Health Conditions

Fertility (Men's) & Sperm Health

Other NamesAbnormal Sperm Morphology

Natural Remedies10

Ingredients79

Table of contents

Other Names

Abnormal Sperm MorphologyAndrologyAntisperm AntibodiesAspermiaAsthenospermiaAsthenozoospermiaAzoospermiaClinical AndrologyCryptozoospermiaEjaculatory DysfunctionGenital Diseases, MaleGlobozoospermiaHematospermiaHyperspermiaHypospermiaIdiopathic Male InfertilityInfertility, MaleLeukocytospermiaLeukospermiaLow Sperm CountLow Sperm MotilityMale Factor InfertilityMale FecundityMale FertilityMale GametogenesisMale InfertilityMale Reproductive FailureMale Reproductive HealthMale Reproductive System DisordersMale SterilityMale SubfertilityMale Urogenital DiseasesNecrospermiaNecrozoospermiaNon-obstructive AzoospermiaNormospermiaNormozoospermiaObstructive AzoospermiaOligoasthenoteratospermia (OAT)OligospermiaOligozoospermiaPoor Sperm QualityPyospermiaReproductive AndrologyReproductive Toxicology (Male)Retrograde EjaculationSemen AnalysisSemen QualitySeminal ParametersSeminal QualitySperm ConcentrationSperm CountSperm DNA FragmentationSperm FunctionSperm HealthSperm MorphologySperm MotilitySperm ParametersSperm ProductionSperm QualitySperm ViabilitySpermatogenesisSpermatogenic DysfunctionSpermatogenic FailureSpermatozoal QualitySterility (Male)TeratospermiaTeratozoospermiaTesticular FailureTesticular Function

Synopsis

Men's Fertility & Sperm Health: A Nutrition and Natural-Health Reference

1. Definition and Overview

Male infertility is defined by the World Health Organization (WHO) as the inability of a male to make a fertile female pregnant for a minimum of at least one year of regular unprotected intercourse. More broadly, infertility is defined by the inability of a sexually active, non-contraceptive couple to achieve spontaneous pregnancy within 12 months. Primary infertility refers to couples who have never had a child and cannot achieve pregnancy after at least 12 consecutive months of unprotected intercourse, while secondary infertility refers to infertile couples who have been able to achieve pregnancy at least once before, with the same or a different sexual partner.

Male factors contribute to about 50 percent of all infertility cases. The WHO reported the number of infertile couples globally at 48 million in 2010, and the current prevalence is likely higher. Epidemiological trends are especially concerning: epidemiological data indicate an increase in the prevalence of male infertility globally, with a meta-regression analysis examining sperm parameters of healthy subjects from around the world reporting that sperm concentration and total sperm count have halved in the last 40 years, with a higher rate of decline after the 2000s.

2. How Male Fertility Presents: Semen Analysis and Sperm Parameters

Semen analysis is one of the first lines of examination for evaluating male infertility. It provides information on both microscopic and macroscopic parameters of the semen, including sperm concentration, motility, morphology, presence of somatic cells, volume, color, pH, and viscosity. However, the interpretation of these parameters has important limitations: although semen parameters may lie within established reference ranges, they do not consistently correlate with male fertility or the absence of underlying pathology; conversely, values outside these limits do not definitively indicate infertility, and semen analysis alone is insufficient for establishing a definitive diagnosis.

Impaired semen parameters alone cannot be used to predict fertility, as these men still have a chance of being fertile, except when a man has azoospermia, necrospermia, or globozoospermia. The nomenclature used to describe impaired sperm parameters includes oligozoospermia (low count), asthenozoospermia (poor motility), and teratozoospermia (abnormal morphology). Uncorrectable male infertility or subfertility — encompassing oligozoospermia, asthenozoospermia, teratozoospermia, and normospermia with functional defects — is found in approximately 70% of cases.

Beyond classical semen parameters, sperm DNA integrity is a clinically relevant dimension. DNA fragmentation is considered one of the main causes of male infertility due to impaired functional capability of sperm; its negative effect on fertility also extends to assisted reproduction, because spermatozoa with impaired DNA can fertilize an oocyte, and high DNA fragmentation has been associated with negative reproductive outcomes and failure to reach the blastocyst stage.

3. Body Systems Involved

3.1 The Hypothalamic–Pituitary–Gonadal (HPG) Axis

Key hormones include inhibin B and Müllerian inhibiting substance (MIS), both produced by the Sertoli cells in the testes. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH), released from the anterior pituitary gland, modulate these and are regulated by gonadotropin-releasing hormone (GnRH), produced by the hypothalamus. The major male androgen is testosterone, produced by Leydig cells in the testes; it can be converted peripherally to dihydrotestosterone via 5-alpha-reductase, or to estradiol via aromatase. Any disruption along this hormonal cascade — from the hypothalamus to the testes — can impair spermatogenesis.

3.2 The Reproductive Tract

The male reproductive system consists of internal structures — the testes, epididymis, vas deferens, and prostate — and external structures — the scrotum and penis. These structures are well-vascularized with many glands and ducts to promote the formation, storage, and ejaculation of sperm.

3.3 Sperm Structure and Energy Metabolism

A spermatozoon consists of a sperm head and sperm tail. The head contains a sperm nucleus with its DNA and is covered by the acrosome. The main functional parts of the sperm tail are the midpiece and the principal piece. Mitochondria, contained in the midpiece, produce energy in the form of ATP, which is mainly used to sustain the propulsive forces for sperm cell movement generated in the axoneme of the principal piece.

3.4 Oxidative Stress and Reactive Oxygen Species (ROS)

Seminal oxidative stress is the main molecular endpoint to which many harmful factors converge. Oxidative stress arises from conditions in which the production of reactive oxygen species (ROS), needed for normal sperm development and function, exceeds the ROS-scavenging capacity of inherent antioxidative systems. The resulting excessive ROS produce a chain of events leading to damage of sperm lipids, proteins, and DNA, ultimately affecting male fertility.

High amounts of polyunsaturated fatty acids (PUFAs), particularly docosahexaenoic acid (DHA), play a major role in regulating membrane fluidity in sperm; however, in studies of human spermatozoa, ROS has been shown to increase membrane fluidity in pathological quantities, disrupting the biochemical cascade of capacitation and the acrosome reaction. Mature sperm is especially susceptible to the effects of environmental factors because, in practice, it does not possess repair mechanisms protecting it against damage caused by oxidative stress.

4. Contributing and Associated Factors

4.1 Etiological Classification

Causes of male infertility include endocrine disorders (usually due to hypogonadism), estimated at 2–5% of cases; sperm transport disorders (such as vasectomy) at 5%; primary testicular defects (which include abnormal sperm parameters without any identifiable cause) at 65–80%; and idiopathic causes (where an infertile male has normal sperm and semen parameters) at 10–20%.

4.2 Varicocele

Varicocele is a pathological condition in which the veins (pampiniform plexus) in the spermatic cord of the testicles become dilated. It is the most common reproductive problem, affecting about 35% of men diagnosed with primary infertility and up to 80% of those with secondary infertility.

4.3 Comorbid Medical Conditions

A variety of medical comorbid conditions have been found to affect semen parameters, including renal disease, liver failure, hemochromatosis, chronic obstructive pulmonary disease, cystic fibrosis, and multiple sclerosis. With an increasing comorbidity burden, semen parameters deteriorate and FSH levels rise, suggestive of pituitary compensation in the setting of spermatogenic dysfunction. The mechanism by which medical conditions may impact fertility includes effects on hormonal levels, impairment of sexual function, or direct impairment of testicular function and spermatogenesis.

4.4 Smoking

Smoking increases sperm DNA fragmentation (SDF) by approximately 10% and alters hormonal profiles; e-cigarettes may carry similar risks. Smoking introduces numerous free radicals into the body, which increase ROS levels and cause oxidative damage to sperm DNA, proteins, and lipids.

4.5 Alcohol

Chronic alcohol use raises sperm DNA fragmentation by a comparable magnitude to smoking, disrupts the hypothalamic–pituitary–gonadal axis, and may cause testicular atrophy. Alcohol drinking was reported to cause a hormonal shift towards a higher free estradiol/free testosterone ratio and to augment the level of reactive oxygen species and DNA damage in male germ cells.

4.6 Obesity and Diet-Related Factors

Obesity impairs spermatogenesis through aromatase-mediated hormonal imbalance and inflammation; even modest weight loss can improve sperm parameters. A high-fat diet and obesity affect the structure of spermatozoa; in obese individuals, disorders on the hypothalamic–pituitary–gonadal axis are observed, as well as elevated oestrogen levels with a simultaneous decrease in testosterone, LH, and FSH. In men, obesity has been linked to an increased prevalence of azoospermia or oligozoospermia, a reduced ejaculate volume, and a higher risk of sperm DNA damage.

4.7 Psychological Stress

Prolonged exposure to psychological stress can reduce testosterone levels, impair sperm production, and decrease libido. The hypothalamic–pituitary–gonadal axis is known to be involved in stress response and controls spermatogenesis; disruption of the HPG axis on account of stress results in the failure of the testes to produce adequate levels of testosterone and a normal number of sperms.

4.8 Endocrine-Disrupting Chemicals (EDCs) and Environmental Toxicants

Male reproductive health is increasingly threatened by endocrine-disrupting chemicals (EDCs), which interfere with hormonal homeostasis and reproductive physiology. Rising rates of male infertility have been linked to greater exposure to pollutants such as heavy metals, phthalates, pesticides, and bisphenol A (BPA). These compounds act through multiple mechanisms, including oxidative stress, apoptosis, receptor-mediated disruption of estrogenic and androgenic signaling, alterations in the HPG axis, and heritable epigenetic changes. Exposure to environmental toxins such as heavy metals (e.g., cadmium, lead) and endocrine-disrupting chemicals (e.g., bisphenol A, phthalates) can increase ROS production in spermatozoa.

4.9 Heat Exposure

Environmental exposures such as heat waves, fine particulate matter, and endocrine-disrupting chemicals reduce semen quality and can contribute to testicular dysgenesis. The excessive generation of ROS in mitochondria, depolarization of mitochondrial membrane potential, changes in cell membrane fluidity and stability, production of heat shock protein, impairment of DNA synthesis, and changes in gene expression are among the molecular effects of heat stress occurring in male germ cells.

4.10 Drug Use

Drug use — particularly anabolic steroids, cannabis, and opioids — may also suppress male fertility.

5. Nutrients Studied in Relation to Male Fertility and Sperm Health

The primary mechanism driving most nutritional research in this field is the management of seminal oxidative stress. Antioxidants such as vitamins C and E, folate, zinc, selenium, carnitine, and carotenoids are scavengers of ROS, and their use has been studied as a treatment to reverse the adverse impact of high ROS concentrations on semen parameters. However, evidence quality varies considerably across individual nutrients, and a critically important finding from one large systematic review and meta-analysis should be noted upfront: no effect on pregnancy and live birth was found across the trials analyzed, although different supplements improved single sperm parameters: zinc and folic acid and multi-substance supplements improved sperm concentration; selenium, carnitine, and coenzyme Q10 improved motility; and alpha-lipoic acid improved normal morphology.

5.1 Zinc

Role and evidence: Zinc deficiency reduces the absorption and metabolism of dietary folate because it works as a cofactor for the folate-metabolizing enzymes dihydrofolate reductase and gamma-glutamyl hydrolase. A systematic review and meta-analysis of randomized clinical trials (RCTs) found that sperm total motility was increased by zinc (7.03%; 95% CI: 6.03–8.03%), and total sperm concentrations were increased by zinc (1.48 × 10⁶ spz/mL; 95% CI: 0.69–2.27 spz/mL). Some supplements including vitamin E and zinc proved beneficial for increasing the live birth rate in couples with male or unexplained subfertility. However, results are not uniformly positive: one study reported a lack of improvement in sperm concentration, motility, and morphology in infertile men with severely impaired sperm parameters after 16 weeks of supplementation with folic acid, zinc, and a combination of these substances. Evidence strength: Moderate for sperm concentration and motility improvements; benefit on live birth rate suggested but not firmly established across all trials.

5.2 Selenium

Role and evidence: Selenium has been shown to be an essential trace element for testosterone biosynthesis and the formation of sperm. Over 25 selenoproteins have been identified in humans, and these selenoproteins contribute to the maintenance of normal sperm structure. A meta-analysis found significant improvement in semen parameters for selenium (200 µg/day and 100 µg/day), with a standard mean difference of 0.64 for oligozoospermia. A 2022 systematic review found that sperm total motility was increased by selenium (3.30%; 95% CI: 2.95–3.65%) and sperm total concentrations by selenium (3.91 × 10⁶ spz/mL; 95% CI: 3.08–4.73 spz/mL). Evidence strength: Moderate; consistent signals across multiple RCTs for motility and concentration, though small study sizes remain a limitation.

5.3 Coenzyme Q10 (CoQ10)

Role and evidence: CoQ10 is an endogenous antioxidant and mitochondrial cofactor found in sperm. A systematic review of CoQ10 and male infertility (PMC, 2021) found that the CoQ10 group exhibited a significant increase in sperm concentration, progressive sperm motility, and total sperm motility, alongside significant improvements in total antioxidant capacity and superoxide dismutase (SOD) activity. A more recent systematic review and network meta-analysis found that L-carnitine, coenzyme Q10, and L-carnitine + acetyl-L-carnitine significantly improved sperm quality parameters compared with placebo, with CoQ10 inducing the highest increase in sperm concentration (SMD 2.98; 95% CI: 1.13–7.87). A 2022 network meta-analysis ranked antioxidants by SUCRA (surface under the cumulative ranking curve) and found that among the different antioxidants, CoQ10 had the highest SUCRA (79.4%) for improvements in sperm quality parameters. Evidence strength: Among the strongest for individual antioxidants, with consistent signals across multiple RCTs and network meta-analyses for sperm concentration and motility. Clinical evidence on live birth rates remains limited.

5.4 L-Carnitine and Acetyl-L-Carnitine

Role and evidence: Carnitine is a quaternary ammonium compound highly concentrated in the epididymis, where it is thought to support sperm maturation and energy metabolism. L-carnitine has the greatest improvement effect on progressive sperm motility (SMD 4.19; 95% CI: 1.60–10.95); CoQ10 was the most effective for improving sperm concentration, and L-carnitine was regarded as the best treatment for enhancing sperm motility. A broader systematic review found that CoQ10 treatment led to improvements in sperm progressive motility, total motility, and seminal antioxidant markers, and a network meta-analysis of 23 RCTs reported that L-carnitine and coenzyme Q10 have a strong ameliorative effect on sperm motility. Certain carnitine supplements proved beneficial for increasing the pregnancy rate. Evidence strength: Moderate to strong for sperm motility; among the better-studied natural compounds in male infertility RCTs.

5.5 Omega-3 Fatty Acids (DHA/EPA)

Role and evidence: DHA is a structural component of the sperm plasma membrane and is essential for membrane fluidity. A systematic review and meta-analysis of RCTs found that sperm total motility was increased by omega-3 fatty acids (7.55%; 95% CI: 7.09–8.01%), and total sperm concentrations were increased by omega-3 fatty acids (10.98 × 10⁶ spz/mL; 95% CI: 10.25–11.72 spz/mL). Mechanistically, administration of PUFA, especially omega-3 PUFA, resulted in an increase in mitochondrial energetic metabolism and a reduction in oxidative damage. However, one large 2025 meta-analysis found that vitamin D, vitamin E, and omega-3 fatty acids showed no improvement in sperm parameters when evaluated against primary outcomes, illustrating the inconsistency in the literature. Evidence strength: Preliminary to moderate; positive signals for concentration and motility in some meta-analyses, but inconsistent across studies. Biological plausibility for DHA is well-established.

5.6 Vitamin C (Ascorbic Acid)

Role and evidence: Vitamin C is a scavenger of ROS and its use has been studied as a treatment to reverse the adverse impact of high ROS concentrations on semen parameters. While observational studies suggest correlations between dietary vitamin C intake and semen quality, evidence from RCTs is mixed. A network meta-analysis found no statistically significant differences between vitamin C and placebo for sperm quality parameters when analyzed independently. It is frequently studied as part of combination antioxidant formulas rather than as monotherapy. Evidence strength: Weak to preliminary for monotherapy; vitamin C appears primarily as a component of multi-antioxidant regimens rather than a standalone intervention with consistent human trial evidence.

5.7 Vitamin E (Tocopherol)

Role and evidence: There are epidemiological data that support a direct relation between improvement of seminal parameters and increased dietary intake of vitamin E. RCT evidence is mixed: vitamin E proved beneficial for increasing the live birth rate in couples with male or unexplained subfertility in some analyses, but a 2025 systematic review found that vitamin E showed no improvement in sperm parameters in its primary analyses. Evidence strength: Mixed; some benefit suggested for live birth in older meta-analyses, but not consistently confirmed for sperm parameter improvements in newer, more rigorously designed studies.

5.8 Folate (Folic Acid)

Role and evidence: Folic acid, as a synthetic form of folate, efficiently scavenges free radicals and has been introduced as an effective factor for reduction of ROS in seminal fluid. However, evidence for sperm parameter improvement is weak: a systematic review and meta-analysis reported no significant difference in sperm motility in the folate-supplemented group compared with the control group, and there was also no significant difference in sperm motility in the folate-plus-zinc group in comparison with the control group. A combination of folic acid and zinc may work more efficiently than when they are taken alone. Evidence strength: Weak to mixed for sperm parameter improvement; the combination with zinc shows more consistent, though still modest, signals.

5.9 Lycopene

Role and evidence: Lycopene is a lipophilic reddish carotenoid frequently found in tomatoes and several red fruits, with known antioxidant and free-radical scavenging activities; it has been demonstrated that lycopene has positive effects on testicular mitochondrial function since it is a modulator of lipid peroxidation, antioxidant enzyme activities, and the activity of the Krebs cycle. Lycopene is frequently included in multi-antioxidant formulations studied in male infertility trials. However, one cross-sectional study of 323 men attending an Italian fertility clinic found a complex picture: lycopene intake was associated with a higher risk for low sperm concentration (aOR 2.46; 95% CI 1.01–5.98) and low total sperm count (aOR 3.11; 95% CI 1.29–7.50) — a finding the authors noted contrasts with other data and may reflect confounding in observational designs. Evidence strength: Preliminary; predominantly based on mechanistic studies and observational data. More robust clinical trial data are needed.

5.10 Vitamin D

Role and evidence: Vitamin D, among other nutrients such as omega-3 fatty acids, vitamins, and some antioxidants, is considered essential for optimal spermatogenesis and fertility. However, a 2025 systematic review and meta-analysis found that vitamin D showed no improvement in sperm parameters in its formal analysis. Evidence remains largely observational and mechanistic. Evidence strength: Weak for direct clinical benefit on sperm parameters; plausible role based on the presence of vitamin D receptors in testicular tissue, but RCT evidence is not currently supportive.

5.11 N-Acetylcysteine (NAC)

Role and evidence: NAC is a precursor to glutathione, the body's principal intracellular antioxidant. It is frequently studied as part of multi-ingredient antioxidant combinations. This analysis suggests that supplementation with selenium alone or combined with N-acetylcysteine may improve the spermiogram of infertile men. NAC monotherapy showed no statistically significant differences versus placebo in the 2022 network meta-analysis of eight antioxidants. Evidence strength: Weak to preliminary as monotherapy; appears more promising in combination regimens, particularly with selenium.

5.12 Alpha-Lipoic Acid

Role and evidence: Alpha-lipoic acid improved normal sperm morphology in the analysis of 50 included studies in one 2025 systematic review. This is a more recent finding and is based on a limited number of trials. Evidence strength: Preliminary; limited clinical trial data, though the mechanistic rationale as a mitochondrial antioxidant is plausible.

6. Herbs and Botanical Ingredients

6.1 Ashwagandha (Withania somnifera)

Traditional use: Ashwagandha (Withania somnifera) has been described in traditional Indian Ayurvedic medicine as an aphrodisiac that can be used to treat male sexual dysfunction and infertility. It has been taken for over 3,000 years to increase energy levels, improve concentration, and relieve stress.

Scientific evidence: Multiple clinical studies and reviews report that ashwagandha can improve semen parameters including semen volume, sperm count, motility, and sometimes testosterone in men with fertility problems; a pilot randomized trial of oligospermic men found a 53% increase in semen volume after 90 days of root extract alongside large gains in count and motility. A significantly greater improvement and regulation were observed in serum hormone levels with ashwagandha treatment compared to placebo. A systematic review of phytotherapy for male fertility found that moderate evidence supports the use of ashwagandha (Withania somnifera) to increase total testosterone and improve seminal parameters. Evidence strength: Among the strongest for any herbal ingredient in this field, with several small-to-moderate RCTs showing consistent signals. However, trials are generally small, use varying extract formulations, and often focus on men with pre-existing fertility issues, limiting generalizability.

6.2 Maca (Lepidium meyenii)

Traditional use: Maca is a Peruvian root vegetable from the Andes, used historically in pre-Columbian Andean cultures as a food staple and for its purported effects on energy, fertility, and libido. It has been cultivated for at least 2,000 years and was used by the Inca people both as food and as a fertility-enhancing plant for humans and livestock.

Scientific evidence: Maca (Lepidium meyenii) shows human trial evidence for improving sperm concentration and sometimes erectile parameters; a 2020 randomized placebo-controlled trial in infertile men found improved sperm concentration after 12 weeks of 2 g/day maca but did not change sperm motility or semen volume. Reviews of common fertility ingredients list maca among agents with possible benefit for libido and some semen parameters, but the pattern across trials is an effect on concentration or subjective sexual function rather than on ejaculate volume; maca's clinical footprint supports fertility-related endpoints selectively. The use of maca was not scientifically supported to improve serum testosterone levels in men in one systematic review. Evidence strength: Weak to preliminary; some signals for sperm concentration, but inconsistent across trials and the evidence base is small.

6.3 Tribulus terrestris

Traditional use: Tribulus terrestris is a traditional medicinal plant belonging to the Zygophyllaceae family whose extracts have been widely used for diuretic, analeptic, aphrodisiac, and profertility properties across traditions in Ayurveda, traditional Chinese medicine, and traditional European medicine.

Scientific evidence: Based on reviewed articles, Tribulus terrestris extract appears to influence the quantity and quality of spermatozoa as well as reproductive hormone levels, with some articles reporting significant increases in sperm parameters. However, the evidence base is thin: a narrative review utilizing Scopus, PubMed, and Cochrane databases found that only three articles met the inclusion criteria after 24 were excluded. A separate systematic review concluded that the use of tribulus was not scientifically supported to improve serum testosterone levels in men. Evidence strength: Weak; very few qualifying clinical trials exist, results are mixed, and it is not currently supported for testosterone elevation. The traditional profertility reputation is more firmly established than the clinical evidence.

6.4 Nigella sativa (Black Seed)

Traditional use: Nigella sativa has been used in Islamic traditional medicine (Unani) and Middle Eastern folk medicine for centuries as a general health tonic and remedy for a wide range of conditions. Its seeds and seed oil are referenced in Prophetic medicine (Tibb al-Nabawi) as a broad-spectrum remedy.

Scientific evidence: Nigella sativa was tested in a clinical context; after intervention with this herb, improvements in several semen parameters in the ejaculate — including semen volume, pH, sperm concentration, motility, morphology, and round cells — were reported. A systematic review found moderate evidence supports the use of black seeds (Nigella sativa) to increase total testosterone and improve seminal parameters. Evidence strength: Preliminary to moderate; signals are positive in small trials, and a moderate evidence designation has been assigned by one systematic review, but the overall trial database remains limited.

6.5 Panax Ginseng

Traditional use: In traditional medicine, ginseng is used to enhance physical and sexual strength, reduce stress and fatigue, and for its anti-inflammatory and antioxidant properties. It occupies a central place in traditional Chinese medicine and Korean herbal tradition, where it has been used for over 2,000 years.

Scientific evidence: Studies have found that ginseng compounds increase nitric oxide in vascular endothelial cells. Ginseng is more frequently studied in the context of erectile function than spermatogenesis. A systematic review of phytotherapy noted that direct evidence for improved serum testosterone from ginseng monotherapy in male infertility is limited, and most fertility-adjacent effects are seen in combination preparations. Evidence strength: Weak for direct sperm parameter improvement; stronger preliminary signals for erectile function and libido. Well-designed RCTs for spermatogenesis specifically are lacking.

6.6 Mucuna pruriens (Velvet Bean)

Traditional use: Mucuna pruriens is used in Ayurvedic medicine as a tonic for the nervous system and reproductive system. It is classified as a vajikaran (aphrodisiac) herb in the Ayurvedic pharmacopoeia and has been used for male sexual dysfunction and infertility.

Scientific evidence: A systematic review found that moderate evidence supports the use of mucuna (Mucuna pruriens) to increase total testosterone and improve seminal parameters. Mucuna pruriens seeds contain significant amounts of L-DOPA (levodopa), a dopamine precursor, which may modulate hypothalamic dopaminergic tone and thereby influence the HPG axis. Evidence strength: Preliminary to moderate based on systematic review designation; human trial data are limited in number and size.

6.7 Fenugreek (Trigonella foenum-graecum)

Traditional use: Fenugreek has long been used in traditional medicine and is now being studied for its benefits in male fertility and reproductive health; known as Trigonella foenum-graecum, it is a key herb in herbal remedies for reproductive issues. It is used in Ayurvedic, Unani, and traditional Mediterranean medicine.

Scientific evidence: A systematic review of phytotherapy found that moderate evidence supports the use of fenugreek (Trigonella foenum-graecum) to increase total testosterone and improve seminal parameters. Proposed mechanisms include inhibition of aromatase (reducing conversion of testosterone to estradiol) and inhibition of 5-alpha reductase. Evidence strength: Preliminary to moderate; limited clinical trial data specifically for spermatogenesis, with more evidence for testosterone modulation.

7. Dietary Patterns and Lifestyle Factors

7.1 The Western Diet as a Risk Factor

Diet may affect male reproductive potential, but the biochemical mechanisms involved in the modulation of sperm quality remain poorly understood. While a Western diet is considered a risk factor for male infertility, the Mediterranean diet seems to protect against it. A diet rich in processed and red meat, fatty dairy, coffee, alcohol, sweet drinks, sweets, and potatoes, and simultaneously deficient in whole-grain products, vegetables, fruits, poultry, fish, seafood, nuts, and lean dairy, is associated with poorer semen parameters and reduced fertility.

7.2 The Mediterranean Diet and Fertility

Adherence to the Mediterranean diet, characterized by a high intake of fruit, vegetables, legumes, whole grains, olive oil, nuts, and a moderate intake of animal products, has demonstrated a positive impact on male fertility, likely due to its antioxidant and anti-inflammatory properties. A systematic review of 10 studies including 2,032 men found that several cross-sectional studies found a positive association between adherence to the Mediterranean diet and semen quality, in particular total and progressive sperm motility, with a 2.6-fold increased likelihood of abnormal sperm concentration, total sperm count, and sperm motility reported for low compared with high adherence. The proposed mechanisms include: the beneficial effects of the Mediterranean diet on semen quality are linked to metabolic factors such as inflammation, oxidative stress, and insulin resistance, all of which are related to sperm function. One reason why the Mediterranean dietary pattern is beneficial for male fertility is that it provides a low level of saturated and trans fatty acids and adequate levels of certain nutrients such as omega-3 fatty acids, antioxidant molecules, and vitamins.

7.3 Fatty Acid Composition of the Diet

Diets rich in saturated fatty acids (SFA) and low in polyunsaturated fatty acids (PUFA) negatively affect sperm quality, whereas unsaturated fatty acid supplementation ameliorates sperm quality. Trans fatty acid intake has also been identified as inversely related to total sperm count in observational studies of young healthy men.

7.4 Physical Activity

Cigarette smoking, alcohol intake, stress, inadequate physical activity, an unequilibrated diet leading to obesity, and use of mobile telephones and portable electronic devices can affect the male reproductive system through multiple mechanisms. Moderate physical activity is generally associated with favorable metabolic and hormonal profiles relevant to fertility, while sedentary behavior contributes to obesity-related hormonal disruption.

7.5 Sleep

The findings of cross-sectional research indicate that obesity, moderate or heavy smoking, and sleep quality have statistically significant effects on sperm concentration, while obesity, moderate or heavy smoking, and sleep duration have statistically significant effects on sperm motility.

7.6 Mobile Phone and Electromagnetic Exposure

Amongst the factors of male infertility in the modern world, significant contributors include unhealthy habits causing obesity, smoking, the use of electronic devices as a source of electromagnetic radiation (mobile phones, portable computers), and alcohol consumption. Evidence in this area is ongoing and findings remain inconclusive, but it represents an active area of investigation.

7.7 Multi-Ingredient Antioxidant Supplementation: An Overview of Evidence Quality

It is important to note the overall quality of the evidence base. Of 3,137 articles identified in one systematic review, 50 were included; no effect on pregnancy and live birth was found overall, though different supplements improved single sperm parameters. Adherence to certain diets and antioxidant supplementation modestly improves sperm quality and reduces sperm DNA fragmentation. The keyword here is "modestly" — improvements in semen analysis parameters observed in trials do not consistently translate into improved pregnancy or live birth rates, and further well-designed clinical studies are necessary to provide treatment recommendations.

Dietary supplements for male infertility have potential efficacy in improving sperm parameters and DNA integrity, though many supplements have uncertain effects. A key structural limitation noted across the literature is that many trials are small, use varying doses, formulations, and inclusion criteria, and are of short duration.

References

Natural Remedies

Remedy 1

Antioxidant-Rich Diet: Oxidative stress is a leading cause of poor sperm function and DNA damage. Load your diet with brightly colored fruits and vegetables (berries, oranges, spinach, kale), walnuts, sunflower seeds, and whole grains like quinoa and brown rice — all of which deliver vitamins C and E, zinc, and selenium to protect and strengthen sperm.

Remedy 2

Zinc & Folate Foods: Zinc and folate are two micronutrients critical for sperm production and quality. Boost your intake naturally through pumpkin seeds, oysters, legumes, leafy greens, and eggs, or look for a whole-food-based supplement combining both to support sperm count and morphology.

Remedy 3

Ashwagandha Root: This adaptogenic herb has been used for centuries in Ayurvedic practice to reduce stress and support reproductive health. Studies show it can improve sperm count, motility, and morphology — take 300–500 mg of a root extract daily, preferably after consulting a health practitioner.

Remedy 4

Maca Root: Maca (Lepidium meyenii) is a Peruvian plant with a long tradition of use for enhancing male vitality and reproductive function. It is commonly taken as a powder (1–3 teaspoons stirred into smoothies or oatmeal daily) and is associated with improved sperm count and libido in natural health practice.

Remedy 5

Fenugreek Seeds: Fenugreek is a culinary and medicinal herb used widely in Mediterranean and Indian traditions to support testosterone levels and sperm count. Consume fenugreek seeds soaked overnight, use them in cooking, or take a standardized extract supplement to stimulate testosterone production and improve sperm motility.

Remedy 6

Healthy Fats & Omega-3s: A diet rich in monounsaturated and polyunsaturated fats — particularly omega-3 fatty acids — is associated with better sperm production, while a diet high in saturated fats is linked to low sperm quality. Prioritize oily fish like salmon and mackerel, avocados, and olive oil, and minimize fried and processed foods.

Remedy 7

Ginger: Ginger contains over 400 phytonutrients including phenolic compounds and terpenes that reduce free-radical production and oxidative stress. Evidence suggests ginger improves sperm count, viability, motility, morphology, and DNA integrity — drink 1–2 cups of fresh ginger tea daily or add grated fresh ginger liberally to meals.

Remedy 8

Keep Scrotal Temperature Cool: Elevated temperature around the testes reduces sperm production, as sperm develop best slightly below core body temperature. Avoid hot tubs, saunas, and prolonged laptop-on-lap use; choose loose-fitting, breathable underwear; and take cool (not ice-cold) showers to help maintain an optimal environment for sperm development.

Remedy 9

Prioritize Quality Sleep: Sleep duration and quality are directly correlated with sperm motility, concentration, count, and morphology. Aim for 7–9 hours of consistent, quality sleep per night by keeping a regular bedtime, limiting screen exposure before bed, and creating a cool, dark sleeping environment to support healthy testosterone rhythms and sperm production.

Remedy 10

Stress Management & Moderate Exercise: Chronic stress disrupts hormone balance and negatively impacts sperm quality, while regular moderate exercise supports healthy testosterone levels and circulation — both essential for sperm health. Practice daily stress-reduction habits such as yoga, meditation, or mindful breathing, and aim for 30 minutes of moderate-intensity movement most days of the week, avoiding extreme endurance training which can have the opposite effect.

Ingredients

These ingredients are often used in alternative medicine to support fertility (men's) & sperm health.

acetyl-L-carnitineScientific
Acetyl-L-carnitine (ALC) is the acetylated form of L-carnitine highly concentrated in the testis and epididymis. When combined with L-carnitine, multiple RCTs have found significant improvements in sperm concentration, total and forward motility, and morphology. A 2022 network meta-analysis ranked the LC+LAC combination among the top antioxidant treatments for sperm morphology and motility.
ALA (alpha-lipoic acid)Scientific
Alpha-lipoic acid (ALA) is a universal antioxidant active in both aqueous and lipid compartments, regenerating vitamins C and E and supporting glutathione synthesis. A 2025 systematic review and meta-analysis of RCTs found ALA was the only standalone supplement to significantly improve normal sperm morphology vs. placebo. It also protects sperm mitochondria and DNA from oxidative damage.
alpinia galangalScientific
Human clinical evidence shows A. galanga (and closely related A. officinarum) improves sperm motility, count, and morphology. A prospective double-blind RCT (Kolangi et al., Andrologia 2019) and a double-blind PLoS ONE trial (Fedder et al., 2014) using galangal rhizome showed significant improvements in spermatogram parameters.
ashwagandhaScientific
Ashwagandha (Withania somnifera) is a foundational Ayurvedic herb used for over 3,000 years to treat male sexual dysfunction and infertility. A placebo-controlled RCT in 46 oligospermic men found 675 mg/day for 90 days produced a 167% increase in sperm count, 53% increase in semen volume, and 57% increase in motility vs. placebo. A 2026 Frontiers RCT in healthy men confirmed approximately 33–87% improvements in semen parameters.
aspartic acidScientific
D-aspartic acid is found endogenously in human seminal plasma and spermatozoa, with significantly lower concentrations in infertile men. Human observational and early interventional data, plus animal studies, support a role in spermatogenesis, sperm motility, and fertilizing capacity. A 2024 RCT found DAA combined with ubiquinol and zinc significantly improved progressive sperm motility in infertile men.
astaxanthinScientific
Small clinical trials show astaxanthin may improve sperm motility and reduce semen oxidative stress in infertile men, with one RCT (n=30, 16 mg/day, 3 months) reporting a 54.5% pregnancy rate vs. 10.5% placebo. However, a 2026 systematic review and meta-analysis of 3 human RCTs found no statistically significant improvement in semen parameters overall, indicating mixed and low-certainty human evidence.
barrenwortScientific
Icariin and its metabolite icariside II restore Sertoli cell function, improve sperm count and viability, and enhance testicular testosterone and estradiol in preclinical aging and chemotoxicity models. Animal data show ICA can activate ERK1/2 signaling to improve sperm quality. Epimedium has a traditional TCM indication for male reproductive deficiency and impotence.
beta and delta tocopherolsScientific
Antioxidant therapy using mixed tocopherol preparations including gamma-tocopherol has been studied for improving sperm quality in infertile men with high reactive oxygen species in semen. A mouse study showed a gamma-tocopherol-rich mixture with ascorbic acid restored fertility in subfertile males with oxidative sperm damage. Reactive oxygen species impair sperm motility, morphology, and DNA integrity in 25–87% of infertile patients, and tocopherols are among the antioxidant interventions under investigation.
black cuminScientific
A systematic review of 24 studies (including RCTs) found N. sativa improved sperm parameters, semen fluid, and testosterone in men. An RCT in infertile men with abnormal morphology demonstrated improved sperm count and motility. TQ promotes spermatogenesis and LH-stimulated testosterone production.
bovine liverScientific
Bovine liver contains zinc, selenium, vitamin A, B12, and CoQ10 — nutrients with documented roles in spermatogenesis, sperm motility, and testosterone production. An observational cohort study found men who consumed organ meats had 40–53% higher sperm count and concentration. CoQ10 meta-analyses show significant improvements in sperm motility, count, and morphology.
boxthorneScientific
A double-blind RCT in varicocele patients (n=80, 400 mg LBP extract, 2 months) demonstrated significant improvements in sperm count, motility, morphology, and testosterone, alongside reduced oxidative stress markers. Multiple animal studies confirm LBP improves spermatogenesis and sperm parameters. TCM documents boxthorn for male infertility and sperm production.
broomrapeScientific
Broomrape (Orobanchaceae family, including Cistanche tubulosa also known as broomrape) has preclinical scientific evidence supporting effects on sperm quality and male reproductive function. Animal studies demonstrate improved sperm count, motility, and testosterone via steroidogenic enzyme upregulation. The ethnopharmacological literature also documents longstanding traditional use of Orobanche spp. against spermatorrhea and infertility.
chrysinScientific
Chrysin inhibits aromatase (CYP19), the enzyme that converts testosterone to estradiol, and also upregulates StAR gene expression in Leydig cells to stimulate testicular steroidogenesis. Rodent studies show increased testosterone, improved sperm count and motility. However, a small human study (21 days, propolis/honey) found no change in urinary testosterone, suggesting poor bioavailability limits in vivo effects in humans.
CoQ10 (coenzyme Q10)Scientific
CoQ10 is concentrated in sperm mitochondria and acts as both an energy promoter and antioxidant for flagellar movement. Multiple RCTs and a 2025 systematic review and meta-analysis found CoQ10 supplementation significantly increases total sperm count, total and progressive motility, and normal morphology while raising serum testosterone and inhibin B. Standard clinical doses are 100–300 mg/day for 3–6 months.
cordycepsScientific
Cordyceps (Cordyceps sinensis/militaris) is a medicinal fungus used for over 2,000 years in TCM to tonify kidney yang and enhance male reproductive function. Active cordycepin enhances testosterone biosynthesis via StAR protein upregulation in Leydig cells. Multiple animal studies and systematic review evidence in phytotherapy support its use for improving sperm count and motility.
cowage seedScientific
Multiple prospective human clinical studies demonstrate that M. pruriens seed powder (5 g/day for 3 months) significantly increases sperm concentration, motility, and seminal antioxidant levels in infertile men. One study showed up to 688% improvement in sperm concentration in oligozoospermic patients.
d-alpha tocopherolScientific
Alpha-tocopherol is a major antioxidant in sperm membranes, protecting against lipid peroxidation-induced damage to sperm DNA, motility, and viability. Multiple clinical studies show supplementation in infertile men improves sperm motility and quality, with some evidence of increased pregnancy rates.
D-aspartic acidScientific
D-Aspartic acid (D-Asp) is an endogenous amino acid found in high concentrations in the testis and pituitary that stimulates LH and testosterone release. A clinical study of 60 subfertile men found that 2.66 g/day sodium D-aspartate for 90 days significantly increased sperm concentration (2-fold in oligoasthenozoospermic patients) and motility, with 27% of partners becoming pregnant. A 2025 RCT confirmed significant improvements in progressive sperm motility vs. placebo.
DHA (docosahexaenoic acid)Scientific
DHA is the most abundant omega-3 in sperm plasma membranes and is specifically essential for flagellar motility, capacitation, and the acrosome reaction. Low testicular and seminal DHA is a recognized marker of asthenozoospermia. An RCT of 238 infertile men found DHA 1.84 g/day for 32 weeks significantly improved sperm motility, concentration, and morphology vs. placebo.
docosahexaenoic acidScientific
DHA is the principal polyunsaturated fatty acid in human sperm membranes and is critical for sperm motility, vitality, and morphology. DHA is significantly reduced in idiopathic infertile men compared to fertile controls. Dietary DHA supplementation improves seminal antioxidant status and decreases sperm DNA fragmentation in clinical trials.
dodderScientific
Cuscuta chinensis has multiple preclinical studies demonstrating significant improvements in sperm count, motility, and viability, and its inclusion in clinical TCM formulas for oligoasthenospermia is well-documented. A 2021 network pharmacology study with in vivo validation showed C. chinensis improves sperm count and viability via the PI3K/Akt pathway. A clinical study using a TCM formula containing C. chinensis found significantly better sperm concentration and morphology in users versus non-users.
DPA (docosapentaenoic acid)Scientific
DPA is a structural component of sperm phospholipid membranes and accumulates in sperm during epididymal maturation, contributing to membrane fluidity and motility. Higher seminal plasma DPA levels have been shown to attenuate the negative impact of endocrine-disrupting chemicals on sperm motility parameters in a human cohort study. DPA stabilizes sperm membrane integrity and mitochondrial function in preclinical models.
EGCG (epigallocatechin gallate)Scientific
EGCG protects sperm from oxidative DNA damage, reduces sperm deformity, inhibits spermatogenic cell apoptosis, and at low concentrations improves sperm motility and capacitation. Addition of EGCG to thawed sperm for IVF after chemotherapy significantly increased penetration and fertilization rates in human studies.
eurycoma longifoliaScientific
Eurycoma longifolia (Tongkat Ali) is a Southeast Asian plant used traditionally as a sexual tonic and male fertility enhancer. A clinical study of 75 men with idiopathic infertility receiving 200 mg/day found significant improvements in sperm motility, concentration, volume, and morphology, with 11 spontaneous pregnancies. A 2017 systematic review rated it with moderate evidence for testosterone improvement and seminal parameter enhancement.
fenugreekScientific
Fenugreek (Trigonella foenum-graecum) has traditional use in Ayurveda and as a culinary herb for male reproductive health. A clinical study with FurosapTM fenugreek seed extract in healthy male volunteers found improvements in free testosterone and sperm profile. A 2017 systematic review rated fenugreek among botanicals with the strongest evidence for testosterone improvement and seminal parameter enhancement.
fish oilScientific
DHA is a major structural component of sperm membranes (~25–35% of total sperm phospholipid fatty acids) and is essential for acrosome formation, sperm motility, and morphology. A 2018 systematic review and meta-analysis found omega-3 supplementation significantly improved sperm concentration and total motility versus controls. A JAMA Network Open study linked fish oil supplementation with improved reproductive hormone levels and semen quality in men.
folic acidScientific
Folic acid is essential for DNA synthesis and repair during spermatogenesis. Subfertile men with low folate show increased sperm DNA fragmentation. Combined zinc+folic acid supplementation improved sperm concentration in some RCTs. However, a large NIH-funded RCT (n=2,370) found no improvement in live birth rates with combined zinc+folic acid vs. placebo, indicating benefits may be limited to folate-deficient men.
fulvic acidScientific
Clinical evaluations of shilajit (containing fulvic acid) in men with oligospermia reported a 61.4% increase in total sperm count and improved motility. A 90-day RCT showed significant increases in total testosterone, free testosterone, and DHEAS in healthy men aged 45–55.
gingerScientific
A double-blind RCT (n=100 infertile men) found that 500 mg/day ginger powder for 3 months significantly reduced sperm DNA fragmentation (SDF) compared to placebo (p=0.02). A systematic review confirmed ginger enhances sperm count, viability, motility, morphology, and DNA integrity via antioxidant and androgenic mechanisms.
ginsengScientific
Panax ginseng has centuries of use in East Asian medicine as a male reproductive tonic. An RCT (n=90 infertile men) found standardized ginseng extract 1,800 mg/day for 12 weeks significantly improved sperm count, motility, and testosterone vs. placebo. Ginsenosides enhance NO production, support Leydig cell testosterone synthesis, and protect testicular tissue from oxidative stress.
goji berryScientific
Goji berry has been used in TCM as a male fertility enhancer for thousands of years, and modern studies support improvements in sperm count, motility, and quality. A Chinese trial in 42 infertile men given daily goji berry for 2 months reported normalization of sperm counts in 33 participants. Animal studies confirm LBP protects against heat- and toxin-induced testicular damage and improves reproductive hormones.
horse chestnutScientific
Aescin from HCSE has been evaluated in a clinical trial for varicocele-associated male infertility. A controlled study in 219 Chinese men found that 60 mg/day oral aescin for two months improved sperm density and motility compared to controls. The venotonic action of aescin on the spermatic vein is proposed as the mechanism.
inositolScientific
Myo-inositol is concentrated in the testes and seminal fluid, where it plays a signaling role in sperm maturation, acrosome reaction, motility, and zona pellucida binding. Double-blind RCTs show significant improvements in sperm concentration, progressive motility, and acrosome reaction with myo-inositol versus placebo. DNA fragmentation is also reduced with supplementation.
L-arginineScientific
L-arginine is a precursor to nitric oxide (NO) in the male reproductive tract, where physiological NO supports sperm capacitation and motility. Early controlled clinical studies showed improvements in sperm count and motility with L-arginine supplementation. It has been included in multi-ingredient fertility formulas showing sperm motility improvements in men with asthenozoospermia.
l-carnitineScientific
L-carnitine is highly concentrated in the epididymis and is critical for sperm energy metabolism and motility. Multiple RCTs and meta-analyses demonstrate that L-carnitine (alone or with acetyl-L-carnitine) significantly improves sperm motility and morphology in infertile men. A 2022 network meta-analysis found L-carnitine ranked highest among antioxidants for improving sperm morphology vs. placebo.
L-citrullineScientific
L-Citrulline improves erectile function by boosting NO-mediated penile vasodilation, with small randomized trials demonstrating improvements in erection hardness and IIEF scores at doses of 1.5–3 g/day. The citrulline–arginine–NO pathway is also physiologically important in testicular and seminal plasma function, with animal studies showing improved sperm motility and density, though dedicated large human sperm-parameter trials are lacking.
L-cysteineScientific
NAC (L-cysteine precursor) has been studied in multiple RCTs for male infertility, showing improvements in sperm concentration, motility, and DNA integrity by reducing oxidative stress in seminal plasma. A 2016 RCT in men with clinical varicocele found NAC significantly improved sperm concentration and clinical pregnancy rate (33% vs 10% for placebo).
L-glutathioneScientific
Seminal glutathione levels correlate positively with sperm motility, morphology, and concentration in infertile men. GSH deficiency leads to instability of the sperm midpiece, defective motility, and increased DNA fragmentation. Clinical studies show glutathione supplementation can improve sperm quality in men with varicocele or genital tract inflammation.
lycopeneScientific
Lycopene is a carotenoid antioxidant that accumulates in the testes and seminal plasma, where it protects sperm from ROS-induced DNA fragmentation. An RCT in men undergoing ICSI found a 6 mg lycopene-containing multi-antioxidant supplement produced significantly higher viable pregnancy rates (38.5% vs. 16%; P=0.03). Systematic reviews consistently list lycopene among antioxidants with beneficial effects on sperm parameters.
macaScientific
Maca (Lepidium meyenii) is a Peruvian plant used by Andean populations for 1,300–2,000 years to promote fertility and reproductive function. A double-blind RCT in healthy men found sperm concentration and motility showed rising trends vs. placebo at 12 weeks. A 2022 systematic review of 5 RCTs found mixed but generally positive results for sperm parameters in infertile men, with traditional use well-documented.
methylcobalaminScientific
Cobalamin, particularly via MeCbl, plays a role in male reproductive function. Studies show significantly lower seminal plasma cobalamin concentrations in azoospermic men versus normozoospermic men. A clinical trial found that 1,500 mcg/day of methylcobalamin for 4–24 weeks resulted in improvements in sperm parameters in infertile males, though the study had methodological limitations.
morindaScientific
Morinda officinalis bajijiasu, oligosaccharides, and polysaccharides have been shown in animal studies to enhance sperm motility, count, and morphology; increase testosterone levels; and protect human sperm DNA from oxidative damage. Polysaccharides activate the SIRT1/PGC-1α pathway in Leydig cells to promote testosterone secretion.
NAC (N-acetyl cysteine)Scientific
N-acetyl cysteine (NAC) is a precursor to glutathione and a direct antioxidant that protects sperm from oxidative stress-induced damage. A meta-analysis of 3 RCTs (n=431 infertile men) found NAC supplementation significantly improved sperm numbers, motility, and morphology. When combined with selenium in a 4-arm RCT, it significantly improved all semen parameters with dose-dependent correlations.
omega-3 fatty acidsScientific
Omega-3 fatty acids (DHA+EPA) are major structural components of sperm plasma membranes essential for motility and the acrosome reaction. A 2019 systematic review identified EPA+DHA as one of the most evidence-supported supplements for improving the spermiogram in infertile men. Low seminal DHA is a consistent marker of poor sperm motility.
palmitateScientific
Retinoic acid derived from vitamin A palmitate is essential for spermatogenesis; vitamin A deficiency causes cessation of sperm production. The mechanism is well-documented through nuclear retinoid receptor signaling in Sertoli and germ cells.
pine barkScientific
Clinical studies show Pycnogenol, alone or combined with L-arginine (as Prelox), improves sperm morphology, motility, and count in subfertile men. The percentage of morphologically normal spermatozoa increased by 99% in one study. Mechanisms involve antioxidant protection of spermatozoa and enhanced nitric oxide signaling.
pomegranateScientific
Animal studies (rat models) demonstrate pomegranate juice improves sperm motility, concentration, and reduces sperm DNA oxidative damage. Limited human data exist, but pomegranate's antioxidant mechanisms are biologically plausible for protecting spermatozoa from oxidative stress. Reviews identify pomegranate as having spermatogenic properties.
prunusScientific
Clinical studies of Prunus africana (pygeum) bark extract have noted increased seminal fluid volume as a positive secondary finding in BPH trials. This is mechanistically consistent with reduced prostatic inflammation improving accessory gland secretion. The evidence is secondary to BPH trials rather than dedicated fertility RCTs, but the finding is documented in clinical literature.
pumpkinScientific
Pumpkin seeds are a concentrated source of zinc and antioxidants that support sperm quality and reproductive hormone levels. Animal studies demonstrate improvements in sperm count, motility, and testosterone levels. The zinc-sperm quality link is well-established in human nutritional science, though direct human RCTs using pumpkin seeds as the sole intervention are limited.
quercetinScientific
Quercetin is a flavonoid antioxidant that activates the Nrf2/HO-1 antioxidant pathway in testicular tissue, chelates heavy metals, and protects sperm from oxidative stress-induced DNA damage. Animal studies consistently demonstrate protection of sperm parameters from multiple toxic insults. Clinical combination supplement evidence and inclusion in evidence-reviewed fertility protocols supports its relevance to male fertility.
resveratrolScientific
Resveratrol activates SIRT1/AMPK pathways in testicular tissue, protecting sperm from oxidative stress and supporting testosterone synthesis. Multiple animal studies document improvements in sperm count, motility, and morphology. A pilot human study reported improvements in sperm quality markers. It is particularly studied for protective effects against environmental toxin-induced and heat-induced spermatogenic damage.
royal jellyScientific
Animal studies consistently show RJ protects sperm parameters, motility, and testosterone levels under oxidative stress conditions. One small uncontrolled human study found improved testosterone and sperm parameters in infertile men taking 1,000 mg/day. Evidence is primarily preclinical; no placebo-controlled RCT in humans exists.
saffronScientific
Small RCTs and a systematic review/meta-analysis show saffron can improve sperm morphology and motility in infertile men, likely via its antioxidant reduction of reactive oxygen species (ROS) damage to sperm DNA. Sperm count is not significantly affected. Evidence is limited by small study numbers and mixed results across trials.
seleniumScientific
Selenium is an essential trace element required for testosterone biosynthesis and the structural integrity of sperm via selenoproteins including PHGPx (expressed in sperm midpiece). RCTs show selenium supplementation (alone or combined with NAC) significantly improves sperm count, motility, and morphology in infertile men. A 2025 systematic review confirmed selenium improved sperm motility vs. placebo.
selenomethionineScientific
Selenomethionine supports male fertility by supplying selenium for selenoprotein synthesis in testicular tissue, particularly GPX4 (PHGPx), which is essential for sperm structural integrity and motility. Clinical trials in infertile men have shown L-selenomethionine supplementation (100–200 µg/day) increases sperm motility. A 2025 comprehensive review supports the potential benefit of selenium supplementation for improving male infertility, particularly sperm motility.
sesameScientific
A clinical trial (PMC, PMID 23930112) in 25 infertile men found that 0.5 mg/kg sesame for 3 months significantly improved sperm count and motility. High seminal reactive oxygen species (ROS) is a major cause of male infertility, and sesame's antioxidant activity is the proposed mechanism. Evidence is limited to one small open-label trial but is published in peer-reviewed literature.
shilajitScientific
Shilajit is a mineral-rich resinous substance classified in Ayurveda as a rasayana with specific indications for male reproductive enhancement. A placebo-controlled RCT (n=60 oligozoospermic men) found purified shilajit 100 mg twice daily for 90 days significantly improved total sperm count (+61%), sperm motility (+37%), and normal morphology (+19%) vs. placebo.
sumaScientific
Animal studies show P. paniculata and related Pfaffia species modulate testosterone and reproductive parameters in male rodents, though results are mixed. One study noted elevated testosterone; another on P. glomerata showed altered testicular microstructure with hydroalcoholic extract at higher doses. No human fertility studies exist.
taurineScientific
Taurine is present in high concentrations in the testes and epididymis, where it supports spermatogenesis, preserves sperm motility and viability through antioxidant and osmoregulatory mechanisms, and modulates the hypothalamic-pituitary-testicular axis. Evidence is primarily from animal models with mechanistic support.
TMG (trimethylglycine)Scientific
Homocysteine accumulation in seminal plasma is associated with impaired sperm function; TMG's ability to reduce homocysteine provides the primary clinical rationale for its use in male fertility. A crossover RCT in healthy male athletes showed TMG at 2.5–5 g/day significantly increased total testosterone. Animal studies (roosters under heat stress) show betaine restores sperm concentration, motility, and fertility rates. Direct human sperm-quality RCT evidence remains limited.
tomatoScientific
A 2025 systematic review and meta-analysis of four clinical trials found lycopene supplementation significantly improved sperm concentration and nonprogressive motility in men. The mechanism involves reduction of ROS-induced oxidative damage to sperm DNA and membranes. Evidence remains preliminary due to small trial numbers.
tongkat aliScientific
Tongkat Ali (Eurycoma longifolia) is a Southeast Asian plant used for centuries as a male sexual tonic and fertility enhancer. A clinical study of 75 infertile men found 200 mg/day significantly improved sperm count, motility, volume, and morphology with 11 spontaneous pregnancies. Multiple systematic reviews rate it with moderate evidence for testosterone and seminal parameter improvements.
tribulusScientific
Clinical trials and a systematic review report that tribulus generally improves sperm count, motility, and morphology in men with idiopathic infertility. The plant is one of the few herbs with evidence in both preclinical and clinical human fertility contexts for men.
tribulus terrestrisScientific
Tribulus terrestris has centuries of traditional use in Ayurveda and Traditional Chinese Medicine for male reproductive health. A double-blind clinical study of 65 infertile men receiving 250 mg extract daily reported significant improvements in sperm concentration and motility. A 2017 systematic review noted evidence for improvement of seminal parameters, though evidence for testosterone elevation is weak.
ubiquinolScientific
Multiple RCTs and retrospective clinical studies specifically using ubiquinol have demonstrated significant improvements in sperm density, motility, and morphology in infertile men. A key double-blind RCT in 228 infertile men (200 mg/day for 26 weeks) found significant improvements across all three primary semen parameters. Ubiquinol is concentrated in spermatozoa and supports mitochondria-dependent sperm motility.
velvet beanScientific
Velvet bean (Mucuna pruriens) is an Ayurvedic herb specifically indicated for male infertility. Rich in L-DOPA, it elevates dopamine and LH to promote testosterone production and spermatogenesis. A clinical study (n=75 infertile men; 5 g/day seed powder for 3 months) significantly improved sperm count, motility, testosterone, LH, and FSH. A 2017 systematic review rated it with moderate evidence for testosterone and seminal parameter improvement.
vitamin B12Scientific
Multiple studies show that vitamin B12 is transferred to male reproductive organs and is positively associated with sperm count, motility, and reduced DNA damage. Plasma B12 levels are lower in infertile men compared to fertile men. A 2017 systematic review concluded that the majority of published work demonstrates positive effects of B12 on semen quality.
vitamin B9 (folate)Scientific
Folate (vitamin B9) is essential for DNA synthesis and methylation during spermatogenesis. Low seminal folate correlates with increased sperm DNA fragmentation and aneuploidy. Combined zinc+folic acid improved sperm concentration in early RCTs. However, a 2020 NIH-funded RCT (n=2,370) found no improvement in live births, indicating benefits are most likely in folate-deficient men.
vitamin B9 (methylfolate/5-MTHF)Scientific
Methylfolate (5-MTHF) is the active bioavailable form of folate, bypassing the MTHFR enzyme and directly supporting DNA synthesis and methylation in spermatogenesis. Men with MTHFR polymorphisms (common in male infertility populations) may have impaired conversion of folic acid to 5-MTHF, and 5-MTHF supplementation can more effectively support sperm DNA integrity in these individuals.
vitamin CScientific
Vitamin C is one of the most abundant antioxidants in seminal plasma, protecting sperm DNA from oxidative damage. Low seminal vitamin C correlates with elevated sperm DNA fragmentation. Clinical studies and systematic reviews consistently support its benefit in combination antioxidant regimens for male infertility, with 26 positive RCTs identified in a 2022 systematic review.
vitamin DScientific
Vitamin D receptors are expressed in sperm cells, Sertoli cells, and Leydig cells. Low serum 25(OH)D levels are associated with reduced sperm motility, morphology, and testosterone in observational studies. Mechanistic studies show calcitriol regulates calcium-mediated sperm motility and testosterone production. Clinical trial results are mixed, with benefits most likely in vitamin D-deficient men.
vitamin EScientific
Vitamin E (alpha-tocopherol) is the primary lipid-soluble antioxidant protecting sperm membranes from lipid peroxidation. An early controlled study found 600 mg/day for 6 months significantly improved sperm motility in infertile men. Systematic reviews of 26 positive RCTs identified vitamin E as consistently beneficial in combination antioxidant regimens for male infertility.
watermelonScientific
Watermelon is a meaningful dietary source of lycopene, which accumulates preferentially in testicular tissue and has demonstrated improvements in sperm concentration and nonprogressive motility in clinical trials. Oxidative stress is a major driver of male infertility and lycopene is among the most potent carotenoid antioxidants.
wheat germScientific
Wheat germ is rich in vitamin E, zinc, and selenium, all of which play evidence-based roles in sperm quality, motility, and protection against oxidative damage. Germinated wheat showed improved sperm motility and viability in an avian model, attributed to its high antioxidant content. The antioxidant-sperm quality relationship is supported by human clinical data on these specific micronutrients.
zincScientific
Zinc is the most extensively studied micronutrient for male fertility. Seminal zinc levels are significantly lower in infertile men, and a meta-analysis in Scientific Reports found zinc supplementation significantly improved semen volume, sperm motility, and normal morphology in infertile males. It plays direct roles in spermatogenesis, sperm chromatin stability, capacitation, and testosterone balance. A 2020 large NIH-funded RCT found no improvement in live birth rates with combined zinc+folic acid, indicating benefits may be specific to zinc-deficient men.
asparagusTraditional
A. racemosus (shatavari) has traditional use for male fertility enhancement in Ayurveda, and preliminary animal findings suggest positive outcomes for sperm parameters. A 2025 PubMed review states preliminary findings indicate positive outcomes for male fertility, but acknowledges more clinical trials are needed. No human RCT evidence for male fertility specifically has been published.
bee pollenTraditional
Traditional apitherapy systems cite bee pollen for male fertility and vitality. A PMC nanotechnology review states pollen may benefit sterility. Animal studies suggest protective effects on sperm from oxidative damage, but no human clinical trials on male fertility endpoints have been published.
pituitary substanceTraditional
Glandular therapy traditions include pituitary substance for male infertility and low libido, premised on the pituitary's production of FSH and LH, which govern testicular function and spermatogenesis. This use dates to the early 20th century organotherapy movement. No modern clinical trials support oral pituitary supplementation for male fertility.
solomon's sealTraditional
Solomon's seal is classified as an aphrodisiac and reproductive tonic in Ayurvedic and TCM traditions, listed in Drugs.com (citing Zhao 2018) for 'sexual dysfunction.' Matthew Wood's herbal writings state it 'increases semen,' and several herbal references list male infertility among medicinal uses.