In the first edition of It Starts with the Egg, I explained that the two most important supplements for improving egg quality are a good quality multivitamin and CoQ10 (ideally as ubiquinol). These are both important because they help to prevent oxidative damage to sperm.
In the upcoming second edition (out in late February, 2019), I explain new research suggesting that for couples with a history of miscarriage, it may be helpful for men to choose a multivitamin that contains methylfolate, rather than synthetic folic acid. Recommended brands include:
- Pure Encapsulations O.N.E. Multivitamin
- Best Nest Men’s Multi +
- UK: NATURELO Prenatal Whole Food Multivitamin
Even without a history of multiple miscarriages, it is likely still best to choose one that contains methylfolate or natural food folate, such as Vitamin Code for Men.
Beyond a multivitamin and CoQ10, there are now further supplements supported by strong scientific evidence, as explained in this excerpt from the upcoming second edition:
Additional Supplements to Improve Sperm Quality
In cases where sperm quality is known to be an issue, or there is a history of failed IVF cycles or recurrent miscarriage, it is likely helpful to go further and add several additional supplements that have been found to improve sperm quality. The most effective supplements are:
- Alpha-lipoic acid
- Omega-3 fats (in fish oil)
Each of these supplements is backed-up by clear scientific evidence. As just one example, a randomized, double-blind, placebo-controlled study found that when men took alpha-lipoic acid each day for 12 weeks, there was a significant improvement in the total sperm count, sperm concentration, and motility levels.[i]
The recommended dose is 600 milligrams per day for a standard alpha-lipoic acid supplement. If you choose a supplement that is in the form of R-alpha lipoic acid, it is likely sufficient to take 200 to 300 milligrams per day.
Double-blind, placebo-controlled trials have also found that omega-3 fish oil supplements improve sperm quality, with a particular improvement in DNA damage.[ii] In a 2016 study, when men took a fish oil supplement for 3 months, the average percentage of sperm with DNA damage decreased from 22% to 9%.[iii] The dose used in this study was 1500 mg of fish oil, containing 990 mg of DHA and 135 of EPA per day. For a similar dose, take 2 capsules of Nordic Naturals DHA Xtra.
Where testing shows that sperm motility is a concern, another useful supplement is L-carnitine. Randomized studies have found that on average, L-carnitine can improve motility by 8% and morphology by 5%.[iv] Yet in men with a significant degree of oxidative damage to sperm, carnitine has a much greater impact. In those cases it can increase the total number of motile sperm by more than two-fold.[v] As a result, carnitine appears to be especially effective in men with poor sperm quality caused by varicocele.[vi] The typical dose is 1000 mg per day.
An alternative form of carnitine, called acetyl-l-carnitine, can also be taken. The body naturally maintains an equilibrium between the two forms and studies have found that taking either can improve sperm quality. So far, a greater number of studies have used L-carnitine, but it appears that both forms are equally effective. Some studies have actually used a combination of the two forms, with good results.
Although taking all of these supplements for several months is no doubt inconvenient, it can make a dramatic difference to the chance of success. It is often well worth the sacrifice in order to save your partner from the physical and emotional toll of yet another failed IVF cycle or pregnancy loss.
- Doctor’s Best Stabilized R-Lipoic Acid
- Jarrow Ubiquinol
- Nordic Naturals DHA Xtra.
- Now Foods L-Carnitine 500 mg
For the men who refuse to take pills:
- Smarty Pants Men’s Complete Gummy (this really does not contain enough selenium, but it is much better than skipping a multi entirely)
- Vitafusion CoQ10 Gummy (again, not the preferred form, but at least he will take it)
- Nordic Naturals – Nordic Omega-3 Fishies, (my kids actually love eating these)
- L-Carnitine Gummy, Extra Strength, 500mg
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[i] Haghighian, H. K., Haidari, F., Mohammadi-asl, J., & Dadfar, M. (2015). Randomized, triple-blind, placebo-controlled clinical trial examining the effects of alpha-lipoic acid supplement on the spermatogram and seminal oxidative stress in infertile men. Fertility and sterility, 104(2), 318-324.
[ii] Salas-Huetos, A., Rosique-Esteban, N., Becerra-Tomás, N., Vizmanos, B., Bulló, M., & Salas-Salvadó, J. (2018). The Effect of Nutrients and Dietary Supplements on Sperm Quality Parameters: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Advances in Nutrition, 9(6), 833-848.
Martínez-Soto, J. C., Domingo, J. C., Cordobilla, B., Nicolás, M., Fernández, L., Albero, P., … & Landeras, J. (2016). Dietary supplementation with docosahexaenoic acid (DHA) improves seminal antioxidant status and decreases sperm DNA fragmentation. Systems biology in reproductive medicine, 62(6), 387-395.
[iii] Martínez-Soto, J. C., Domingo, J. C., Cordobilla, B., Nicolás, M., Fernández, L., Albero, P., … & Landeras, J. (2016). Dietary supplementation with docosahexaenoic acid (DHA) improves seminal antioxidant status and decreases sperm DNA fragmentation. Systems biology in reproductive medicine, 62(6), 387-395.
[iv] Salas-Huetos, A., Rosique-Esteban, N., Becerra-Tomás, N., Vizmanos, B., Bulló, M., & Salas-Salvadó, J. (2018). The Effect of Nutrients and Dietary Supplements on Sperm Quality Parameters: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Advances in Nutrition, 9(6), 833-848.
[v] Vessey, W., McDonald, C., Virmani, A., Almeida, P., Jayasena, C., & Ramsay, J. (2016, October). Levels of reactive oxygen species (ROS) in the seminal plasma predicts the effectiveness of L-carnitine to improve sperm function in men with infertility. In Society for Endocrinology BES 2016 (Vol. 44). BioScientifica.
[vi] Sofimajidpour, H., Ghaderi, E., & Ganji, O. (2016). Comparison of the effects of varicocelectomy and oral L-carnitine on sperm parameters in infertile men with varicocele. Journal of clinical and diagnostic research: JCDR, 10(4), PC07.