmd.com/vitamins/ai/ingredientmono-1026/l-carnitine.

Leisegang, Kristian, Pallav Sengupta, Ashok Agarwal, and Ralf Henkel. “Obesity and Male Infertility: Mechanisms and Management.” Andrologia 53, no. 1 (February 2021). https://doi.org/10.1111/and.13617.

Lenzi, Andrea, Paolo Sgrò, Pietro Salacone, Donatella Paoli, Barbara Gilio, Francesco Lombardo, Maria Santulli, Ashok Agarwal, and Loredana Gandini. “A Placebo-Controlled Double-Blind Randomized Trial of the Use of Combined l-Carnitine and l-Acetyl-Carnitine Treatment in Men with Asthenozoospermia.” Fertility and Sterility 81, no. 6 (June 2004): 1578–84. https://doi.org/10.1016/j.fertnstert.2003.10.034.

León-Ramírez, Yeimy Mar De, Eliut Pérez Sánchez, Adriana Corona Pérez, Cristhian Neftaly Sánchez-Solís, Jorge Rodríguez-Antolín, and Leticia Nicolás-Toledo. “Dietary Intervention in Adult Rats Exposed to a High-Sugar Diet Early in Life Permanently Impairs Sperm Quality.” Annales d’Endocrinologie 84, no. 6 (December 2023): 779–89. https://doi.org/10.1016/j.ando.2023.06.002.

Leslie, Stephen W., Taylor L. Soon-Sutton, and Moien AB Khan. “Male Infertility.” In StatPearls. Treasure Island (FL): StatPearls Publishing, 2024. http://www.ncbi.nlm.nih.gov/books/NBK562258/.

Li, Hui, Ningshan Li, Qudong Lu, Jun Yang, Jiang Zhao, Qiong Zhu, Shanhong Yi, et al. “Chronic Alcohol-Induced Dysbiosis of the Gut Microbiota and Gut Metabolites Impairs Sperm Quality in Mice.” Frontiers in Microbiology 13 (December 1, 2022): 1042923. https://doi.org/10.3389/fmicb.2022.1042923.

Livestrong.com. “7 Foods High in D-Aspartic Acid for Plant-Based and Meat-Eaters Alike.” Accessed November 25, 2024. https://www.livestrong.com/article/518754-foods-high-in-d-aspartic-acid/.

Ma, L., and Y. Sun. “Comparison of L-Carnitine vs. Coq10 and Vitamin E for Idiopathic Male Infertility: A Randomized Controlled Trial.” European Review for Medical and Pharmacological Sciences 26, no. 13 (July 2022): 4698–4704. https://doi.org/10.26355/eurrev_202207_29194.

Madej, Dawid, Dominika Granda, Ewa Sicinska, and Joanna Kaluza. “Influence of Fruit and Vegetable Consumption on Antioxidant Status and Semen Quality: A Cross-Sectional Study in Adult Men.” Frontiers in Nutrition 8 (October 15, 2021): 753843. https://doi.org/10.3389/fnut.2021.753843.

Maghsoumi-Norouzabad, Leila, Ahmad Zare Javid, Anahita Mansoori, Mohammadreza Dadfar, and Amirarsalan Serajian. “Vitamin D3 Supplementation Effects on Spermatogram and Oxidative Stress Biomarkers in Asthenozoospermia Infertile Men: A Randomized, Triple-Blind, Placebo-Controlled Clinical Trial.” Reproductive Sciences 29, no. 3 (March 2022): 823–35. https://doi.org/10.1007/s43032-021-00769-y.

“Male Infertility | Effective Health Care (EHC) Program.” Accessed December 6, 2024. https://effectivehealthcare.ahrq.gov/health-topics/male-infertility?_gl=1*rk8e8o*_ga*MTQzOTc4MzIzNS4xNzMzNTMwNzk2*_ga_45NDTD15CJ*MTczMzUzMDgxMS4xLjEuMTczMzUzMDgyMi40OS4wLjA.

Male Infertility Guide. “Hormone Testing and Interpretation for Male Infertility.” Accessed November 24, 2024. https://www.maleinfertilityguide.com/hormone-testing-and-interpretation.

Malik, Sonia, Sanjay Kalra, Pm Gopinath, Ajit Saxena, Bharti Kalra, Kapil Kochhar, and Hemant Zaveri. “Fixed Dose Combination Therapy of Antioxidants in Treatment of Idiopathic Oligoasthenozoospermia: Results of a Randomized, Double-Blind, Placebo-Controlled Clinical Trial.” International Journal of Infertility & Fetal Medicine 4, no. 1 (April 2013): 6–13. https://doi.org/10.5005/jp-journals-10016-1053.

Mannucci, Amanda, Flavia Rita Argento, Eleonora Fini, Maria Elisabetta Coccia, Niccolò Taddei, Matteo Becatti, and Claudia Fiorillo. “The Impact of Oxidative Stress in Male Infertility.” Frontiers in Molecular Biosciences 8 (2021): 799294. https://doi.org/10.3389/fmolb.2021.799294.

Mayo Clinic. “Abnormal Sperm Morphology? What It Could Mean for You.” Accessed November 25, 2024. https://www.mayoclinic.org/diseases-conditions/male-infertility/expert-answers/sperm-morphology/faq-20057760.

MedicineNet. “Lycopene: Supplement Uses, Warnings, Side Effects, Dosage.” Accessed November 25, 2024. https://www.medicinenet.com/lycopene/article.htm.

Meldgaard, Maiken, Nis Brix, Anne Gaml-Sørensen, Andreas Ernst, Cecilia Høst Ramlau-Hansen, Sandra Søgaard Tøttenborg, Karin Sørig Hougaard, Jens Peter Ellekilde Bonde, and Gunnar Toft. “Consumption of Sugar-Sweetened or Artificially Sweetened Beverages and Semen Quality in Young Men: A Cross-Sectional Study.” International Journal of Environmental Research and Public Health 19, no. 2 (January 7, 2022): 682. https://doi.org/10.3390/ijerph19020682.

Melnikovova, Ingrid, Tomas Fait, Michaela Kolarova, Eloy C. Fernandez, and Luigi Milella. “Effect of Lepidium Meyenii Walp. on Semen Parameters and Serum Hormone Levels in Healthy Adult Men: A Double-Blind, Randomized, Placebo-Controlled Pilot Study.” Evidence-Based Complementary and Alternative Medicine: eCAM 2015 (2015): 324369. https://doi.org/10.1155/2015/324369.

“Effect of Lepidium Meyenii Walp. on Semen Parameters and Serum Hormone Levels in Healthy Adult Men: A Double-Blind, Randomized, Placebo-Controlled Pilot Study.” Evidence-Based Complementary and Alternative Medicine: eCAM 2015 (2015): 324369. https://doi.org/10.1155/2015/324369.

“Minister for Health Announces Plans to Roll out a Model of Care for Infertility,” December 19, 2019. https://www.gov.ie/en/press-release/2d19d3-minister-for-health-announces-plans-to-roll-out-a-model-of-care-for-/.

“Mission, Vision and Values.” Accessed December 5, 2024. https://www.asrm.org/about-us/about-asrm/mission-vision-and-values/.

Moslemi, Mohammad Kazem, and Seiied Ali Zargar. “Selenium&Vitamin E Supplementation in Infertile Men: Effects on Semen Parameters and Pregnancy Rate.” International Journal of General Medicine, January 2011, 99. https://doi.org/10.2147/IJGM.S16275.

Mount Sinai Health System. “Vitamin D Information | Mount Sinai – New York.” Accessed November 26, 2024. https://www.mountsinai.org/health-library/supplement/vitamin-d.

Mount Sinai Health System. “Zinc Information | Mount Sinai – New York.” Accessed November 26, 2024. https://www.mountsinai.org/health-library/supplement/zinc.

Munira, S. M., Nastaran Lasker, Rawnok Laila, Asma Akter, Jesmine Banu, and Shakeela Ishrat. “Effect of Omega 3 Fatty Acid in Infertile Males with Oligozoospermia.” International Journal of Reproduction, Contraception, Obstetrics and Gynecology 13, no. 2 (January 29, 2024): 270–76. https://doi.org/10.18203/2320-1770.ijrcog20240121.

Mushannen, Tasnim, Priscilla Cortez, Fatima Cody Stanford, and Vibha Singhal. “Obesity and Hypogonadism-A Narrative Review Highlighting the Need for High-Quality Data in Adolescents.” Children (Basel, Switzerland) 6, no. 5 (May 1, 2019): 63. https://doi.org/10.3390/children6050063.

Muthusami, K.R., and P. Chinnaswamy. “Effect of Chronic Alcoholism on Male Fertility Hormones and Semen Quality.” Fertility and Sterility 84, no. 4 (October 2005): 919–24. https://doi.org/10.1016/j.fertnstert.2005.04.025.

My Food Data. “Top 10 Foods Highest in Lycopene,” November 10, 2024. https://www.myfooddata.com/articles/high-lycopene-foods.php.

My Food Data. “Top 10 Foods Highest in Selenium,” November 10, 2024. https://www.myfooddata.com/articles/foods-high-in-selenium.php.

Nassan, F. L., L. Priskorn, A. Salas-Huetos, T. I. Halldorsson, T. K. Jensen, N. Jørgensen, and J. E. Chavarro. “Association between Intake of Soft Drinks and Testicular Function in Young Men.” Human Reproduction (Oxford, England) 36, no. 12 (November 18, 2021): 3036–48. https://doi.org/10.1093/humrep/deab179.

News, Purovitalis. “Spermidine Side Effects – Myths vs Reality.” Purovitalis, January 4, 2023. https://purovitalis.com/spermidine-side-effects-myths-vs-reality/.

Nhs.uk. “Causes of Infertility,” October 23, 2017. https://www.nhs.uk/conditions/infertility/causes/.

Nhs.uk. “Low Sperm Count,” October 19, 2017. https://www.nhs.uk/conditions/low-sperm-count/.

Nouri, Mehran, Reza Amani, Mohammadhossein Nasr‐Esfahani, and Mohammad Javad Tarrahi. “The Effects of Lycopene Supplement on the Spermatogram and Seminal Oxidative Stress in Infertile Men: A Randomized, Double‐blind, Placebo‐controlled Clinical Trial.” Phytotherapy Research 33, no. 12 (December 2019): 3203–11. https://doi.org/10.1002/ptr.6493.

Nugent, Colleen N., and Anjani Chandra. “Infertility and Impaired Fecundity in Women and Men in the United States, 2015-2019.” National Health Statistics Reports 202 (2024): 1–19. https://doi.org/10.15620/cdc/147886 .

“Office of Dietary Supplements – Nutrient Recommendations and Databases.” Accessed November 26, 2024. https://ods.od.nih.gov/HealthInformation/nutrientrecommendations.aspx.

“Office of Dietary Supplements – Omega-3 Fatty Acids.” Accessed November 25, 2024. https://ods.od.nih.gov/factsheets/Omega3FattyAcids-Consumer/.

“Office of Dietary Supplements – Vitamin C.” Accessed November 26, 2024. https://ods.od.nih.gov/factsheets/VitaminC-Consumer/.

Oflaherty, C, P Rodriguez, and S Srivastava. “-Arginine Promotes Capacitation and Acrosome Reaction in Cryopreserved Bovine Spermatozoa.” Biochimica et Biophysica Acta (BBA) – General Subjects 1674, no. 2 (September 24, 2004): 215–21. https://doi.org/10.1016/j.bbagen.2004.06.020.

Omu, A.E., M.K. Al-Azemi, E.O. Kehinde, J.T. Anim, M.A. Oriowo, and T.C. Mathew. “Indications of the Mechanisms Involved in Improved Sperm Parameters by Zinc Therapy.” Medical Principles and Practice 17, no. 2 (2008): 108–16. https://doi.org/10.1159/000112963.

OstroVit. “Arginine – Properties, Health-Promoting Effects and Food Sources.” Accessed November 25, 2024. https://ostrovit.com/en/blog/arginine-properties-health-promoting-effects-and-food-sources-1636970344.html.

“Our Mission | RESOLVE: The National Infertility Association,” August 27, 2021. https://resolve.org/about-us/mission/.

“Overview | Fertility Problems: Assessment and Treatment | Guidance | NICE,” February 20, 2013. https://www.nice.org.uk/guidance/cg156.

Pacey, Allan. “Male Fertility and the Need for More Research.” Human Fertility 22, no. 2 (April 3, 2019): 77–77. https://doi.org/10.1080/14647273.2019.1611281.

Pacey, Allan A. “Sperm, Human Fertility and Society.” In Sperm Biology, 565–97. Elsevier, 2009. https://doi.org/10.1016/B978-0-12-372568-4.00015-X.

Pajarinen, Jarkko, Pekka J. Karhunen, Vesa Savolainen, Kaisa Lalu, Antti Penttilä, and Pekka Laippala. “Moderate Alcohol Consumption and Disorders of Human Spermatogenesis.” Alcoholism: Clinical and Experimental Research 20, no. 2 (April 1996): 332–37. https://doi.org/10.1111/j.1530-0277.1996.tb01648.x.

Park, Hyun Jun, Sangmin Choe, and Nam Cheol Park. “Effects of Korean Red Ginseng on Semen Parameters in Male Infertility Patients: A Randomized, Placebo-Controlled, Double-Blind Clinical Study.” Chinese Journal of Integrative Medicine 22, no. 7 (July 2016): 490–95. https://doi.org/10.1007/s11655-015-2139-9.

Park, Yoo-Jin, El-Sayed A. Mohamed, Woo-Sung Kwon, Young-Ah You, Buom-Yong Ryu, and Myung-Geol Pang. “Xenoestrogenic Chemicals Effectively Alter Sperm Functional Behavior in Mice.” Reproductive Toxicology 32, no. 4 (December 2011): 418–24. https://doi.org/10.1016/j.reprotox.2011.09.011.

Pecora, Giulia, Francesca Sciarra, Elena Gangitano, and Mary Anna Venneri. “How Food Choices Impact on Male Fertility.” Current Nutrition Reports 12, no. 4 (October 20, 2023): 864–76. https://doi.org/10.1007/s13668-023-00503-x.

“Possible Interactions with: Omega-3 Fatty Acids | Complementary and Alternative Medicine | St. Luke’s Hospital.” Accessed November 25, 2024. https://www.stlukes-stl.com/health-content/medicine/33/000971.htm.

PRODIA. “12 Foods Rich in Omega-3 Fatty Acids: Benefits for Heart and Brain Health.” PRODIA. Accessed November 25, 2024. https://prodiadigital.com/en/articles/foods-containing-omega-fatty-acids.

Raeeszadeh, Mahdieh, Nadia Khademi, and Abolfazl Akbari. “The Effects of Broccoli and Caraway Extracts on Serum Oxidative Markers, Testicular Structure and Function, and Sperm Quality before and after Sperm Cryopreservation.” Cryobiology 99 (April 2021): 11–19. https://doi.org/10.1016/j.cryobiol.2021.02.003.

Rahman, Md Saidur, Woo-Sung Kwon, June-Sub Lee, Sung-Jae Yoon, Buom-Yong Ryu, and Myung-Geol Pang. “Bisphenol-A Affects Male Fertility via Fertility-Related Proteins in Spermatozoa.” Scientific Reports 5, no. 1 (March 16, 2015): 9169. https://doi.org/10.1038/srep09169.

Raspa, Marcello, Renata Paoletti, Manon Peltier, Mohamed Majjouti, Michele Protti, Laura Mercolini, Esther Mahabir, and Ferdinando Scavizzi. “Oral D-Aspartate Treatment Improves Sperm Fertility in Both Young and Adult B6N Mice.” Animals 12, no. 11 (May 25, 2022): 1350. https://doi.org/10.3390/ani12111350.

Rhim, Hye Chang, Min Seo Kim, Young-Jin Park, Woo Suk Choi, Hyoung Keun Park, Hyeong Gon Kim, Aram Kim, and Sung Hyun Paick. “The Potential Role of Arginine Supplements on Erectile Dysfunction: A Systemic Review and Meta-Analysis.” The Journal of Sexual Medicine 16, no. 2 (February 1, 2019): 223–34. https://doi.org/10.1016/j.jsxm.2018.12.002.

Roaiah, Mohamed Farid, Yasser Ibrahim Elkhayat, Sameh Fayek GamalEl Din, and Mohamed Ahmed Abd El Salam. “Prospective Analysis on the Effect of Botanical Medicine (Tribulus Terrestris) on Serum Testosterone Level and Semen Parameters in Males with Unexplained Infertility.” Journal of Dietary Supplements 14, no. 1 (January 2, 2017): 25–31. https://doi.org/10.1080/19390211.2016.1188193.

RxList. “Folic Acid (Folic Acid): Side Effects, Uses, Dosage, Interactions, Warnings.” Accessed November 26, 2024. https://www.rxlist.com/folic-acid-drug.htm.

Ryu, Do-Yeal, Won-Ki Pang, Elikanah Olusayo Adegoke, Md Saidur Rahman, Yoo-Jin Park, and Myung-Geol Pang. “Bisphenol-A Disturbs Hormonal Levels and Testis Mitochondrial Activity, Reducing Male Fertility.” Human Reproduction Open 2023, no. 4 (September 10, 2023): hoad044. https://doi.org/10.1093/hropen/hoad044.

Sabetian, Soudabeh, Bahia Namavar Jahromi, Sina Vakili, Sedighe Forouhari, and Shohreh Alipour. “The Effect of Oral Vitamin E on Semen Parameters and IVF Outcome: A Double-Blinded Randomized Placebo-Controlled Clinical Trial.” BioMed Research International 2021 (2021). https://doi.org/10.1155/2021/5588275 .

Safarinejad, M. R. “Effect of Omega-3 Polyunsaturated Fatty Acid Supplementation on Semen Profile and Enzymatic Anti-Oxidant Capacity of Seminal Plasma in Infertile Men with Idiopathic Oligoasthenoteratospermia: A Double-Blind, Placebo-Controlled, Randomised Study: Effect of Omega-3 Polyunsaturated Fatty Acid Supplementation.” Andrologia 43, no. 1 (February 2011): 38–47. https://doi.org/10.1111/j.1439-0272.2009.01013.x.

Safarinejad, Mohammad Reza. “Efficacy of Coenzyme Q10 on Semen Parameters, Sperm Function and Reproductive Hormones in Infertile Men.” Journal of Urology 182, no. 1 (July 2009): 237–48. https://doi.org/10.1016/j.juro.2009.02.121.

Safarinejad, Mohammad Reza, and Shiva Safarinejad. “Efficacy of Selenium and/or N-Acetyl-Cysteine for Improving Semen Parameters in Infertile Men: A Double-Blind, Placebo Controlled, Randomized Study.” Journal of Urology 181, no. 2 (February 2009): 741–51. https://doi.org/10.1016/j.juro.2008.10.015.

Salas-Huetos, Albert, Mònica Bulló, and Jordi Salas-Salvadó. “Dietary Patterns, Foods and Nutrients in Male Fertility Parameters and Fecundability: A Systematic Review of Observational Studies.” Human Reproduction Update 23, no. 4 (July 1, 2017): 371–89. https://doi.org/10.1093/humupd/dmx006.

Salas-Huetos, Albert, Rocío Moraleda, Simona Giardina, Ester Anton, Joan Blanco, Jordi Salas-Salvadó, and Mònica Bulló. “Effect of Nut Consumption on Semen Quality and Functionality in Healthy Men Consuming a Western-Style Diet: A Randomized Controlled Trial.” The American Journal of Clinical Nutrition 108, no. 5 (November 2018): 953–62. https://doi.org/10.1093/ajcn/nqy181.

Salgado, R. M., M. H. Marques-Silva, E. Gonçalves, A. C. Mathias, J. G. Aguiar, and P. Wolff. “Effect of Oral Administration of Tribulus Terrestris Extract on Semen Quality and Body Fat Index of Infertile Men.” Andrologia 49, no. 5 (June 2017): e12655. https://doi.org/10.1111/and.12655.

Santi, Daniele, Carla Greco, Arcangelo Barbonetti, Manuela Simoni, Mario Maggi, and Giovanni Corona. “Weight Loss as Therapeutic Option to Restore Fertility in Obese Men: A Meta-Analytic Study.” The World Journal of Men’s Health, 2024. https://doi.org/10.5534/wjmh.240091 

Sarkar, Sneha. “20 Vitamin E-Rich Foods to Include in Your Diet.” Nutrition World (blog), March 27, 2023. https://www.fastandup.in/nutrition-world/foods-high-in-vitamin-e/.

Schisterman, Enrique F., Traci Clemons, C. Matthew Peterson, Erica Johnstone, Ahmad O. Hammoud, Denise Lamb, Douglas T. Carrell, et al. “A Randomized Trial to Evaluate the Effects of Folic Acid and Zinc Supplementation on Male Fertility and Livebirth: Design and Baseline Characteristics.” American Journal of Epidemiology 189, no. 1 (January 31, 2020): 8–26. https://doi.org/10.1093/aje/kwz217.

Schlegel, Peter N. “Aromatase Inhibitors for Male Infertility.” Fertility and Sterility 98, no. 6 (December 2012): 1359–62. https://doi.org/10.1016/j.fertnstert.2012.10.023.

Schlegel, Peter N., Mark Sigman, Barbara Collura, Christopher J. De Jonge, Michael L. Eisenberg, Dolores J. Lamb, John P. Mulhall, et al. “Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline Part I.” Journal of Urology 205, no. 1 (January 2021): 36–43. https://doi.org/10.1097/JU.0000000000001521.

“Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline PART II.” Journal of Urology 205, no. 1 (January 2021): 44–51. https://doi.org/10.1097/JU.0000000000001520.

Scott, Macpherson, Yates, Hussain, and Dixon. “The Effect of Oral Selenium Supplementation on Human Sperm Motility.” British Journal of Urology 82, no. 1 (July 1998): 76–80. https://doi.org/10.1046/j.1464-410x.1998.00683.x.

“SELENIUM: Overview, Uses, Side Effects, Precautions, Interactions, Dosing and Reviews.” Accessed November 25, 2024. https://www.webmd.com/vitamins/ai/ingredientmono-1003/selenium.

Senekowitsch, Stefan, Eliza Wietkamp, Michael Grimm, Franziska Schmelter, Philipp Schick, Anna Kordowski, Christian Sina, Hans Otzen, Werner Weitschies, and Martin Smollich. “High-Dose Spermidine Supplementation Does Not Increase Spermidine Levels in Blood Plasma and Saliva of Healthy Adults: A Randomized Placebo-Controlled Pharmacokinetic and Metabolomic Study.” Nutrients 15, no. 8 (April 12, 2023): 1852. https://doi.org/10.3390/nu15081852.

Sharlip, Ira D, Jonathan P Jarow, Arnold M Belker, Larry I Lipshultz, Mark Sigman, Anthony J Thomas, Peter N Schlegel, et al. “Best Practice Policies for Male Infertility.” Fertility and Sterility 77, no. 5 (May 2002): 873–82. https://doi.org/10.1016/S0015-0282(02)03105-9.

Snow, Summer. “The Power of Spermidine: How This Natural Compound Can Benefit Your Health.” Burick Center for Health and Wellness (blog), July 28, 2023. https://burickcenter.com/the-power-of-spermidine-how-this-natural-compound-can-benefit-your-health/.

Song, Sang-Wook, Ha-Na Kim, Jae-Yong Shim, Byeong-Yeon Yoo, Dae-Hyun Kim, Sang-Hyun Lee, Joo-Sung Park, et al. “Safety and Tolerability of Korean Red Ginseng in Healthy Adults: A Multicenter, Double-Blind, Randomized, Placebo-Controlled Trial.” Journal of Ginseng Research 42, no. 4 (October 2018): 571–76. https://doi.org/10.1016/j.jgr.2018.07.002.

The Nutrition Source. “Processed Foods and Health,” June 24, 2019. https://nutritionsource.hsph.harvard.edu/processed-foods/.

Topo, Enza, Andrea Soricelli, Antimo D’Aniello, Salvatore Ronsini, and Gemma D’Aniello. “The Role and Molecular Mechanism of D-Aspartic Acid in the Release and Synthesis of LH and Testosterone in Humans and Rats.” Reproductive Biology and Endocrinology: RB&E 7 (October 27, 2009): 120. https://doi.org/10.1186/1477-7827-7-120.

Tua Saúde. “Tribulus Terrestris: Health Benefits, Dose & Side Effects,” December 20, 2023. https://www.tuasaude.com/en/tribulus-terrestris/.

Valle-Hita, Cristina, Albert Salas-Huetos, María Fernández De La Puente, María Ángeles Martínez, Silvia Canudas, Antoni Palau-Galindo, Cristina Mestres, et al. “Ultra-Processed Food Consumption and Semen Quality Parameters in the Led-Fertyl Study.” Human Reproduction Open 2024, no. 1 (January 5, 2024): hoae001. https://doi.org/10.1093/hropen/hoae001.

Vanderhout, Shelley M., Matineh Rastegar Panah, Bibiana Garcia-Bailo, Patricia Grace-Farfaglia, Konrad Samsel, Judith Dockray, Keith Jarvi, and Ahmed El-Sohemy. “Nutrition, Genetic Variation and Male Fertility.” Translational Andrology and Urology 10, no. 3 (March 2021): 1410–31. https://doi.org/10.21037/tau-20-592.

Verywell Health. “How D-Aspartic Acid Functions in the Body.” Accessed November 25, 2024. https://www.verywellhealth.com/d-aspartic-acid-uses-and-safety-8356258.

“Vitamin C | Natural Grocers.” Accessed November 26, 2024. https://www.naturalgrocers.com/article/vitamin-c.

“VITAMIN E: Overview, Uses, Side Effects, Precautions, Interactions, Dosing and Reviews.” Accessed November 26, 2024. https://www.webmd.com/vitamins/ai/ingredientmono-954/vitamin-e.

Wang, Jin-Yuan, Duo Ma, Min Luo, Yong-Peng Tan, Ou Zhong, Ge Tian, Yong-Ting Lv, et al. “Effect of Spermidine on Ameliorating Spermatogenic Disorders in Diabetic Mice via Regulating Glycolysis Pathway.” Reproductive Biology and Endocrinology 20, no. 1 (March 7, 2022): 45. https://doi.org/10.1186/s12958-022-00890-w.

“What Are Contraindications for Taking Maca Root?” Accessed November 24, 2024. https://www.themacateam.com/what-are-contraindications-for-taking-maca-root?srsltid=AfmBOorYd22KD_XhLZeiDb8tIFaR9wga_kkOvJqM6R7eL6ligKX8ygRX.

“Which Foods Have the Highest Content of Spermidine?” Accessed November 25, 2024. https://us.supersmart.com/en/blog/anti-aging/us.supersmart.com/en/blog/anti-aging/which-foods-have-the-highest-content-spermidine-s420.

“WHO Laboratory Manual for the Examination and Processing of Human Semen.” Accessed December 6, 2024. https://www.who.int/publications/i/item/9789240030787.

Yahyavi, Sam Kafai, Ida Marie Boisen, Zhihui Cui, Mads Joon Jorsal, Ireen Kooij, Rune Holt, Anders Juul, and Martin Blomberg Jensen. “Calcium and Vitamin D Homoeostasis in Male Fertility.” Proceedings of the Nutrition Society 83, no. 2 (May 2024): 95–108. https://doi.org/10.1017/S002966512300486X.

Yamamoto, Yu, Koichi Aizawa, Makiko Mieno, Mika Karamatsu, Yasuko Hirano, Kuniko Furui, Tatsuya Miyashita, et al. “The Effects of Tomato Juice on Male Infertility.” Asia Pacific Journal of Clinical Nutrition 26, no. 1 (January 2017): 65–71. https://doi.org/10.6133/apjcn.102015.17.

Zhao, Jiang, Xingyou Dong, Xiaoyan Hu, Zhou Long, Liang Wang, Qian Liu, Bishao Sun, Qingqing Wang, Qingjian Wu, and Longkun Li. “Zinc Levels in Seminal Plasma and Their Correlation with Male Infertility: A Systematic Review and Meta-Analysis.” Scientific Reports 6, no. 1 (March 2, 2016): 22386. https://doi.org/10.1038/srep22386.

---

1. Ashok Agarwal et al., “A Unique View on Male Infertility around the Globe,” Reproductive Biology and Endocrinology : RB&E 13 (2015), https://doi.org/10.1186/s12958-015-0032-1. ↩︎

2. Colleen N. Nugent and Anjani Chandra, “Infertility and Impaired Fecundity in Women and Men in the United States, 2015-2019.,” National Health Statistics Reports 202 (2024): 1–19. https://doi.org/10.15620/cdc/147886 .↩︎

3. Aris Kaltsas et al., “Empirical Treatments for Male Infertility: A Focus on Lifestyle Modifications and Medicines,” Diseases 12, no. 9 (September 11, 2024): 209, https://doi.org/10.3390/diseases12090209.↩︎

4. Stephen W. Leslie, Taylor L. Soon-Sutton, and Moien AB Khan, “Male Infertility,” in StatPearls (Treasure Island (FL): StatPearls Publishing, 2024), http://www.ncbi.nlm.nih.gov/books/NBK562258/.↩︎

5. Sarah Biggs, Jane Halliday, and Karin Hammarberg, “Psychological Consequences of a Diagnosis of Infertility in Men: A Systematic Analysis,” Asian Journal of Andrology 26 (2023): 10–19, https://doi.org/10.4103/aja202334. ↩︎

6. Shelley M. Vanderhout et al., “Nutrition, Genetic Variation and Male Fertility,” Translational Andrology and Urology 10, no. 3 (March 2021): 1410–31, https://doi.org/10.21037/tau-20-592.↩︎

7. “The Hormones That Drive Male Fertility | Legacy,” Https://Www.Givelegacy.Com/ (blog), February 4, 2023, https://www.givelegacy.com/resources/the-hormones-that-drive-male-fertility/.↩︎

8. “Hormone Testing and Interpretation for Male Infertility,” Male Infertility Guide, accessed November 24, 2024, https://www.maleinfertilityguide.com/hormone-testing-and-interpretation.↩︎

9. Jennifer Gordetsky, Edwin Van Wijngaarden, and Jeanne O’Brien, “Redefining Abnormal Follicle‐stimulating Hormone in the Male Infertility Population,” BJU International 110, no. 4 (August 2012): 568–72, https://doi.org/10.1111/j.1464-410X.2011.10783.x.↩︎

10. Zeinab Dabbous and Stephen L. Atkin, “Hyperprolactinaemia in Male Infertility: Clinical Case Scenarios,” Arab Journal of Urology 16, no. 1 (March 2018): 44–52, https://doi.org/10.1016/j.aju.2017.10.002.↩︎

11. Sedigheh Ahmadi et al., “Antioxidant Supplements and Semen Parameters: An Evidence Based Review,” International Journal of Reproductive Biomedicine 14, no. 12 (December 2016): 729–36.↩︎

12. “Normal Sperm Count: Understanding Your Semen Analysis,” Healthline, August 29, 2018, https://www.healthline.com/health/mens-health/normal-sperm-count.↩︎

13. “Abnormal Sperm Morphology? What It Could Mean for You,” Mayo Clinic, accessed November 25, 2024, https://www.mayoclinic.org/diseases-conditions/male-infertility/expert-answers/sperm-morphology/faq-20057760.↩︎

14. Shi-Ya Jiao, Yi-Hong Yang, and Su-Ren Chen, “Molecular Genetics of Infertility: Loss-of-Function Mutations in Humans and Corresponding Knockout/Mutated Mice,” Human Reproduction Update 27, no. 1 (January 4, 2021): 154–89, https://doi.org/10.1093/humupd/dmaa034.↩︎

15. Valeriy A. Chereshnev et al., “Pathogenesis of Autoimmune Male Infertility: Juxtacrine, Paracrine, and Endocrine Dysregulation,” Pathophysiology: The Official Journal of the International Society for Pathophysiology 28, no. 4 (October 15, 2021): 471–88, https://doi.org/10.3390/pathophysiology28040030.↩︎

16. Amanda Mannucci et al., “The Impact of Oxidative Stress in Male Infertility,” Frontiers in Molecular Biosciences 8 (2021): 799294, https://doi.org/10.3389/fmolb.2021.799294.↩︎

17. Jing-Bo Dai, Zhao-Xia Wang, and Zhong-Dong Qiao, “The Hazardous Effects of Tobacco Smoking on Male Fertility,” Asian Journal of Andrology 17, no. 6 (2015): 954–60, https://doi.org/10.4103/1008-682X.150847.↩︎

18. Houda Amor et al., “The Impact of Heavy Smoking on Male Infertility and Its Correlation with the Expression Levels of the PTPRN2 and PGAM5 Genes,” Genes 14, no. 8 (August 12, 2023): 1617, https://doi.org/10.3390/genes14081617.↩︎

19. Aris Kaltsas et al., “Empirical Treatments for Male Infertility: A Focus on Lifestyle Modifications and Medicines,” Diseases 12, no. 9 (September 11, 2024): 209, https://doi.org/10.3390/diseases12090209.↩︎

20. Giulia Pecora et al., “How Food Choices Impact on Male Fertility,” Current Nutrition Reports 12, no. 4 (October 20, 2023): 864–76, https://doi.org/10.1007/s13668-023-00503-x.↩︎

21. Jarkko Pajarinen et al., “Moderate Alcohol Consumption and Disorders of Human Spermatogenesis,” Alcoholism: Clinical and Experimental Research 20, no. 2 (April 1996): 332–37, https://doi.org/10.1111/j.1530-0277.1996.tb01648.x.↩︎

22. K.R. Muthusami and P. Chinnaswamy, “Effect of Chronic Alcoholism on Male Fertility Hormones and Semen Quality,” Fertility and Sterility 84, no. 4 (October 2005): 919–24, https://doi.org/10.1016/j.fertnstert.2005.04.025.↩︎

23. Hui Li et al., “Chronic Alcohol-Induced Dysbiosis of the Gut Microbiota and Gut Metabolites Impairs Sperm Quality in Mice,” Frontiers in Microbiology 13 (December 1, 2022): 1042923, https://doi.org/10.3389/fmicb.2022.1042923.↩︎

24. Tina Kold Jensen et al., “Habitual Alcohol Consumption Associated with Reduced Semen Quality and Changes in Reproductive Hormones; a Cross-Sectional Study among 1221 Young Danish Men,” BMJ Open 4, no. 9 (September 2014): e005462, https://doi.org/10.1136/bmjopen-2014-005462.↩︎

25. Tasnim Mushannen et al., “Obesity and Hypogonadism-A Narrative Review Highlighting the Need for High-Quality Data in Adolescents,” Children (Basel, Switzerland) 6, no. 5 (May 1, 2019): 63, https://doi.org/10.3390/children6050063.↩︎

26. Daniele Santi et al., “Weight Loss as Therapeutic Option to Restore Fertility in Obese Men: A Meta-Analytic Study.,” The World Journal of Men’s Health, 2024.https://doi.org/10.5534/wjmh.240091 ↩︎

27. Kaltsas et al., “Empirical Treatments for Male Infertility,” September 11, 2024.↩︎

28. Véronique Braesco et al., “Ultra-Processed Foods: How Functional Is the NOVA System?,” European Journal of Clinical Nutrition 76, no. 9 (September 2022): 1245–53, https://doi.org/10.1038/s41430-022-01099-1.↩︎

29. Cristina Valle-Hita et al., “Ultra-Processed Food Consumption and Semen Quality Parameters in the Led-Fertyl Study,” Human Reproduction Open 2024, no. 1 (January 5, 2024): hoae001, https://doi.org/10.1093/hropen/hoae001.↩︎

30. Anna Danielewicz, Katarzyna Przybyłowicz, and Jakub Morze, “Processed Meat Intake in Relation to Semen Quality Indicators among Men Attending a Fertility Clinic,” Proceedings of the Nutrition Society 79, no. OCE2 (2020): E650, https://doi.org/10.1017/S0029665120005996.↩︎

31. Yoo-Jin Park et al., “Xenoestrogenic Chemicals Effectively Alter Sperm Functional Behavior in Mice,” Reproductive Toxicology 32, no. 4 (December 2011): 418–24, https://doi.org/10.1016/j.reprotox.2011.09.011.↩︎

32. “Processed Foods and Health,” The Nutrition Source (blog), June 24, 2019, https://nutritionsource.hsph.harvard.edu/processed-foods/.↩︎

33. James B Burch et al., “Mercury in Fish and Adverse Reproductive Outcomes: Results from South Carolina,” International Journal of Health Geographics 13, no. 1 (2014): 30, https://doi.org/10.1186/1476-072X-13-30.↩︎

34. Christine M.Y. Choy et al., “Relationship between Semen Parameters and Mercury Concentrations in Blood and in Seminal Fluid from Subfertile Males in Hong Kong,” Fertility and Sterility 78, no. 2 (August 2002): 426–28, https://doi.org/10.1016/S0015-0282(02)03232-6.↩︎

35. “Should You Avoid Fish Because of Mercury?,” Healthline, September 14, 2018, https://www.healthline.com/nutrition/mercury-content-of-fish.↩︎

36. T. K. Jensen et al., “Caffeine Intake and Semen Quality in a Population of 2,554 Young Danish Men,” American Journal of Epidemiology 171, no. 8 (April 15, 2010): 883–91, https://doi.org/10.1093/aje/kwq007.↩︎

37. Albert Salas-Huetos, Mònica Bulló, and Jordi Salas-Salvadó, “Dietary Patterns, Foods and Nutrients in Male Fertility Parameters and Fecundability: A Systematic Review of Observational Studies,” Human Reproduction Update 23, no. 4 (July 1, 2017): 371–89, https://doi.org/10.1093/humupd/dmx006.↩︎

38. Yeimy Mar De León-Ramírez et al., “Dietary Intervention in Adult Rats Exposed to a High-Sugar Diet Early in Life Permanently Impairs Sperm Quality,” Annales d’Endocrinologie 84, no. 6 (December 2023): 779–89, https://doi.org/10.1016/j.ando.2023.06.002.↩︎

39. D.A. Adekunbi et al., “Consumption of High Sucrose and/or High Salt Diet Alters Sperm Function in Male Sprague–Dawley Rats,” Egyptian Journal of Basic and Applied Sciences 3, no. 2 (June 2016): 194–201, https://doi.org/10.1016/j.ejbas.2016.03.003.↩︎

40. F. L. Nassan et al., “Association between Intake of Soft Drinks and Testicular Function in Young Men,” Human Reproduction (Oxford, England) 36, no. 12 (November 18, 2021): 3036–48, https://doi.org/10.1093/humrep/deab179.↩︎

41. Maiken Meldgaard et al., “Consumption of Sugar-Sweetened or Artificially Sweetened Beverages and Semen Quality in Young Men: A Cross-Sectional Study,” International Journal of Environmental Research and Public Health 19, no. 2 (January 7, 2022): 682, https://doi.org/10.3390/ijerph19020682.↩︎

42. Jorge E. Chavarro et al., “Soy Food and Isoflavone Intake in Relation to Semen Quality Parameters among Men from an Infertility Clinic,” Human Reproduction (Oxford, England) 23, no. 11 (November 2008): 2584–90, https://doi.org/10.1093/humrep/den243.↩︎

43. Do-Yeal Ryu et al., “Bisphenol-A Disturbs Hormonal Levels and Testis Mitochondrial Activity, Reducing Male Fertility,” Human Reproduction Open 2023, no. 4 (September 10, 2023): hoad044, https://doi.org/10.1093/hropen/hoad044.↩︎

44. Md Saidur Rahman et al., “Bisphenol-A Affects Male Fertility via Fertility-Related Proteins in Spermatozoa,” Scientific Reports 5, no. 1 (March 16, 2015): 9169, https://doi.org/10.1038/srep09169.↩︎

45. Sam Kafai Yahyavi et al., “Calcium and Vitamin D Homoeostasis in Male Fertility,” Proceedings of the Nutrition Society 83, no. 2 (May 2024): 95–108, https://doi.org/10.1017/S002966512300486X.↩︎

46. Ermanno Greco et al., “Reduction of the Incidence of Sperm DNA Fragmentation by Oral Antioxidant Treatment,” Journal of Andrology 26, no. 3 (May 6, 2005): 349–53, https://doi.org/10.2164/jandrol.04146.↩︎

47. Mohammed Akmal et al., “Improvement in Human Semen Quality After Oral Supplementation of Vitamin C,” Journal of Medicinal Food 9, no. 3 (September 2006): 440–42, https://doi.org/10.1089/jmf.2006.9.440.↩︎

48. Shelley M. Vanderhout et al., “Nutrition, Genetic Variation and Male Fertility,” Translational Andrology and Urology 10, no. 3 (March 2021): 1410–31, https://doi.org/10.21037/tau-20-592.↩︎

49. Leila Maghsoumi-Norouzabad et al., “Vitamin D3 Supplementation Effects on Spermatogram and Oxidative Stress Biomarkers in Asthenozoospermia Infertile Men: A Randomized, Triple-Blind, Placebo-Controlled Clinical Trial,” Reproductive Sciences 29, no. 3 (March 2022): 823–35, https://doi.org/10.1007/s43032-021-00769-y.↩︎

50. L. Ma and Y. Sun, “Comparison of L-Carnitine vs. Coq10 and Vitamin E for Idiopathic Male Infertility: A Randomized Controlled Trial,” European Review for Medical and Pharmacological Sciences 26, no. 13 (July 2022): 4698–4704, https://doi.org/10.26355/eurrev_202207_29194.↩︎

51. Ermanno Greco et al., “Reduction of the Incidence of Sperm DNA Fragmentation by Oral Antioxidant Treatment,” Journal of Andrology 26, no. 3 (May 6, 2005): 349–53, https://doi.org/10.2164/jandrol.04146.↩︎

52. Soudabeh Sabetian et al., “The Effect of Oral Vitamin E on Semen Parameters and IVF Outcome: A Double-Blinded Randomized Placebo-Controlled Clinical Trial,” BioMed Research International 2021 (2021), https://doi.org/10.1155/2021/5588275 .↩︎

53. Ali Cyrus et al., “The Effect of Adjuvant Vitamin C after Varicocele Surgery on Sperm Quality and Quantity in Infertile Men: A Double Blind Placebo Controlled Clinical Trial,” International Brazilian Journal of Urology : Official Journal of the Brazilian Society of Urology 41 (2015): 230–38.https://doi.org/10.1590/s1677-5538.ibju.2015.02.07. ↩︎

54. Mohammed Akmal et al., “Improvement in Human Semen Quality After Oral Supplementation of Vitamin C,” Journal of Medicinal Food 9, no. 3 (September 2006): 440–42, https://doi.org/10.1089/jmf.2006.9.440.↩︎

55. Emmanuelle Mathieu d’Argent et al., “High-Dose Supplementation of Folic Acid in Infertile Men Improves IVF-ICSI Outcomes: A Randomized Controlled Trial (FOLFIV Trial),” Journal of Clinical Medicine 10 (2021).  https://doi.org/10.3390/jcm10091876 .↩︎

56. Arthit Boonyarangkul et al., “Comparative Study of the Effects of Tamoxifen Citrate and Folate on Semen Quality of the Infertile Male with Semen Abnormality,” Journal of the Medical Association of Thailand = Chotmaihet Thangphaet 98, no. 11 (November 2015): 1057–63.↩︎

57. Enrique F. Schisterman et al., “A Randomized Trial to Evaluate the Effects of Folic Acid and Zinc Supplementation on Male Fertility and Livebirth: Design and Baseline Characteristics,” American Journal of Epidemiology 189, no. 1 (January 31, 2020): 8–26, https://doi.org/10.1093/aje/kwz217.↩︎

58. “Office of Dietary Supplements – Nutrient Recommendations and Databases,” accessed November 26, 2024, https://ods.od.nih.gov/HealthInformation/nutrientrecommendations.aspx.↩︎

59. “Vitamin D Rich Food- Fruits, Vegetables & Other Sources,” https://www.hdfcergo.com/, accessed November 26, 2024, https://www.hdfcergo.com/health-insurance/wellness-corner/vitamin-d-rich-food-in-india.↩︎

60. “Vitamin C | Natural Grocers,” accessed November 26, 2024, https://www.naturalgrocers.com/article/vitamin-c.↩︎

61. Sneha Sarkar, “20 Vitamin E-Rich Foods to Include in Your Diet,” Nutrition World (blog), March 27, 2023, https://www.fastandup.in/nutrition-world/foods-high-in-vitamin-e/.↩︎

62. “15 Healthy Foods That Are High in Folate (Folic Acid),” Healthline, March 8, 2023, https://www.healthline.com/nutrition/foods-high-in-folate-folic-acid.↩︎

63. “Vitamin D Information | Mount Sinai – New York,” Mount Sinai Health System, accessed November 26, 2024, https://www.mountsinai.org/health-library/supplement/vitamin-d.↩︎

64. “Office of Dietary Supplements – Vitamin C,” accessed November 26, 2024, https://ods.od.nih.gov/factsheets/VitaminC-Consumer/.↩︎

65. “VITAMIN E: Overview, Uses, Side Effects, Precautions, Interactions, Dosing and Reviews,” accessed November 26, 2024, https://www.webmd.com/vitamins/ai/ingredientmono-954/vitamin-e.↩︎

66. “Folic Acid (Folic Acid): Side Effects, Uses, Dosage, Interactions, Warnings,” RxList, accessed November 26, 2024, https://www.rxlist.com/folic-acid-drug.htm.↩︎

67. Ali Fallah, Azadeh Mohammad-Hasani, and Abasalt Hosseinzadeh Colagar, “Zinc Is an Essential Element for Male Fertility: A Review of Zn Roles in Men’s Health, Germination, Sperm Quality, and Fertilization,” Journal of Reproduction & Infertility 19, no. 2 (2018): 69–81.↩︎

68. Mohammad Reza Safarinejad and Shiva Safarinejad, “Efficacy of Selenium and/or N-Acetyl-Cysteine for Improving Semen Parameters in Infertile Men: A Double-Blind, Placebo Controlled, Randomized Study,” Journal of Urology 181, no. 2 (February 2009): 741–51, https://doi.org/10.1016/j.juro.2008.10.015.↩︎

69. A.E. Omu et al., “Indications of the Mechanisms Involved in Improved Sperm Parameters by Zinc Therapy,” Medical Principles and Practice 17, no. 2 (2008): 108–16, https://doi.org/10.1159/000112963.↩︎

70. Jiang Zhao et al., “Zinc Levels in Seminal Plasma and Their Correlation with Male Infertility: A Systematic Review and Meta-Analysis,” Scientific Reports 6, no. 1 (March 2, 2016): 22386, https://doi.org/10.1038/srep22386.↩︎

71. Enrique F. Schisterman et al., “Effect of Folic Acid and Zinc Supplementation in Men on Semen Quality and Live Birth Among Couples Undergoing Infertility Treatment: A Randomized Clinical Trial,” JAMA 323, no. 1 (January 7, 2020): 35–48, https://doi.org/10.1001/jama.2019.18714.↩︎

72. Scott et al., “The Effect of Oral Selenium Supplementation on Human Sperm Motility,” British Journal of Urology 82, no. 1 (July 1998): 76–80, https://doi.org/10.1046/j.1464-410x.1998.00683.x.↩︎

73. Mohammad Kazem Moslemi and Seiied Ali Zargar, “Selenium&Vitamin E Supplementation in Infertile Men: Effects on Semen Parameters and Pregnancy Rate,” International Journal of General Medicine, January 2011, 99, https://doi.org/10.2147/IJGM.S16275.↩︎

74. Mohammad Reza Safarinejad and Shiva Safarinejad, “Efficacy of Selenium and/or N-Acetyl-Cysteine for Improving Semen Parameters in Infertile Men: A Double-Blind, Placebo Controlled, Randomized Study,” Journal of Urology 181, no. 2 (February 2009): 741–51, https://doi.org/10.1016/j.juro.2008.10.015.↩︎

75. “15 Best Food Sources of Zinc,” CNET, accessed November 26, 2024, https://www.cnet.com/health/nutrition/best-food-sources-of-zinc/.↩︎

76. “Top 10 Foods Highest in Selenium,” My Food Data, November 10, 2024, https://www.myfooddata.com/articles/foods-high-in-selenium.php.↩︎

77. “Zinc Information | Mount Sinai – New York,” Mount Sinai Health System, accessed November 26, 2024, https://www.mountsinai.org/health-library/supplement/zinc.↩︎

78. “SELENIUM: Overview, Uses, Side Effects, Precautions, Interactions, Dosing and Reviews,” accessed November 25, 2024, https://www.webmd.com/vitamins/ai/ingredientmono-1003/selenium.↩︎

79. Dr Jolene Brighten, “25 Health Benefits of Omega-3 Fatty Acids,” Dr. Jolene Brighten, March 7, 2020, https://drbrighten.com/25-health-benefits-of-omega-3-fatty-acids/.↩︎

80. M. R. Safarinejad, “Effect of Omega-3 Polyunsaturated Fatty Acid Supplementation on Semen Profile and Enzymatic Anti-Oxidant Capacity of Seminal Plasma in Infertile Men with Idiopathic Oligoasthenoteratospermia: A Double-Blind, Placebo-Controlled, Randomised Study: Effect of Omega-3 Polyunsaturated Fatty Acid Supplementation,” Andrologia 43, no. 1 (February 2011): 38–47, https://doi.org/10.1111/j.1439-0272.2009.01013.x.↩︎

81. Albert Salas-Huetos et al., “Effect of Nut Consumption on Semen Quality and Functionality in Healthy Men Consuming a Western-Style Diet: A Randomized Controlled Trial,” The American Journal of Clinical Nutrition 108, no. 5 (November 2018): 953–62, https://doi.org/10.1093/ajcn/nqy181.↩︎

82. S. M. Munira et al., “Effect of Omega 3 Fatty Acid in Infertile Males with Oligozoospermia,” International Journal of Reproduction, Contraception, Obstetrics and Gynecology 13, no. 2 (January 29, 2024): 270–76, https://doi.org/10.18203/2320-1770.ijrcog20240121.↩︎

83. “Office of Dietary Supplements – Omega-3 Fatty Acids,” accessed November 25, 2024, https://ods.od.nih.gov/factsheets/Omega3FattyAcids-Consumer/.↩︎

84. PRODIA, “12 Foods Rich in Omega-3 Fatty Acids: Benefits for Heart and Brain Health,” PRODIA, accessed November 25, 2024, https://prodiadigital.com/en/articles/foods-containing-omega-fatty-acids.↩︎

85. Mostafa M. Al Tarique et al., “Effects of Levo-Carnitine in Infertile Men with Asthenozoospermia: A Randomized Placebo-Controlled Trial,” International Journal of Reproduction, Contraception, Obstetrics and Gynecology 13, no. 6 (May 29, 2024): 1409–14, https://doi.org/10.18203/2320-1770.ijrcog20241421.↩︎

86. Ahmed T. Alahmar, “The Impact of Two Doses of Coenzyme Q10 on Semen Parameters and Antioxidant Status in Men with Idiopathic Oligoasthenoteratozoospermia,” Clinical and Experimental Reproductive Medicine 46, no. 3 (September 2019): 112–18, https://doi.org/10.5653/cerm.2019.00136.↩︎

87. Kaltsas et al., “Empirical Treatments for Male Infertility,” September 11, 2024.↩︎

88. Yu Yamamoto et al., “The Effects of Tomato Juice on Male Infertility,” Asia Pacific Journal of Clinical Nutrition 26, no. 1 (January 2017): 65–71, https://doi.org/10.6133/apjcn.102015.17.↩︎

89. Mehran Nouri et al., “The Effects of Lycopene Supplement on the Spermatogram and Seminal Oxidative Stress in Infertile Men: A Randomized, Double‐blind, Placebo‐controlled Clinical Trial,” Phytotherapy Research 33, no. 12 (December 2019): 3203–11, https://doi.org/10.1002/ptr.6493.↩︎

90. Andrea Lenzi et al., “A Placebo-Controlled Double-Blind Randomized Trial of the Use of Combined l-Carnitine and l-Acetyl-Carnitine Treatment in Men with Asthenozoospermia,” Fertility and Sterility 81, no. 6 (June 2004): 1578–84, https://doi.org/10.1016/j.fertnstert.2003.10.034.↩︎

91. Mostafa M. Al Tarique et al., “Effects of Levo-Carnitine in Infertile Men with Asthenozoospermia: A Randomized Placebo-Controlled Trial,” International Journal of Reproduction, Contraception, Obstetrics and Gynecology 13, no. 6 (May 29, 2024): 1409–14, https://doi.org/10.18203/2320-1770.ijrcog20241421.↩︎

92. Yasir I. Abbas, Mazin A. Yadigar, and Shayma S. Khuder, “The Effect of L-Carnitine Supplement on Seminal Fluid Parameters in Males with Infertility,” Tikrit Journal of Pharmaceutical Sciences 13, no. 1 (April 26, 2023): 23–29, https://doi.org/10.25130/tjphs.2018.13.1.4.23.29.↩︎

93. Ahmed T Alahmar, “The Impact of Two Doses of Coenzyme Q10 on Semen Parameters and Antioxidant Status in Men with Idiopathic Oligoasthenoteratozoospermia,” Clinical and Experimental Reproductive Medicine 46, no. 3 (September 1, 2019): 112–18, https://doi.org/10.5653/cerm.2019.00136.↩︎

94. Mohammad Reza Safarinejad, “Efficacy of Coenzyme Q10 on Semen Parameters, Sperm Function and Reproductive Hormones in Infertile Men,” Journal of Urology 182, no. 1 (July 2009): 237–48, https://doi.org/10.1016/j.juro.2009.02.121.↩︎

95. “Lycopene: Supplement Uses, Warnings, Side Effects, Dosage,” MedicineNet, accessed November 25, 2024, https://www.medicinenet.com/lycopene/article.htm.↩︎

96. “L-CARNITINE: Overview, Uses, Side Effects, Precautions, Interactions, Dosing and Reviews,” accessed November 25, 2024, https://www.webmd.com/vitamins/ai/ingredientmono-1026/l-carnitine.↩︎

97. R. Morgan Griffin, “Conenzyme Q10 (CoQ10): Should You Take Supplements?,” WebMD, accessed November 25, 2024, https://www.webmd.com/diet/supplement-guide-coenzymeq10-coq10.↩︎

98. “Top 10 Foods Highest in Lycopene,” My Food Data, November 10, 2024, https://www.myfooddata.com/articles/high-lycopene-foods.php.↩︎

99. “L-Carnitine – A Review of Benefits, Side Effects and Dosage,” Healthline, March 27, 2023, https://www.healthline.com/nutrition/l-carnitine.↩︎

100. C Oflaherty, P Rodriguez, and S Srivastava, “-Arginine Promotes Capacitation and Acrosome Reaction in Cryopreserved Bovine Spermatozoa,” Biochimica et Biophysica Acta (BBA) – General Subjects 1674, no. 2 (September 24, 2004): 215–21, https://doi.org/10.1016/j.bbagen.2004.06.020.↩︎

101. Enza Topo et al., “The Role and Molecular Mechanism of D-Aspartic Acid in the Release and Synthesis of LH and Testosterone in Humans and Rats,” Reproductive Biology and Endocrinology: RB&E 7 (October 27, 2009): 120, https://doi.org/10.1186/1477-7827-7-120.↩︎

102. Marcello Raspa et al., “Oral D-Aspartate Treatment Improves Sperm Fertility in Both Young and Adult B6N Mice,” Animals 12, no. 11 (May 25, 2022): 1350, https://doi.org/10.3390/ani12111350.↩︎

103. Gemma D’Aniello et al., “D-Aspartate, a Key Element for the Improvement of Sperm Quality,” Advances in Sexual Medicine 02, no. 04 (2012): 45–53, https://doi.org/10.4236/asm.2012.24008.↩︎

104. Abdul Rahman Jihad Manssor1, Zaid Mohammed Mubarak Al–Mahdawi1, and Azzawi Mustafa Hadi2, “The Effect of L-Arginine of Treatment for Infertile Men on Semen Parameters,” Tikrit Journal of Pure Science 24, no. 5 (September 13, 2019): 1, https://doi.org/10.25130/j.v24i5.858.↩︎

105. Hye Chang Rhim et al., “The Potential Role of Arginine Supplements on Erectile Dysfunction: A Systemic Review and Meta-Analysis,” The Journal of Sexual Medicine 16, no. 2 (February 1, 2019): 223–34, https://doi.org/10.1016/j.jsxm.2018.12.002.↩︎

106. “7 Foods High in D-Aspartic Acid for Plant-Based and Meat-Eaters Alike,” Livestrong.com, accessed November 25, 2024, https://www.livestrong.com/article/518754-foods-high-in-d-aspartic-acid/.↩︎

107. “Arginine – Properties, Health-Promoting Effects and Food Sources,” OstroVit, accessed November 25, 2024, https://ostrovit.com/en/blog/arginine-properties-health-promoting-effects-and-food-sources-1636970344.html.↩︎

108. “How D-Aspartic Acid Functions in the Body,” Verywell Health, accessed November 25, 2024, https://www.verywellhealth.com/d-aspartic-acid-uses-and-safety-8356258.↩︎

109. “L-ARGININE: Overview, Uses, Side Effects, Precautions, Interactions, Dosing and Reviews,” accessed November 25, 2024, https://www.webmd.com/vitamins/ai/ingredientmono-875/l-arginine.↩︎

110. Stefan Senekowitsch et al., “High-Dose Spermidine Supplementation Does Not Increase Spermidine Levels in Blood Plasma and Saliva of Healthy Adults: A Randomized Placebo-Controlled Pharmacokinetic and Metabolomic Study,” Nutrients 15, no. 8 (April 12, 2023): 1852, https://doi.org/10.3390/nu15081852.↩︎

111. Dan Guo et al., “The Impact of BMI on Sperm Parameters and the Metabolite Changes of Seminal Plasma Concomitantly,” Oncotarget 8, no. 30 (July 25, 2017): 48619–34, https://doi.org/10.18632/oncotarget.14950.↩︎

112. Richard Bendera and Leanna S. Wilson, “The Regulatory Effect of Biogenic Polyamines Spermine and Spermidine in Men and Women,” Open Journal of Endocrine and Metabolic Diseases 09, no. 03 (2019): 35–48, https://doi.org/10.4236/ojemd.2019.93004.↩︎

113. Jin-Yuan Wang et al., “Effect of Spermidine on Ameliorating Spermatogenic Disorders in Diabetic Mice via Regulating Glycolysis Pathway,” Reproductive Biology and Endocrinology 20, no. 1 (March 7, 2022): 45, https://doi.org/10.1186/s12958-022-00890-w.↩︎

114. Patrick Keohane et al., “Supplementation of Spermidine at 40 Mg/Day Has Minimal Effects on Circulating Polyamines: An Exploratory Double-Blind Randomized Controlled Trial in Older Men,” Nutrition Research 132 (December 2024): 1–14, https://doi.org/10.1016/j.nutres.2024.09.012.↩︎

115. Purovitalis News, “Spermidine Side Effects – Myths vs Reality,” Purovitalis, January 4, 2023, https://purovitalis.com/spermidine-side-effects-myths-vs-reality/.↩︎

116. “Which Foods Have the Highest Content of Spermidine?,” accessed November 25, 2024, https://us.supersmart.com/en/blog/anti-aging/us.supersmart.com/en/blog/anti-aging/which-foods-have-the-highest-content-spermidine-s420.↩︎

117. Summer Snow, “The Power of Spermidine: How This Natural Compound Can Benefit Your Health,” Burick Center for Health and Wellness (blog), July 28, 2023, https://burickcenter.com/the-power-of-spermidine-how-this-natural-compound-can-benefit-your-health/.↩︎

118. Vijay R. Ambiye et al., “Clinical Evaluation of the Spermatogenic Activity of the Root Extract of Ashwagandha ( Withania Somnifera ) in Oligospermic Males: A Pilot Study,” Evidence-Based Complementary and Alternative Medicine 2013 (2013): 1–6, https://doi.org/10.1155/2013/571420.↩︎

119. Vijay R. Ambiye et al., “Clinical Evaluation of the Spermatogenic Activity of the Root Extract of Ashwagandha ( Withania Somnifera ) in Oligospermic Males: A Pilot Study,” Evidence-Based Complementary and Alternative Medicine 2013 (2013): 1–6, https://doi.org/10.1155/2013/571420.↩︎

120. “Does Ashwagandha Make You Fertile? What the Research Says,” Healthline, September 21, 2023, https://www.healthline.com/health/does-ashwagandha-make-you-fertile.↩︎

121. “Ashwagandha: 10 Side Effects & Contraindications to Know,” Gaia Herbs, accessed November 24, 2024, https://www.gaiaherbs.com/blogs/seeds-of-knowledge/ashwagandha-side-effects.↩︎

122. Ingrid Melnikovova et al., “Effect of Lepidium Meyenii Walp. on Semen Parameters and Serum Hormone Levels in Healthy Adult Men: A Double-Blind, Randomized, Placebo-Controlled Pilot Study,” Evidence-Based Complementary and Alternative Medicine: eCAM 2015 (2015): 324369, https://doi.org/10.1155/2015/324369.↩︎

123. G. F. Gonzales et al., “Lepidium Meyenii (Maca) Improved Semen Parameters in Adult Men,” Asian Journal of Andrology 3, no. 4 (December 2001): 301–3.↩︎

124. Ingrid Melnikovova et al., “Effect of Lepidium Meyenii Walp. on Semen Parameters and Serum Hormone Levels in Healthy Adult Men: A Double-Blind, Randomized, Placebo-Controlled Pilot Study,” Evidence-Based Complementary and Alternative Medicine: eCAM 2015 (2015): 324369, https://doi.org/10.1155/2015/324369.↩︎

125. “What Are Contraindications for Taking Maca Root?,” accessed November 24, 2024, https://www.themacateam.com/what-are-contraindications-for-taking-maca-root?srsltid=AfmBOorYd22KD_XhLZeiDb8tIFaR9wga_kkOvJqM6R7eL6ligKX8ygRX.↩︎

126. Hyun Jun Park, Sangmin Choe, and Nam Cheol Park, “Effects of Korean Red Ginseng on Semen Parameters in Male Infertility Patients: A Randomized, Placebo-Controlled, Double-Blind Clinical Study,” Chinese Journal of Integrative Medicine 22, no. 7 (July 2016): 490–95, https://doi.org/10.1007/s11655-015-2139-9.↩︎

127. Spandana Rajendra Kopalli et al., “Korean Red Ginseng (Panax Ginseng Meyer) with Enriched Rg3 Ameliorates Chronic Intermittent Heat Stress–Induced Testicular Damage in Rats via Multifunctional Approach,” Journal of Ginseng Research 43, no. 1 (January 2019): 135–42, https://doi.org/10.1016/j.jgr.2018.06.004.↩︎

128. Sang-Wook Song et al., “Safety and Tolerability of Korean Red Ginseng in Healthy Adults: A Multicenter, Double-Blind, Randomized, Placebo-Controlled Trial,” Journal of Ginseng Research 42, no. 4 (October 2018): 571–76, https://doi.org/10.1016/j.jgr.2018.07.002.↩︎

129. “Ginseng: Uses, Interactions & Side Effects,” Cleveland Clinic, accessed November 24, 2024, https://my.clevelandclinic.org/health/drugs/19105-ginseng-capsules-or-tablets.↩︎

130. R. M. Salgado et al., “Effect of Oral Administration of Tribulus Terrestris Extract on Semen Quality and Body Fat Index of Infertile Men,” Andrologia 49, no. 5 (June 2017): e12655, https://doi.org/10.1111/and.12655.↩︎

131. Mohamed Farid Roaiah et al., “Prospective Analysis on the Effect of Botanical Medicine ( Tribulus Terrestris ) on Serum Testosterone Level and Semen Parameters in Males with Unexplained Infertility,” Journal of Dietary Supplements 14, no. 1 (January 2, 2017): 25–31, https://doi.org/10.1080/19390211.2016.1188193.↩︎

132. Mrinalini Kumari, Praveen Kumar, and Poonam Jayant Singh, “Safety Evaluation of Tribulus Terrestris on the Male Reproductive Health of Laboratory Mouse,” International Journal of Pharmaceutical and Phytopharmacological Research 4 (2017): 281–87, https://api.semanticscholar.org/CorpusID:89826565.↩︎

133. “Tribulus Terrestris: Health Benefits, Dose & Side Effects,” Tua Saúde, December 20, 2023, https://www.tuasaude.com/en/tribulus-terrestris/.↩︎

134. Dawid Madej et al., “Influence of Fruit and Vegetable Consumption on Antioxidant Status and Semen Quality: A Cross-Sectional Study in Adult Men,” Frontiers in Nutrition 8 (October 15, 2021): 753843, https://doi.org/10.3389/fnut.2021.753843.↩︎

135. Y.H. Chiu et al., “Fruit and Vegetable Intake and Their Pesticide Residues in Relation to Semen Quality among Men from a Fertility Clinic,” Human Reproduction 30, no. 6 (June 2015): 1342–51, https://doi.org/10.1093/humrep/dev064.↩︎

136. Mahdieh Raeeszadeh, Nadia Khademi, and Abolfazl Akbari, “The Effects of Broccoli and Caraway Extracts on Serum Oxidative Markers, Testicular Structure and Function, and Sperm Quality before and after Sperm Cryopreservation,” Cryobiology 99 (April 2021): 11–19, https://doi.org/10.1016/j.cryobiol.2021.02.003.↩︎

137. Peter Kelechi Ajuogu et al., “The Effect of Dietary Protein Intake on Factors Associated with Male Infertility: A Systematic Literature Review and Meta-Analysis of Animal Clinical Trials in Rats,” Nutrition and Health 26, no. 1 (March 2020): 53–64, https://doi.org/10.1177/0260106019900731.↩︎

138. Nooshin Abdollahi et al., “The Relationship between Plant and Animal Based Protein with Semen Parameters: A Cross-Sectional Study in Infertile Men,” Clinical Nutrition ESPEN 49 (June 2022): 372–77, https://doi.org/10.1016/j.clnesp.2022.03.019.↩︎

139. Ahmed T Alahmar, “Effect of Vitamin C, Vitamin E, Zinc, Selenium, and Coenzyme Q10 in Infertile Men with Idiopathic Oligoasthenozoospermia,” International Journal of Infertility & Fetal Medicine 8, no. 2 (August 2017): 45–49, https://doi.org/10.5005/jp-journals-10016-1147.↩︎

140. Sonia Malik et al., “Fixed Dose Combination Therapy of Antioxidants in Treatment of Idiopathic Oligoasthenozoospermia: Results of a Randomized, Double-Blind, Placebo-Controlled Clinical Trial,” International Journal of Infertility & Fetal Medicine 4, no. 1 (April 2013): 6–13, https://doi.org/10.5005/jp-journals-10016-1053.↩︎

141. Peter N. Schlegel et al., “Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline Part I,” Journal of Urology 205, no. 1 (January 2021): 36–43, https://doi.org/10.1097/JU.0000000000001521.↩︎

142. Ira D Sharlip et al., “Best Practice Policies for Male Infertility,” Fertility and Sterility 77, no. 5 (May 2002): 873–82, https://doi.org/10.1016/S0015-0282(02)03105-9.↩︎

143. Peter N. Schlegel et al., “Diagnosis and Treatment of Infertility in Men: AUA/ASRM Guideline PART II,” Journal of Urology 205, no. 1 (January 2021): 44–51, https://doi.org/10.1097/JU.0000000000001520.↩︎

144. Peter N. Schlegel, “Aromatase Inhibitors for Male Infertility,” Fertility and Sterility 98, no. 6 (December 2012): 1359–62, https://doi.org/10.1016/j.fertnstert.2012.10.023.↩︎

145. Allan Pacey, “Male Fertility and the Need for More Research,” Human Fertility 22, no. 2 (April 3, 2019): 77–77, https://doi.org/10.1080/14647273.2019.1611281.↩︎

146. Allan A. Pacey, “Sperm, Human Fertility and Society,” in Sperm Biology (Elsevier, 2009), 565–97, https://doi.org/10.1016/B978-0-12-372568-4.00015-X.↩︎

147. Ashok Agarwal et al., “Effect of Antioxidant Supplementation on the Sperm Proteome of Idiopathic Infertile Men,” Antioxidants 8, no. 10 (October 16, 2019): 488, https://doi.org/10.3390/antiox8100488.↩︎

148. Ashok Agarwal and Lucky H. Sekhon, “The Role of Antioxidant Therapy in the Treatment of Male Infertility,” Human Fertility 13, no. 4 (December 2010): 217–25, https://doi.org/10.3109/14647273.2010.532279.↩︎

149. Kristian Leisegang et al., “Obesity and Male Infertility: Mechanisms and Management,” Andrologia 53, no. 1 (February 2021), https://doi.org/10.1111/and.13617.↩︎

150. “Male Infertility | Effective Health Care (EHC) Program,” accessed December 6, 2024, https://effectivehealthcare.ahrq.gov/health-topics/male-infertility?_gl=1*rk8e8o*_ga*MTQzOTc4MzIzNS4xNzMzNTMwNzk2*_ga_45NDTD15CJ*MTczMzUzMDgxMS4xLjEuMTczMzUzMDgyMi40OS4wLjA.↩︎

151. “Overview | Fertility Problems: Assessment and Treatment | Guidance | NICE,” February 20, 2013, https://www.nice.org.uk/guidance/cg156.↩︎

152. “Infertility,” accessed December 6, 2024, https://www.who.int/news-room/fact-sheets/detail/infertility.↩︎

153. “WHO Laboratory Manual for the Examination and Processing of Human Semen,” accessed December 6, 2024, https://www.who.int/publications/i/item/9789240030787.↩︎

154. Robert E. Brannigan et al., “Updates to Male Infertility: AUA/ASRM Guideline (2024),” Journal of Urology 212, no. 6 (December 2024): 789–99, https://doi.org/10.1097/JU.0000000000004180.↩︎

155. “Low Sperm Count,” nhs.uk, October 19, 2017, https://www.nhs.uk/conditions/low-sperm-count/.↩︎

156. “Causes of Infertility,” nhs.uk, October 23, 2017, https://www.nhs.uk/conditions/infertility/causes/.↩︎

157. CDC, “Infertility: Frequently Asked Questions,” Reproductive Health, November 25, 2024, https://www.cdc.gov/reproductive-health/infertility-faq/index.html.↩︎

158. Health Canada, “Assisted Human Reproduction,” decisions, July 26, 2004, https://www.canada.ca/en/health-canada/services/drugs-health-products/biologics-radiopharmaceuticals-genetic-therapies/legislation-guidelines/assisted-human-reproduction.html.↩︎

159. “Minister for Health Announces Plans to Roll out a Model of Care for Infertility,” December 19, 2019, https://www.gov.ie/en/press-release/2d19d3-minister-for-health-announces-plans-to-roll-out-a-model-of-care-for-/.↩︎

160. “Mission, Vision and Values,” accessed December 5, 2024, https://www.asrm.org/about-us/about-asrm/mission-vision-and-values/.↩︎

161. “Our Mission | RESOLVE: The National Infertility Association,” August 27, 2021, https://resolve.org/about-us/mission/.↩︎

162. “FertilityIQ: All The Best Family Building Education,” accessed December 5, 2024, https://www.fertilityiq.com/.↩︎