Nutrient Supplementation

Improving Male Fertility Fourfold

Cesar Mora-Esteves, MD; David Shin, MD


Semin Reprod Med. 2013;31(4):293-300. 

In This Article

Vitamins C and E

Vitamin E (α-tocopherol) is one of the most important lipid-soluble antioxidant molecules. It is located mainly in the cell membranes. It is thought to interrupt the chain reactions involving lipid peroxidation. It also enhances the activity of various antioxidants that scavenge free radicals generated during the univalent reduction of molecular oxygen and during normal activity of oxidative enzymes.[41,42] Vitamin E acts by breaking pathological, ROS-induced chain reactions. It confers its protective effects by shielding sperm membrane components from OS damage. Vitamin E has been used extensively in vivo to treat a variety of diseases.[43] Recent randomized, control trials have reported vitamin E supplementation to be efficacious in treating infertility in males with OS.[44,45] Oral vitamin E significantly increased spermatozoal motility and seemed to improve the likelihood of pregnancy in the patient's spouse.[44]

Vitamin C (ascorbic acid) is a high potency water-soluble ROS scavenger. It is found in concentrations 10 times higher in seminal plasma than in serum.[46,47] It protects human spermatozoa against endogenous oxidative DNA damage.[48] Significantly reduced ascorbate concentrations have been observed in poor semen samples riddled with excess ROS.[49] Seminal plasma ascorbic acid concentrations have been positively correlated with percentage of morphologically normal spermatozoa.[50] Vitamin C has been assessed for its potential as an oral supplement, along with vitamin E, in the treatment of idiopathic male infertility. Their combination in vivo has been hypothesized to act synergistically by reducing peroxidative attack on spermatozoa.[51] In a randomized, controlled, double-blind study by Rolf et al, high-dose oral treatment with vitamins C and E for 56 days did not improve semen parameters, sperm survival, or pregnancy rates in couples with male-factor infertility.[52] Despite the fact that multiple studies have demonstrated that vitamins C and E are not effective,[45,52–54] further prospective, controlled, clinical trials could be conducted on patients with known DNA damage for whom antioxidant therapy may be useful.