The Effect of Nutrients and Dietary Supplements on Sperm Quality Parameters: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

Salas-Huetos A1,2Rosique-Esteban N1,2Becerra-Tomás N1,2Vizmanos B3Bulló M1,2Salas-Salvadó J1,2.

Adv Nutr. 2018 Nov 1;9(6):833-848. doi: 10.1093/advances/nmy057.


Infertility, which affects 15% of the world’s population, is a global public health issue recognized by the WHO. Therefore, it is of major clinical and public health importance to investigate whether modifiable lifestyle factors-such as stress, drug use, smoking, alcohol intake, and diet-may influence human fertility. A systematic review and meta-analysis of randomized clinical trials (RCTs) from the MEDLINE-PubMed database was conducted to assess the effect of nutrients, dietary supplements, or food on sperm quality parameters. In total, 28 articles were included for qualitative analysis and 15 for quantitative meta-analysis.

Total sperm concentrations [expressed as mean differences (MDs); 95% CIs, in spermatozoa (spz)/mL] were increased by selenium (3.91 × 106 spz/mL; 3.08, 4.73 spz/mL), zinc (1.48 × 106 spz/mL; 0.69, 2.27 spz/mL), omega-3 (n-3) fatty acids (10.98 × 106 spz/mL; 10.25, 11.72 spz/mL), and coenzyme Q10 (CoQ10) (5.93 × 106 spz/mL; 5.36, 6.51 spz/mL). Sperm counts were increased by ω-3 fatty acids (18.70 × 106 spz/mL; 16.89, 20.51 spz/mL) and CoQ10 supplementation (10.15 × 106 spz/mL; 8.34, 11.97 spz/mL). Sperm total motility was increased by selenium (3.30%; 2.95%, 3.65%), zinc (7.03%; 6.03%, 8.03%), ω-3 fatty acids (7.55%; 7.09%, 8.01%), CoQ10 (5.30%; 4.98%, 5.62%), and carnitines (7.84%; 6.54%, 9.13%), whereas sperm progressive motility was increased only after supplementation with carnitines (7.45%; 6.24%, 8.67%). Finally, sperm morphology was enhanced by selenium (1.87%; 1.50%, 2.24%), ω-3 fatty acid (0.91%; 0.69%, 1.13%), CoQ10 (1.06%; 0.72%, 1.41%), and carnitine (4.91%; 3.68%, 6.15%) supplementation. This meta-analysis of RCTs suggests that some dietary supplements could beneficially modulate sperm quality parameters and affect male fertility. However, results must be cautiously interpreted due to the limited sample size of the meta-analyzed studies and the considerable observed interstudy heterogeneity.


The Impact of a Standardized Oral Multinutrient Supplementation on Embryo Quality in in vitro Fertilization/Intracytoplasmic Sperm Injection: A Prospective Randomized Trial.

Nouri K1Walch KWeghofer AImhof MEgarter COtt J.

Gynecol Obstet Invest .2017;82(1):8-14. doi: 10.1159/000452662. Epub 2016 Nov 11


The role of micronutrients in fertility has recently gained increased attention. We aimed to test the impact of a standardized, multinutrient supplementation on outcomes after in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) in a pilot study. One hundred women undergoing IVF/ICSI were prospectively included and randomized to receive either a multinutrient supplementation named PROfertil® female that included folic acid, selenium, vitamin E, catechins, glycyrrhizin, diosgenin, damiana and omega-3-fatty acids (study group; n = 50), or 400 µg folic acid (control group; n = 50). Outcome parameters were embryo quality on day 3 after oocyte retrieval (good quality vs. poor quality) and the clinical pregnancy rate. In an intention-to-treat analyses, a higher rate of women with at least one good quality embryo (with at least 6 cells and a fragmentation rate <20%) were found for the study (29/50, 58.0%) compared to the control group (18/50, 36.0%; p = 0.045 in chi-square test; relative risk 1.611, 95% CI 1.009-2.597). In conclusion, a multinutrient supplementation that includes folic acid, selenium, vitamin E, catechins, glycyrrhizin, diosgenin, damiana and omega-3-fatty acids seems beneficial in terms of embryo quality.


Comparison of the effect of a combination of eight micronutrients versus a standard mono preparation on sperm parameters

Markus Lipovac 1,2* , Florian Bodner 1,2, Martin Imhof 1,2,3 and Peter Chedraui 4

1 IMI Fertility Center, Vienna, Austria

2 Karl Landsteiner Institute for cell-based therapy in Gynecology, Wiener Ring

3-5, 2100 Korneuburg, Austria

Lipovac et al. Reproductive Biology and Endocrinology (2016) 14:84 DOI 10.1186/s12958-016-0219-0


Background: There are reports showing that l-carnitine alone or in combination with other micronutrients improve sperm parameters. However, comparative studies are still lacking. This study was carried out to compare the short term effects of a combination of eight micronutrients including l-carnitine vs. a mono-substance (l-carnitine alone) on sperm parameters.

Methods: This was a prospective, open-labelled, nonrandomized study that included male subjects (20 to 60 years) with at least 1 year of subfertility and at least one pathological semen analysis who received 3 months treatment with a mono-substance (500 mg l-carnitine/twice a day, n = 156) or a combined compound (440 mg l-carnitine + 250 mg l-arginine + 40 mg zinc + 120 mg vitamin E + 80 mg glutathione + 60 μg selenium + 15 mg coenzyme Q10 + 800 μg folic acid/once a day, n = 143) for the same time period. Sperm parameters were analyzed before and after treatment and groups comparisons performed.

Results: Baseline characteristics were similar among studied groups (age and body mass indices). Semen parameters (volume, density, overall progressive motility [including slow and fast motility]) and percentage of sperm with normal morphology improved after 3 months in both groups as compared to baseline. However, relative change (expressed as % increase of absolute values) for sperm density and overall progressive motility (including fast motility) was found to be higher for the combined micronutrient treatment group as compared to the mono-treatment using l-carnitine alone.

Conclusion: Both analyzed groups displayed a positive short term effect on all sperm parameters; however effect on density and motility was significantly better for the combined formulation. There is need for more research in this matter that includes long term outcome data.

Trial registration: Retrospectively registered at ISRCTN (7th October 2016). Study ID: ISRCTN48594239


Antioxidant Supplementation of Subfertile Men Improves Top Blastocyst Rate in Couples Undergoing IVF/IMSI

Johannes Wogatzky 1*, Dietmar Spitzer2 , Maximilian Schuff1 , Birgit Schechinger1 and Nicolas H. Zech1

1 IVF Centers Prof. Zech-Bregenz, Austria

2 IVF Centers Prof. Zech-Salzburg, Austria,

IVF Centers Prof Zech-Bregenz, Roemerstrasse 2, 6900 Bregenz, Austria, Pub date: Sep 22, 2014

Wogatzky et al., Journal Andrology & Gynecology: Current Research 2014, 2:4


In recent years, oxidative stress (OS) has been identified as important factor in male infertility. Thus, the intake of antioxidants to improve semen quality (in subfertile men) has been widely discussed. Improvements of semen quality after supplementation have been reported. However, this issue is still underevaluated. Critics complain a lack of data regarding firstly the use of antioxidants due to the heterogeneity between patient groups, nutritional supplements and treatment effect and secondly rare data in regard to the impact of supplementation on assisted reproduction technique (ART) outcome. In this study the effect of an antioxidant supplementation (AOS) on semen quality and therapy outcome of 92 couples undergoing fertility treatment was assessed. Semen analysis was performed during a first treatment cycle and data regarding treatment outcome were recorded. These were compared to a second treatment cycle of the same couples, prior to which the male partners had received AOS (Fertilovit® Mplus for 3 – 6 months). Semen samples were assessed according to WHO and MSOME (motile sperm organelle morphology examination) criteria. Parameters chosen for evaluation of treatment outcome were fertilization-, (top-)blastocyst rate, pregnancy- and clinical pregnancy rate. After AOS, we found a slight improvement of semen quality according to WHO – and a significant improvement according to MSOME criteria (p< 0.01). Even though – naturally – the age of the female partner had increased, we observed a rise of blastocyst rate after AOS. Top-blastocyst rate even improved significantly (p< 0.05). In addition to this, pregnancy- and clinical pregnancy rate showed a marked improvement. In summary, the use of a concomitant AOS might be discussed not only for men with impaired semen quality, but also for men with normozoospermia undergoing ART as it may contribute to improved semen parameters and an increased success of the treatment.


Markus Lipovac,1, 2 Florian Bodner,1 Alexander Schütz,3 Harald Kurz,3 Claus Riedl,4 Julia Mair,1,2 *Martin Imhof1,2.

1. Fertility Clinic IMI, Vienna, Austria

2. Department of Obstetrics and Gynecology, General Public Teaching Hospital Korneuburg, Vienna, Austria

3. Adebar Fertility Clinic, Wiener Neustadt, Austria

4. Department of Urology, General Public Hospital Baden, Austria

European Medical Journal Urol. 2014;1:60-65.


Measuring the hyaluronan-binding ability of spermatozoa is useful in predicting the ability of spermatozoa to fertilise oocytes during in vitro fertilisation (IVF). Recent publications discuss an influence of micronutrients on sperm quality. The objective of this paper was to evaluate the effect of a non-prescription nutraceutical containing eight micronutrients on sperm-hyaluronan binding assay (SHBA) values among males with idiopathic sub-/infertility, using an open comparative pilot study. The study took place at the Outpatient Fertility Centre IMI, Vienna, Austria, and involved 67 sub-/infertile males. Sub-/infertile males were invited to participate and take two daily capsules of the active compound for a 3-month period between the first and the follow-up semen analysis. Each capsule contained L-carnitine, L-arginine, zinc, vitamin E, glutathione, selenium, coenzyme Q10 (CoQ10), and folic acid (Profertil®). 40 sub-/infertile men receiving no active treatment served as controls; this was measured by change in SHBA after 3 months. It was found that SHBA values significantly increased after 3 months of treatment with the active compound, from a median baseline value of 56.0% to 74% (p<0.05). This represented a 19.7% increase compared to baseline, which was significantly higher than the 2.1% decrease observed in the control group. The rate of subjects displaying an increase in SHBA values after 3 months was significantly higher in the active group (74.6% versus 30.0%, p=0.0001), which showed that sub-/infertile men treated with the active micronutrient compound displayed increased SHBA ability. However, more research is necessary to get detailed information on this specific subject.


Dietary Supplementation Improves Blastocyst Number and Ongoing Pregnancy Rate of IVF Patients with Hashimoto Thyroiditis

Johannes Wogatzky 1 *, Birgit Schechinger 1 , Dietmar Spitzer 2 and Nicolas Herbert Zech 1

*Johannes Wogatzky, IVF Centers Prof Zech-Bregenz, Roemerstrasse 2, 6900 Bregenz

1.Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, et al. (2002) Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab 87: 489-499.

2. Duntas LH (2011) Environmental factors and thyroid autoimmunity. Ann Endocrinol (Paris) 72: 108-113.

Wogatzky et al., Journal of Food & Nutritional Disorders 2013, 2:4

Published: October 15, 2013


In Assisted Reproduction Techniques (ART), autoimmune disorders of the thyroid gland present as common concomitant diseases. Hypothyroidism caused by autoimmune thyroiditis can impair fertility and pregnancy. Hashimoto thyroiditis (HT) is the most common autoimmune thyroid disease (AITD). Patients with HT undergoing IVF/ICSI using the long protocol are thought to benefit from a broad therapeutic concept. We compared the outcome of two different therapeutic schemes for HT patients presenting at our fertility clinic and compared the outcome to ART patients without thyroiditis. TSH level was adjusted to under 2 µIU/mL using L-thyroxine, as required. Concurrent medication from the time of oocyte puncture included daily administration of fragmin (dalteparin) and acetylsalicylic acid (ASA), as well as prednisolone in increasing dosage. One group of these HT patients (group1, n=56) had additionally highly-dosed folic acid, another group (group 2, n=50, referred to as the supplemented group) was alternatively supplemented with a micronutrient preparation containing selenium, high-dose folic acid, B-vitamins, antioxidants and iron. We compared the number of oocytes, fertilization rate, blastocyst formation rate, pregnancy- and ongoing pregnancy rate between the two groups. Also, the ART outcomes of both groups were compared to ART results of non-HT patients within the same age group. We observed a significant increase in the blastocyst rate and demonstrated a substantial rise in ongoing pregnancy rate of the supplemented patients. These also needed less L-thyroxine to achieve optimal TSH level. The outcome of the micronutrient supplemented patients corresponded to the average of healthy IVF patients without HT at our clinic.


Impact of antioxidative supplementation on semen quality according to MSOME criteria

Richardson Ajayi1, Jasmin Okhowat2, Dietmar Spitzer2, Birgit Schechinger2, Nicolas Herbert Zech2,3

1 TheBridgeClinic,Lagos,Nigeria
2 IVFCentersProfZech,Austria
3 The study was carried out at the IVF Center Prof. Zech – Bregenz (Austria)

JBRA Assisted Reproduction 2013; 17 (1) :27-31 ORIGINAL ARTICLE doi: 10.5935/1518-0557.20130003


Purpose: To investigate the influence of an oral antioxidative and micronutrient supplementation on semen quality assessed by MSOME (motile sperm organelle morphology examination) criteria in a collective of in vitro fertilization (IVF) patients.
Methods: Sperm analysis of 160 IVF patients was evaluated 2-12 months before undergoing IVF/IMSI (intracytoplasmic morphologically selected sperm injection) cycle. The following parameters were analyzed: semen volume, sperm concentration, motility and morphology according to MSOME criteria. Patients were grouped according to the WHO criteria into normozoospermic, oligoasthenoteratozoospermic (OAT) oligo- and asthenozoospermic men, respectively. Between first and second semen analysis, patients were treated orally with a dietary antioxidative supplement. The Student’s t-test was used to evaluate the significance of data.
Results: In the total number of patients we found a significant reduction in the percentage of immotile sperms and a highly significant increase of total sperm motility after antioxidative therapy. We also observed substantial improvement of motility, the sperm concentration as well as sperm morphology (according to MSOME criteria) in the semen of oligozoospermic, asthenozoospermic and OAT patients. For normozoospermic patients, we found almost no significant increase in sperm parameters.
Conclusions: The results display a considerable improvement in semen quality, such as motility, sperm concentration and morphology after dietary supplementation, notably in IVF patients
with poor semen quality. Amelioration of sperm quality of IVF patients can have a crucial impact in assisted reproductive technology (ART). Our findings suggest that micronutrient supplementation might be generally beneficial for semen quality in men undergoing ART, but mostly in those with a higher grade of alterations in their sperm parameters. The suggested mode of action is probably due to a decline of oxidative stress.

Dietary supplementation of antioxidants improves semen quality of IVF patients in terms of motility, sperm count, and nuclear vacuolization

Wirleitner B1Vanderzwalmen PStecher ASpitzer DSchuff MSchwerda DBach MSchechinger BHerbert Zech N

International Journal for Vitamin and Nutrition Research (2012), 82, pp. 391-398



This study aimed to investigate the influence of an oral antioxidative supplementation on sperm quality of in vitro fertilization (IVF) patients, as analyzed by sperm motility according to the WHO criteria and motile sperm organelle morphology examination (MSOME).


Semen samples were collected from 147 patients before undergoing an IVF/intracytoplasmic morphologically-selected sperm injection (IMSI) cycle and 2 – 12 months after an antioxidative supplementation. Semen analysis was evaluated according to WHO and MSOME criteria. Spermatozoa were grouped according to the size of nuclear vacuoles within the sperm’s heads. Patients were divided into oligoasthenoteratozoospermic (OAT) and non-OAT men. Between first and second semen analysis, patients were supplemented orally with an antioxidative preparation.


After the antioxidative therapy we observed a significant reduction in the percentage of immotile sperm cells in the patients. Additionally, the percentage of class I spermatozoa according to MSOME criteria was significantly higher after antioxidative supplementation. In OAT patients the percentage of class I sperm was found to be increased, although not significantly. However, we observed a drastic improvement in sperm motility as well as in total sperm count in this group.


The results demonstrated a considerable improvement in semen quality, notably in OAT patients. Considering the putative relationship between semen quality on the one hand and reactive oxygen species on the other, the observed changes in the sperm parameters indicate that a decline in semen quality, and even subtle morphological changes, might be associated with oxidative stress. Our findings suggest that an antioxidative and micronutrient supplementation has a remarkable benefit for IVF patients having restricted sperm parameters, in particular.


Improvement of sperm quality after micronutrient supplementation

MartinImhofab, JakobLacknera c, MarkusLipovacab, PeterChedrauid , ClausRiedle

e-SPEN Journal, Volume 7, Issue 1, February 2012, Pages e50-e53


Background & aims

Nearly 50% of male infertility is idiopathic and to date there still is no proven therapy. We evaluated the effect of a non prescription nutraceutical containing eight micronutrients on sperm quality in males with idiopathic sub-fertility.


This open comparative pilot study was carried out at the Fertility Center IMI, Vienna, Austria. A total of 132 sub-fertile males (active treatment group) were invited to participate and take two daily capsules of the active compound for a three month period between the first and the follow-up semen analysis. Each capsule contained L-carnitine, L-arginine, zinc, vitamin E, glutathione, selenium, coenzyme Q10 and folic acid. Sub-fertile men receiving no active treatment served as controls (n = 73). Main outcome measure was the standardized semen analysis.


All parameters evaluated by semen analysis significantly increased after 3 months of treatment with the active compound. Median ejaculatory volume, sperm cell density, sperm motility (progressive and total) and normal morphology rate increased by 33.3%, 215.5%, 83.1%, 36.4% and 23.0%, respectively. These increments were significantly higher than those observed among controls. In the active treatment group no side effects were encountered and a total of 34 pregnancies were reported after 6 months follow-up whereas 11 were reported in the control group.


Semen analysis significantly improved in sub-fertile men after treatment with an active micronutrient compound, leading to pregnancies without any adverse effects.