From the Guidelines
NAD supplementation is not recommended for infertility treatment due to insufficient evidence supporting its effectiveness, as stated in the most recent guidelines 1.
Current Recommendations
When it comes to treating male infertility, the current guidelines suggest that there is limited evidence to support the use of supplements, including antioxidants and vitamins, for improving fertility outcomes 1.
- The American Urological Association (AUA) and the American Society for Reproductive Medicine (ASRM) recommend that clinicians inform patients about the questionable clinical utility of supplements in treating male infertility 1.
- The guidelines also suggest that the benefits of selective estrogen receptor modulators (SERMs) and other medical interventions for idiopathic infertility are small and may be outweighed by the advantages of assisted reproduction techniques like in vitro fertilization (IVF) 1.
Evidence Review
A review of the literature on antioxidants and herbal therapies for male infertility found that the methodological quality of most studies is poor, and the heterogeneity of the selected studies makes meta-analysis challenging 1.
- The review concluded that there is insufficient evidence to recommend the use of supplemental antioxidant therapies or herbal therapies for the treatment of men with abnormal semen parameters and/or male infertility 1.
- The most recent guidelines emphasize the need for large, well-designed placebo-controlled randomized trials to clarify the effects of dietary supplementation, vitamins, and herbal remedies on male fertility 1.
Clinical Implications
In clinical practice, the treatment of male infertility should be individualized and based on a comprehensive evaluation of the patient's medical history, physical examination, and laboratory results.
- Clinicians should counsel patients about the limited evidence supporting the use of supplements and the potential benefits and risks of medical interventions for infertility treatment 1.
- A comprehensive fertility treatment plan should include lifestyle modifications, such as maintaining a healthy weight, reducing alcohol consumption, managing stress, and following a nutrient-rich diet, in addition to evidence-based medical interventions 1.
From the Research
NAD Infertility
- NAD (Nicotinamide Adenine Dinucleotide) deficiency has been linked to infertility in both men and women, with studies suggesting that it can affect ovarian function, oocyte quality, and sperm motility 2, 3, 4, 5, 6.
- In women with polycystic ovary syndrome (PCOS), NAD+ levels in granulosa cells have been found to be significantly decreased, leading to mitochondrial dysfunction, increased reactive oxygen species (ROS) accumulation, and decreased adenosine triphosphate (ATP) generation 4.
- Supplementation with NAD+ precursors, such as nicotinamide riboside (NR), has been shown to improve ovarian function, oocyte quality, and mitochondrial function in PCOS mice, and may be a promising therapeutic strategy for addressing ovarian infertility associated with PCOS 3, 4.
- Mitochondrial dysfunction has also been implicated in male infertility, with studies suggesting that it can affect sperm motility, capacitation, and overall quality, and that mitochondrial mutations, deletions, and single nucleotide polymorphisms can impact spermatogenesis and sperm function 5, 6.
- The relationship between NAD+ levels, mitochondrial function, and infertility is complex, and further research is needed to fully understand the underlying mechanisms and to develop effective therapeutic strategies for addressing NAD-related infertility 2, 3, 4, 5, 6.