Infertility and subfertility are significant health problems with sweeping social implications and approximately 10-15% of couples will seek medical care for assisted reproduction. Prior to presenting to the obstetrician/gynecologist or reproductive endocrinologist, however, couples often seek relief by complementary and alternative medicine therapies. In fact, dietary supplements – including herbs, vitamins, minerals and other products – are used by the great majority of infertile couples. These food and drug supplements are taken either per the recommendation of their attending physician, as an adjunct to infertility treatment, or more commonly taken independently by the couple to improve their conception rate. Unfortunately, many of the supplements taken by infertility patients in this country are sourced and/or manufactured outside of the United States, are not made in a Food and Drug Administration-approved facility, are not outside laboratory-certified for quality and quantity, and may contain ingredients of dubious quality or unknown potency or actions. Caveat emptor: all fertility supplements are not alike, and all are not benign.
In large part an Internet-based commerce, in 2016 dietary supplements were a $37 billion industry in the United States and the global market is estimated to be more than $278 billion by 20241. Presently, 60% of women are taking them regularly. Middle-aged, Caucasian women were the chief users.2 Although a Google search for “Herbal supplements and fertility” yields 7,900,000 sites, there is much misinformation on the unsubstantiated benefits of the unregulated, relatively inexpensive herbs, potions, vitamins, oils, and minerals. Infertility, premenstrual syndrome, and menopause are the main health conditions for which women seek herbal and complementary therapies, but increasingly more couples are now purchasing supplements for male subfertility. Indeed, infertility supplements is a rapidly growing marketplace with the common misperception that these are “natural” ingredients and therefore are without side effects or potential longer-term complications.
Most of the supplements taken by infertility patients, male and female, contain antioxidants including Vitamins A, C, and E, carotenoids, carnitines, coenzyme Q10, cysteine, lycopenes, and the micronutrients folate, selenium, and zinc. These antioxidants are indeed capable of reducing the production of reactive oxygen species (ROS or free radicals), slowing or preventing the oxidation and repairing cell damage.3 Several studies have found a correlation between the blood concentrations of micronutrients and sperm quality, showing a positive effect for Vitamin A, folic acid, vitamin B12, ascorbic acid, vitamin D, vitamin E, iodine, zinc, and copper.4 While the current literature suggests a beneficial effect on both male and female infertility (See 2017 and 2019 Cochrane Systematic Reviews below) well-designed studies are limited and the number of appropriately-powered, randomized, placebo-controlled clinical trials is very small. Two recently published randomized, controlled trials on semen, the Folic Acid and Zinc Supplementation Trial (FAZST)5 and the Males, Antioxidants, and Infertility trial (MOXI)6 suggested no effect on live birth rates. Neither of these studies was without methodologic concerns, however.
Considering that the above-listed nutrients have a positive general health and fertility effect and do not have any negative health impact, specific supplementation seems to be justified.7
Prolog Health offers high-quality, clinical-grade nutraceuticals. All ingredients are sourced, and all products manufactured in the United States. Each product is made in an FDA-certified facility and third-party validated for quality and quantity.
Antioxidants for Male Sub-Fertility
Cochrane Systematic Review – Intervention Version published: 14 March 2019
Antioxidants for Female Sub-Fertility
Cochrane Systematic Review – Intervention Version published: 27 August 2020
Inositol for subfertile women with polycystic ovary syndrome
Cochrane Systematic Review – Intervention Version published: 20 December 2018
Dietary supplements market size, share & trends analysis report by ingredient (vitamins, minerals), by form, by application, by end user, by distribution channel, by region, and segment forecasts, 2020-2027. https://www.grandviewresearch.com/industry-analysis/dietary-supplements-market.
2 Harvard Women’s Health Watch
3 Mironczuk-Chodakowska I, Witkowska A, Zujko M.
Endogenous nonenzymatic antioxidants in the human body. Adv Med Sci 2018; 16:113-24.
4 Buhling K, Chan P, Kathrins M, Showell M, Vij S, Sigman M:
Should empiric therapies be used for male factor fertility? Fertil Steril 2020 113:6 1121-1127. https://doi.org/10.1016/j.fertnstert.2020.04.015
5 Schisterman E, Sjaarda L, Clemons T, Carrell D, Perkins N, Johnstone E, 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 2020;323:35-48.
6 Steiner A, Hansen K, Barnhart K, Cedars M, Legro R, Diamond M, et al. The effect of antioxidants on male factor infertility: the Males, Antioxidants, and Infertility (MOXI) randomized clinical trial. Fertil Steril 2020; 113:552-60.e3.