Can men take methylfolate (methylated folate) to improve semen quality?

Methylfolate Supplementation for Improving Semen Quality in Men

Methylfolate supplementation may improve semen quality in men with infertility, particularly those with MTHFR gene polymorphisms, with studies showing increased total normal sperm count when combined with zinc. 1, 2

Mechanism and Evidence

Folate plays a critical role in male fertility through several mechanisms:

• Acts as an antioxidant in seminal plasma, potentially reducing DNA damage in sperm 3
• Supports proper DNA synthesis and methylation necessary for spermatogenesis
• May be particularly beneficial for men with methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms 2

Research evidence demonstrates:

• A significant 74% increase in total normal sperm count was observed when folate (5mg daily) was combined with zinc sulfate (66mg daily) in subfertile men 1
• Higher intake of antioxidants, including folate, is associated with better semen quality parameters 4
• Men with MTHFR polymorphisms (particularly those with T allele of C677T polymorphism) showed improved semen parameters with sufficient vitamin B9 (folate) and B12 intake 2
• Combination therapy with folate (5mg/day) and tamoxifen significantly improved both sperm concentration and motility, while also decreasing DNA damage 5

Clinical Application

For men seeking to improve semen quality:

1. Dosage: Consider methylfolate supplementation at 5mg daily, ideally combined with zinc sulfate (66mg daily) 1
2. Duration: Treatment should continue for at least 3 months (the duration of spermatogenesis) 5
3. Monitoring: Semen analysis before and after treatment to assess improvement
4. Genetic testing: Consider MTHFR genotyping, as men with certain polymorphisms may benefit more from folate supplementation 2

Considerations and Caveats

• While the AUA/ASRM guidelines do not specifically recommend folate for male infertility, they acknowledge that idiopathic male infertility may benefit from various treatments 6
• The guidelines caution that "the benefits of supplements (eg, antioxidants, vitamins) are of questionable clinical utility in treating male infertility" 6
• However, this statement is general and does not specifically address methylfolate
• For men with abnormal semen parameters without clear etiology, a trial of methylfolate with zinc is reasonable given the positive evidence and minimal risk

Potential Pitfalls

• Supplementation alone may not address underlying causes of infertility
• Men should be evaluated for other causes of infertility before relying solely on supplements
• Excessive supplementation beyond recommended doses has not shown additional benefits
• Supplements should not delay appropriate medical evaluation or treatment for infertility

For optimal results, methylfolate supplementation should be part of a comprehensive approach to male fertility that includes lifestyle modifications (avoiding smoking, excessive alcohol, and maintaining healthy weight) and appropriate medical evaluation for underlying causes of infertility.