No Evidence of Infertility Risk from NAD Supplementation in Males
There is no documented risk of infertility in males taking Nicotinamide adenine dinucleotide (NAD) or its precursors such as nicotinamide riboside (NR). In fact, the available evidence suggests potential reproductive benefits rather than harm.
Current Evidence on NAD and Male Fertility
NAD supplementation has not been identified as a risk factor for male infertility in any major clinical guidelines. The AUA/ASRM guidelines on male infertility diagnosis and treatment discuss numerous risk factors including medications, environmental exposures, and lifestyle factors, but NAD supplementation is notably absent from these lists 1.
The EULAR recommendations for antirheumatic drugs in reproduction specifically catalog medications with known or potential fertility impacts in males, and NAD supplementation does not appear among drugs requiring caution or discontinuation when attempting conception 1.
The European Association of Urology's 2025 guidelines on male infertility comprehensively review lifestyle modifications, oxidative stress therapies, and supplements affecting male fertility, without mentioning NAD as a concern 1.
Potential Reproductive Benefits of NAD
Research in female reproductive aging demonstrates that NAD+ precursor supplementation (nicotinamide riboside) actually improved ovarian function, increased follicle numbers, enhanced oocyte quality, and increased live birth rates in aging mice 2.
NAD+ supplementation improved mitochondrial function, reduced oxidative stress, and corrected age-related cellular dysfunction in reproductive tissues 2.
While this research focused on female fertility, the fundamental mechanisms—improved mitochondrial function and reduced oxidative stress—are equally relevant to male spermatogenesis, which is highly dependent on mitochondrial energy metabolism 1.
Medications That Actually Impair Male Fertility
For context, medications with documented negative impacts on male fertility include:
Exogenous testosterone and anabolic steroids completely suppress spermatogenesis through negative feedback on the hypothalamus and pituitary, causing azoospermia that can take months to years to recover 1, 3.
Cyclophosphamide causes dose-dependent, potentially irreversible infertility, with doses ≥4000 mg/m² likely resulting in permanent azoospermia 1.
Certain antidiabetic medications have controversial and inconsistent effects on male reproductive function, though evidence remains limited 4.
Clinical Recommendations
Males of reproductive age taking NAD supplements do not need to discontinue them for fertility preservation purposes, as there is no evidence of reproductive harm 1.
Focus fertility counseling on established risk factors: avoid exogenous testosterone/anabolic steroids, maintain healthy body weight (BMI <25), cease smoking, optimize diet with lower fats/meats and more fruits/vegetables, and minimize heat exposure to testes 1.
If fertility concerns exist, obtain baseline semen analysis and hormonal evaluation (FSH, LH, testosterone) to establish actual fertility status rather than making assumptions based on supplement use 1.
Important Caveats
The absence of evidence is not definitive proof of safety—NAD supplementation simply has not been studied specifically for male fertility outcomes in controlled trials 5.
Most over-the-counter fertility supplements lack rigorous clinical trial evidence, with only 38% having published clinical trials, and most studies being of poor quality 5.
However, NAD differs from typical "fertility supplements" in that it is a fundamental cellular metabolite with well-established roles in energy metabolism and cellular function, rather than a proprietary blend making unsubstantiated fertility claims 2.