Lifechoicesandfertility.com
Male fertility supplements
***Summary below***
As we discussed regarding life choices and fertility, the health and viability of sperm depend on the amount of antioxidant protecting them from the damaging effects of oxidation products. All of the information regarding erectile function applies to fertility as well, with the exception of limiting caffeine to 3 cups of coffee or less and minimizing or eliminating alcohol. The testicles produce sperm over a 2 to 3 month period and two agents known to increase nitric oxide and therefore blood flow were shown to increase sperm quality as well as circulating testosterone levels when taken for 2 months. Testosterone is important for sperm production by the testicles.
Based on our research, we recommend the following supplements, and we will give you a brief rationale for each.
· Omega 3 fatty acids: These healthy essential fats increase NO production by your blood vessels, which will help to maximize blood flow to the testicles. 
They also help to prevent heart attacks and strokes. In various recent studies, omega-3’s have been associated with improved sperm quality (Chavarro, 2009, Safarinejad, 2011, Attaman, 2012). We recommend 500 to 1200 mg. per day of EPA/DHA. A higher dose (1,000 to 2,000 mg) for several months may have further beneficial effects on sperm numbers, motility, and morphology (Safarinejad, 2011). Caution: Do not increase omega-3’s without a large increase of antioxidants. These polyunsaturated fats, while being essential to sperm membrane function, are particularly vulnerable to the effects of oxidative compounds such as free oxygen radicals (Walthes, 2007). Minimizing your intake of transfats may also improve sperm quality (Chavarro, 2009).
· Folic acid: This B vitamin is a specific co-factor in the production of NO in the body. 
The recommended daily allowance (RDA) is 400 micrograms. We do not recommend taking more than 400 micrograms long-term, and if you are getting extra folic acid in wheat bread and cereal or if you eat a lot of veggies, we recommend cutting the tablets in two and taking only 200 micrograms per day. There has been some recent concern that excessive folic acid could increase colon cancer. Prenatal vitamins do often contain more than 400 micrograms. Folic acid for the female helps to prevent a small group of birth defects.
· Vitamin C, 500 mg This antioxidant stimulates NO production. Vitamin C can worsen heartburn, so don’t take it before bedtime.
· L-citrulline: L-citrulline and L-arginine are the raw materials for NO production, but L-arginine is largely broken down before being absorbed by the body. 
L-citrulline is an important intracellular source of L-arginine, and what is inside the cell is what counts for NO production. In a well-controlled study of 3 gm of L-arginine plus pycnogenol, a significant increase was noted in all semen parameters. Two grams of L-citrulline will increase L-arginine levels more than 3 grams of L-arginine (Schwedhelm, 2008). Natural sources of L-citrulline are melons, particularly watermelon, but you could not eat enough to influence your levels. These supplements are not clearly of benefit for somone with a normal intake of protein, but are logical for someone who's protein intake is low, as is often the case for vegetarians.
· Pycnogenol: We recommend increasing your intake of natural antioxidants such as pomegranate, blackberries, blueberries, strawberries, chocolate, green tea and lots of fruits and vegetables. 
Also, pycnogenol is a potent antioxidant that helps decrease the breakdown of NO and has been shown to be quite effective for stimulating NO. It contains proanthocyanidins similar to the principle antioxidants in blueberries and also found in cocoa, green tea and red wine. The dose that was shown to increase sperm quality is 80 mg. You could take 60-120 mg of pycnogenol per day depending on your intake of natural antioxidants and vitamin C.
· Green tea: Green tea contains lots of antioxidants. If you are bothered by the caffeine, you can take decaf green tea. 
The decaffeination process does decrease the content of antioxidants, but their absorption can be markedly increased without increasing the absorption of caffeine by simply adding 50 mg of vitamin C to each cup. (below). There are many good-tasting specialty green teas available. Green tea extract is another way to boost your level of antioxidants.
· Liquid Vitamin C: 
If you are not drinking three cups of regular green tea per day, you can add 50 mg to each cup. The absorption of antioxidants may increase three-fold according to one study. Green tea is also important in the prevention of prostate cancer.
· Coffee: Of course many men will prefer coffee, and coffee actually contains more antioxidants than tea. In one study drinking 5 cups of coffee per day was associated with a lower rate of prostate cancer. In another study more than 3 cups daily was associated with increased sperm DNA fragmentation. Large amounts of coffee can have serious adverse effects on the heart in some individuals.
· CO Enzyme Q-10: is critical to energy production in the cell. In men given 200 mg of Q-10 twice daily, the percentage of sperm with forward movement and the average sperm velocity were significantly increased (Balercia 2004) 
The Q-10 was given for 6 months, but an effect could occur in a very short time because Q-10 acts on the biochemical pathway producing energy. Because Q-10 is itself an antioxidant, it is difficult to separate a direct effect on the generation of energy by mitochondria from a non-specific effect due to its antioxidant properties. Supplements of Q-10 have been used in a number of other studies with no side effects or adverse events being reported. A man with low sperm motility could choose to take Q-10 if the other measures above do not normalize motility.
· Dark Chocolate: Chocolate has potent effects on NO production, but it usually contains a lot of sugar, which reduces NO. 
You can get all of the advantages and avoid the sugar with a low sugar chocolate. You will get to enjoy it as much as regular chocolate. Don’t overdo it. This is our only recommendation that could make you gain weight. An ounce or so will give you lots of antioxidant and is enough to look forward to each day. Have some for a mid-afternoon break along with a cup of green tea.
These supplements are all quite reasonable in price. They will cost you less than other supplements marketed for fertility. Fertility is not the only reason to consider improving your nutrition. Infertility and erectile health are like most other things- an ounce of prevention is worth a pound of cure! And you will also improve your overall health.
A Note of Caution Most dietary supplements are not independently evaluated for quality control. There are four websites that list quality products and companies. You can look for one of their symbols but unfortunately most products will not have undergone independent testing.
Summary (you can cut, paste and print):
Recommended for all:
1. A healthy diet with fruits (especially berries) and vegetables, less red meat and no trans fats (doughnuts, French pastries, fried foods)
2. Omega-3’s (fish oil) 500-1,000 mg daily
For men over age 40 and/or with abnormal semen (low count, motility, and/or morphology) add to the above:
1. Increase antioxidants- 500-1,000 mg vitamin C, green tea (1-3 cups per day); consider adding pycnogenol, 40-60 mg twice daily (this may replace or be added to the other antioxidants already mentioned).
2. Consider increasing omega-3's to 1,000 to 2,000 mg. In one study of 1840 mg for 8 months all semen parameters improved, particularly strict morphology.
3. Consider adding folic acid, 400 micrograms and zinc, 15-30 mg per day as some studies have shown benefits for sperm. These are in many multivitamins.
4. Consider adding 2 gm of L-citrulline (see above explanation under “L-citrulline").
5. dark chocolate is another strong antioxidant- use a low sugar brand.
6. A small amount of vitamin C added to green tea aids absorption of antioxidants (see above under “liquid vitamin C”)
7. Consider adding Co-enzyme Q-10, 200 mg twice daily. In one study it stimulated sperm motility.
Note: These suggestions can be progressively added but that will require more time as at least 30 days should be allowed to see an effect (a full effect could take up to 90 days).
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