Male Fertility Vitamins and Supplements
The evidence for vitamins and supplements improving male fertility outcomes (live births) is conflicting and of low quality, so I recommend prioritizing proven lifestyle modifications—weight loss, exercise, and smoking cessation—over empiric supplementation, though antioxidants and probiotics may be considered as adjunctive therapy for men with idiopathic infertility. 1
Evidence Quality and Limitations
The 2025 European Association of Urology guidelines emphasize that antioxidant therapy evidence remains conflicting—a Cochrane review of 61 studies (6,264 men) showed potential live birth rate improvements, but when high-risk-of-bias studies were removed, this benefit disappeared. 1 The quality of evidence is consistently rated as low across multiple guideline organizations. 2, 3
Lifestyle Modifications (Strongest Evidence)
These interventions should be your first-line approach:
- Weight loss for overweight/obese men demonstrably enhances sperm parameters and should be strongly encouraged. 1, 2
- Regular physical exercise improves both sperm quality and overall cardiovascular health. 1, 2
- Smoking cessation directly improves sperm parameters and should be mandatory counseling. 1, 2
These modifications are particularly critical because infertile men have higher cardiovascular mortality and cardiometabolic disease risk compared to fertile controls. 1
Supplements with Limited Supporting Evidence
Antioxidants
Oxidative stress contributes to idiopathic male infertility through elevated reactive oxygen species (ROS) that impair sperm parameters and increase DNA fragmentation. 1 However, clinical benefit for live births remains unproven despite theoretical rationale. 1, 2, 3
Probiotics/Prebiotics
One RCT (56 men) showed significant improvements in sperm concentration, motility, morphology, and DNA integrity with prebiotic/probiotic supplementation versus placebo. 1, 2 However, this is a single small study requiring validation through larger trials. 1
Specific Micronutrients
Research suggests zinc, selenium, and folic acid may benefit sperm quality, though guideline-level evidence is lacking. 4, 5 The American Urological Association notes that data on most dietary supplements including trace minerals remain limited. 6
Critical Clinical Caveats
- Spermatogenesis requires 74 days, so any intervention needs at least 2.5 months to show effects. 2
- Testosterone therapy is absolutely contraindicated in men seeking fertility as it suppresses spermatogenesis. 2
- For severe oligoasthenoteratozoospermia (OAT), assisted reproductive technology may be more effective than supplements alone. 2
- Underlying treatable conditions (varicocele, infections, hormonal imbalances) must be addressed first. 2
Hormonal Considerations
For men with secondary hypogonadism seeking fertility, use gonadotropin therapy (hCG ± FSH) rather than testosterone—this achieves sperm production in 75% of men with hypogonadotropic hypogonadism. 1, 2
Selective estrogen receptor modulators (SERMs) and aromatase inhibitors show promise for improving pregnancy rates and sperm parameters, but evidence quality remains low with few placebo-controlled trials. 1, 2
Practical Recommendation Algorithm
- Screen and treat modifiable cardiovascular risk factors (obesity, smoking, sedentary lifestyle). 1, 2
- Rule out and treat underlying pathology (varicocele, infections, hormonal disorders). 2
- Consider empiric antioxidant or probiotic supplementation for idiopathic infertility after counseling about limited evidence. 1, 2
- Reassess after minimum 3 months to allow complete spermatogenic cycle. 2
- Refer for ART if severe OAT or no improvement after conservative measures. 2