Best Supplements to Increase Sperm Count
The evidence for supplements improving sperm count is weak and of questionable clinical utility, with lifestyle modifications (weight loss, exercise, smoking cessation) being more reliably beneficial than any specific supplement. 1
Clinical Recommendation Based on Guidelines
Clinicians should counsel patients that the benefits of supplements (antioxidants, vitamins) are of questionable clinical utility in treating male infertility, as existing data are inadequate to provide recommendations for specific agents. 1 The AUA/ASRM guidelines explicitly state there are no clear, reliable data to support the variety of supplements that have been offered to men attempting conception, though they are likely not harmful. 1
Evidence Quality and Limitations
The most recent European Association of Urology (EAU) 2025 guidelines acknowledge that while oxidative stress contributes to idiopathic male infertility, evidence for antioxidant therapy remains conflicting—a Cochrane meta-analysis of 61 studies (6,264 men) showed that when studies with high risk of bias were removed, the apparent increase in live birth rate disappeared. 1
Supplements with Limited Supporting Evidence
If supplements are to be considered despite weak evidence, the following have shown some association with improved sperm parameters (though not necessarily fertility outcomes):
Antioxidants
- Selenium, zinc, vitamin E, vitamin C, and CoQ10 have been associated with modest improvements in sperm concentration and motility in some studies, but these findings come from low-quality evidence with high heterogeneity. 2
- Omega-3 fatty acids showed increases in sperm concentration (10.98 × 10⁶ spz/mL) and total motility (7.55%) in meta-analysis, though clinical significance for fertility remains unclear. 2
Carnitine Supplements
- L-carnitine demonstrated improvements in sperm progressive motility (7.45%) and morphology (4.91%) in pooled analyses, but again from limited quality studies. 2
Probiotics/Prebiotics
- One RCT of 56 men showed prebiotic/probiotic supplementation significantly increased sperm concentration, motility, normal morphology, and DNA integrity compared to placebo, but this requires validation in larger trials. 1
Lifestyle Modifications: The Stronger Evidence
The EAU guidelines strongly recommend the following lifestyle changes, which have more robust evidence than supplements: 1
- Weight loss for overweight/obese men enhances sperm parameters 1
- Regular physical exercise improves sperm quality 1
- Smoking cessation improves sperm parameters 1
Critical Caveats
- Spermatogenesis requires approximately 74 days (2.5 months), so any intervention needs at least this timeframe to show effects. 3
- Testosterone therapy is absolutely contraindicated in men seeking fertility as it suppresses spermatogenesis and can cause azoospermia. 1
- For men with severe oligoasthenoteratozoospermia (OAT), assisted reproductive technology (ART) may be more effective than empiric supplement therapy. 3
- Underlying treatable conditions (varicocele, infections, hormonal imbalances) should be addressed first, as they may have greater impact than supplements. 3
Hormonal Considerations
For men with documented hormonal abnormalities:
- Men with hypogonadotropic hypogonadism should receive gonadotropin therapy (hCG ± FSH), not testosterone, as this can restore spermatogenesis in 75% of cases. 1
- Selective estrogen receptor modulators (SERMs) and aromatase inhibitors may be considered for men with low testosterone and normal pituitary function, though benefits are small and outweighed by ART in most cases. 1
Bottom Line
Prioritize lifestyle modifications over supplements. If supplements are used, they should be viewed as adjunctive therapy with realistic expectations about limited evidence for improving actual fertility outcomes (pregnancy, live birth) rather than just laboratory parameters. The cost-benefit ratio favors proceeding directly to ART in many cases rather than prolonged empiric supplement trials. 1