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Complementary and Alternative Medicine Interventions for Male Infertility/Subfertility: First Do No Harm

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Complementary & Alternative Medicine for Prostate and Urologic Health

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Abstract

Oxidative stress is associated with up to 80 % of the male subfertility cases. A notable Cochrane Database of Systematic Reviews provided one of the most extensive analyses of 34 randomized trials of supplements for male subfertility during ART (assisted reproductive technologies). It found a highly statistically significant increased chance of pregnancy and live birth for men that used one or several dietary supplements, with side effects that were identical to placebo. Critics might argue that the pregnancy rate (96 pregnancies, 15 clinical trials, 964 couples) and especially the live birth rate (20 events, 3 clinical trials, 214 couples) were not large enough to endorse some supplementation for male subfertility. I strongly disagree because when considering the cost of ART, the added cost of supplementation is just pennies per day for most science-based products, and I believe the benefit greatly outweighs the risk.

Dietary supplementation for male subfertility without the use of ART is also plausible. There is accumulating evidence that the use of one or several low-cost dietary supplement options for men with idiopathic asthenozoospermia or oligoasthenoteratozoospermia (OAT) can improve various aspects of infertility (motility, concentration, morphology) and perhaps even pregnancy and live birth rates. Yet the specific supplements recommended should be curtailed by experts because, overall, some of the supplements that may be successful in improving male subfertility have other acute and chronic health issues according to the medical literature. This has been the limitation of most of the extensive reviews of supplements for male subfertility—the lack of recommending specific compounds based on efficacy and safety. In other words, only the supplements that follow a “first do no harm” approach within fertility and for overall health should be currently considered. Thus, it makes it easier to recommend supplements such as coenzyme Q10, carnitine, N-acetylcysteine (NAC), omega-3 fatty acids, and/or vitamin C, or perhaps combinations of multiple low-dose formulas/multivitamins (along with encouraging research of novel supplements such as L-citrulline), but to discourage the use of arginine, astaxanthin, DHEA, folic acid, glutathione, lycopene, magnesium, plant estrogens, selenium, Tongkat ali, vitamin D, vitamin E, and zinc.

Using a dietary supplement for male subfertility to improve pregnancy probability has diverse encouraging data, but using any supplement currently to maintain fertility or prevent future issues as a preventive agent does not have adequate clinical research or justification and could theoretically do harm.

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  1. Department of Urology, University of Michigan Medical Center, Ann Arbor, MI, USA

    Mark A. Moyad M.D., M.P.H.

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Moyad, M.A. (2014). Complementary and Alternative Medicine Interventions for Male Infertility/Subfertility: First Do No Harm. In: Complementary & Alternative Medicine for Prostate and Urologic Health. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8492-9_4

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