MEDICAL RESEARCH

Vitamin A:

Vitamin A is involved in various functions in the body including vision, bone metabolism, reproduction and embryo development. It plays a significant role in the immune system and can serve as an anti-oxidant. Retinal and retinoic acid are the two forms of Vitamin A in the body that are biologically active and formed from the preformed vitamin (retinol) or provitamin carotenoids (i.e. beta-carotene).

Vitamin A deficiency can cause dry eye, intrauterine growth restriction and may increase the risk of maternal and infant morbidity and mortality in pregnant women and during lactation. Pregnant women need extra vitamin A for fetal growth and maintenance of normal metabolism. In men, vitamin A deficiency may interfere with sperm differentiation and production of healthy sperm.

Women trying to conceive or undergoing In Vitro Fertilization (IVF) treatment may benefit from using vitamin and anti-oxidant therapy. However, excessive vitamin A consumption is not recommended and prenatal vitamins should contain no more than 10,000 international units of vitamin A. Amounts over 25,000 international units may increase the risk of birth defects.

Vitamin A is naturally found in carrots, liver, sweet potatoes, spinach, kale and broccoli.

Vitamin B:

B vitamins are involved in the function of the brain and nervous system, cell metabolism, contribute in the formation of red blood cells and should be essential components of a healthy diet. B complex vitamins may be helpful in the treatment of infertility related to ovulation dysfunction. Adequate levels of vitamin B should be consumed prior to and during pregnancy, and a Mediterranean type diet may provide an adequate amount.

Vitamin B is naturally found in a variety of meats, eggs, fish, green vegetables, beans, chicken, cereals, breads and dairy products.

Folic Acid (Folate):

Folate plays a significant role in DNA synthesis and repair, formation of red cells and cell development prior to and during pregnancy. Folic acid is essential in the development of the fetal nervous system including the brain and the spinal column.

Folic acid taken prior to and during pregnancy significantly reduces the risk of having neural tube defects (NTDs). Folic acid may also decrease the risk of miscarriage, birth defects and premature birth. American College of Obstetricians and Gynecologists (ACOG) recommends that women in the childbearing years consume folic acid at least three months prior to a planned pregnancy and continue during the pregnancy.

Men deficient in folic acid may have significant sperm abnormalities. Recent medical evidence has shown that supplementation of folic acid and zinc improves sperm parameters significantly. It is recommended that men consume a healthy balanced diet and supplement with vitamins and anti-oxidants if they have abnormal sperm parameters.

Folic acid is naturally found in a variety of green vegetables, lettuce, beans, spinach, pastas, bread and cereals.

References for Vitamin Folic Acid:
Folic acid and human reproduction. Dunlap B. J Exp Clin Assist Reprod. 2011.

Effect of folic acid and zinc sulfate on male factor subfertility: a double-blind, randomized, placebo-controlled trial. Wong WY. Fertil Steril. 2002.

Vitamin C:

Vitamin C is an essential nutrient and has anti-oxidant properties protecting the cells from oxidative damage. It is involved in collagen synthesis, numerous metabolic reactions and stimulates production of sex hormones necessary for the development of healthy eggs and sperm.

Vitamin C is present in most fruits and vegetables.

Reference for Vitamin C:
Moderate amount of supplemental vitamin C improves hormone levels and increases fertility in women with luteal phase defect. Hirofumi. Fertil Steril. 2003.

Vitamin D:

Vitamin D is involved in various metabolic reactions including the immune system and calcium and phosphorus metabolism as well as the bone. Two common forms that can be found in foods are cholecalciferol (vitamin D3) and ergocalciferol (vitamin D2). Vitamin D is also produced in the body when exposed to direct sunlight. Through a number of metabolic steps, vitamin D is synthesized from cholesterol.

Vitamin D appears to impact the hormonal system and may impact the production of progesterone and estrogen, which regulate menstrual cycles. Vitamin D deficiency may result in lower fertility rates and abnormal sperm parameters. Vitamin D may impact testosterone levels, increase libido and thus the production of sperm. It is essential for the development of healthy sperm as well.

Vitamin D exposure during pregnancy may decrease the risk of having certain medical problems in children such as allergic rhinitis. Pregnancy rates may be lower in women with low vitamin D levels undergoing In Vitro Fertilization (IVF) treatment. Vitamin D supplementation is recommended to women with low vitamin D levels (less than 30 ng/mL) prior to a planned pregnancy and during pregnancy.

Natural sources of vitamin D include certain mushrooms, cheese, cod liver, fish, cereal and milk, orange juice and yogurt.

References for Vitamin D:
Replete vitamin D stores predict reproductive success following in vitro fertilization. Ozkan. Fertil Steril. 2010.

Vitamin D is positively associated with sperm motility and increases intracellular calcium in human spermatozoa. Blomberg. Hum Reprod. 2011.

Prenatal, perinatal, and childhood vitamin D exposure and their association with childhood allergic rhinitis and allergic sensitization. Bunyavanich S. Journal of Allergy & Clinical Immunology. 2016.

Vitamin D deficiency and infertility: insights from in vitro fertilization cycles. Paffoni A. Journal of Clinical Endocrinology & Metabolism. 2014.

Vitamin E:

Vitamin E is a fat-soluble vitamin involved in many metabolic activities, but it’s most known for its anti-oxidant properties. It’s present in cell membranes protecting the cells from oxidative damage and has functions in the neurological and clotting systems. It’s present in many different forms, but the most common form present in the US diet is γ-tocopherol.

It is considered an essential component of prenatal vitamins and it may be useful in men with low sperm count and motility. It may be helpful in couples undergoing IVF treatment because fertilization rates may be improved.

Vitamin E can be found in sunflower oil, corn oil, soybean oil, almonds, hazelnuts, asparagus and avocado.

References for Vitamin E:
Combination clomiphene citrate and antioxidant therapy for idiopathic male infertility: a randomized controlled trial. Ghanem. Fertil Steril. 2010.

A carbohydrate-antioxidant hybrid polymer reduces oxidative damage in spermatozoa and enhances fertility. Fleming. Nature Chem Biol. 2005.

Selenium-vitamin E supplementation in infertile men. Effects on semen parameters and micronutrient levels and distribution. Vezina. Biol Tr Elem Res. 1996.

The effect of antioxidant treatment on human spermatozoa and fertilization rate in an in vitro fertilization program. Geva. Fertil Steril. 1996.

Vitamin K:

Vitamin K is a fat soluble vitamin involved in the clotting system and bone metabolism. It is considered an important component of supplements in preparation and during pregnancy.

Vitamin K can be naturally found in leafy green vegetables and high levels are reported in kale, cabbage, cauliflower, parsley, spinach, broccoli, asparagus and Brussels sprouts.

Zinc:

Zinc is essential component of nutrition during pregnancy and necessary for cell growth, DNA repair, immune system and for the development of a healthy fetus. Zinc deficiency is rare, but may be related to miscarriage, preeclampsia and low birth weight. Men with infertility have been shown to have lower zinc levels than fertile men and its supplementation has been shown to improve sperm parameters.

Zinc is found in very high levels in oysters, although this is not a common source of intake, especially during pregnancy or in men who have subfertility. Common sources include beef, chicken, cereals, nuts and dairy products.

References for Zinc:
Male factor subfertility: possible causes and the impact of nutritional factors. Wong. Fertil Steril. 2000.

Effect of folic acid and zinc sulfate on male factor subfertility: a double-blind, randomized, placebo-controlled trial. Wong . Fertil Steril. 2002.

A systematic review of the effect of oral antioxidants on male infertility. Ross. Reprod Biomed Online. 2010.

Zinc, human diseases and aging. Fabris. Aging. 1995.

Zinc requirements and the risks and benefits of zinc supplementation. Maret. J Trace Elem Med Biol. 2006.

Selenium:

Selenium is involved in protein synthesis, immunological reactions and cell metabolism. It also acts as anti-oxidant protecting cells from free oxygen radicals which are known to cause DNA damage. Selenium deficiency has been shown to be present in men with poor sperm parameters and its supplementation has been shown to improve sperm parameters.

Selenium is found in nuts, meats, fish, oils, eggs, oatmeal and whole wheat bread.

The effect of oral selenium supplementation on human sperm motility. Scott. Br J Urol. 1998.

Copper:

Copper is an important mineral present in various tissues in the body. It’s essential for production of red blood cells, maintenance of healthy bones, immune system and wound healing. Women deficient in copper may have anemia, immunological problems, heart rhythm abnormalities and bone fractures. Copper supplementation can be helpful in avoiding such complications during pregnancy

Copper is present in oysters, liver, whole grain breads and cereals, shellfish, dark green leafy vegetables, dried legumes, nuts, and chocolate.

Iodine:

Iodine is most known for its role in the production of thyroid hormones. Thyroid function of the mother is important especially in the first trimester because maternal thyroid hormones are essential for the developing fetus until fetal thyroid gland becomes functional. If iodine is deficient from the diet and results in hypothyroidism, it can be risky for the developing fetus.

Iodine deficiency is the most common form of preventable mental retardation and brain damage and can also increase the risk of having a miscarriage, preterm delivery, and stillbirth. Therefore, adequate amounts of iodine should be consumed prior to and during pregnancy to avoid such complications.

Iodine is found in seaweed, dairy products, eggs, vegetables, seafood and iodized salt.

Magnesium:

Magnesium is an essential component of a healthy balanced diet. It is involved in the function of the muscle and helps build bone and teeth. Low levels of magnesium have been associated with chronic diseases such as diabetes, hypertension, coronary heart disease, and osteoporosis.

Magnesium is present in green leafy vegetables, seeds, cereals, grains, nuts and legumes. Chocolate, vegetables, fruits, meats and fish also provide adequate levels.

Manganese:

Manganese is an essential mineral necessary for brain development, building bones, cholesterol synthesis and a major component of hormones and proteins in the body. Its deficiency can result in severe birth defects, asthma, convulsions, osteoporosis, skeletal defects and joint problems in children and adults.

Manganese is found in kale, raspberries, strawberries, green vegetables, pineapple, squash, eggplant, brown rice, and beans.

Chromium:

Chromium is involved primarily in glucose and insulin actions in the body and its deficiency may elevate cholesterol levels increasing the risk of cardiovascular disease.

Chromium is naturally found in broccoli, grapes, whole wheat, fruits, vegetables and spices.

Iron:

Iron is an essential element in the synthesis of hemoglobin of red blood cells in order to transport oxygen from the lungs to the tissues and carbon dioxide back to the lungs. If iron intake is inadequate, iron stores in the body may be depleted and this may eventually result in anemia (low red blood cell volume).

Iron can be naturally found in liver, oysters, beef, turkey, tuna, chicken, cereal, oatmeal, beans, lentil, spinach and raisins.

 

Potassium:

Potassium is a crucial mineral for the human body to function. It helps the body build protein, use sugar, build muscle and control cellular functions.

Potassium can be found in almost all meats products, green vegetables, broccoli, peas, beans, tomatoes, potatoes, bananas, apricots, cantaloupe and citrus fruits.

Coenzyme Q10:

Coenzyme Q10 (CoQ10) is found in almost every cell in the body and helps convert food into energy. CoQ10 is also known for its powerful antioxidant properties and protects the cells from oxidative damage.

Based on a recent medical study, patients undergoing IVF treatment who had higher levels of CoQ10 in their follicular fluid had more mature eggs and better quality embryos. It’s possible that CoQ10 provides more energy at the level of the mitochondria which results in better egg and embryo quality and potentially higher pregnancy rates.

CoQ10 may have a significant impact on sperm parameters. When sperm was analyzed and CoQ10 levels were compared, more sperm abnormalities were found in men with low seminal levels of CoQ10. It is possible that higher levels of CoQ10 may protect sperm from oxidative stress and result in healthier sperm.

CoQ10 can be found in fish, chicken liver, parsley, broccoli, grape, avocado, whole grains and cauliflower.

References for CoQ10:
Coenzyme Q10 content in follicular fluid and its relationship with oocyte fertilization and embryo grading. Turi. Arch Gynecol Obstet. 2012.

Coenzyme Q10 and oxidative stress markers. Abdul-Rasheed. S Med Jour. 2010.

Acai Berry:

The acai berry is a type of fruit harvested from acai palm trees, and may be a good source of antioxidants, fiber and healthy type of fats. It may be helpful in providing more energy and improving the immune response.

L-Carnitine Fumarate and N-Acetyl L-Carnitine:

L-carnitine is an amino acid that is naturally produced and the body can convert L-carnitine to acetyl-L-carnitine and vice versa. L-carnitine is used as a complementary supplement in a variety of diseases including male infertility, diabetes, thyroid disorders, anorexia and to improve athletic performance.

L-carnitine helps the body produce energy. It is important for heart and brain function, muscle movement and the reproductive system. Acetyl-L-carnitine has been used for infertility, symptoms of male ageing.

A recent study demonstrated beneficial effects on sperm parameters and in reduction of sperm DNA damage. Men who took L-carnitine had higher sperm count, motility and morphology. Additionally, sperm DNA integrity was significantly improved as well. In another randomized controlled study, sperm volume was significantly improved with the use of L-carnitine.

L-carnitine is primarily found in red meat, but also in fish, chicken and dairy products as well.

References for L-Carnitine Fumarate:
Effects of oral antioxidant treatment upon the dynamics of human sperm DNA fragmentation and subpopulations of sperm with highly degraded DNA. Abad C. Androlo. 2013.

Safety and efficacy of clomiphene citrate and L-carnitine in idiopathic male infertility: a comparative study. Moradi M. Urol Jour. 2010.

L-Methionine:

Methionine is an essential amino acid and involved in a variety of metabolic functions. Its depletion in diet can result in birth defects, muscle loss, skin lesions and possible developmental problems.

Methionine is naturally found in sesame seeds, eggs, dairy products, some cereals brands, nuts, fish, meats and plant seeds.

Reference for L-Methionine:
Preliminary study of the use of s. adenosyl methionine in the management of male sterility. Piacentino R. Min Ginecol. 1991.

Citric acid:

Citric acid is a weak organic acid found in citrus fruits and acts as an antioxidant. It regulates acidity, functions as a preservative and may help boost ATP production which may improve fatigue.

Citric acid is naturally found in a variety of fruits and vegetables, but it is most abundant in limes and lemons.

Pycnogenol:

Pycnogenol is pine bark extract that has strong antioxidant properties and involved in metabolic reactions creating hyaluronic acid (HA) and collagen. It inhibits cyclooxygenase enzyme, reduces prostaglandin production and acts as an anti-inflammatory agent protecting cell integrity.

A randomized controlled study showed that pycnogenol results in improvement of semen volume, sperm count, motility and morphology. Another study showed improvement in morphology and possible fertilization potential of sperm

References for Pycnogenol:
Improvement of seminal parameters with Prelox: a randomized, double-blind, placebo-controlled, cross-over trial. Stanislavov R. Phyto Res. 2009.

Improvement in sperm quality and function with French maritime pine tree bark extract. Roseff SJ. J Reprod Med. 2002.

Tribulus Terrestris:

Tribulus Terrestris has been utilized to boost male hormones, improve libido and overall enhance fertility. It has been suggested to improve sperm motility and frequency of sexual intercourse. Tribulus may boost energy, improve mood and sleep disturbances, increase endurance and sexual drive.

Although tribulus has not been shown to increase blood testosterone levels or significant muscle tone in athletes, it has been recommended for men with erectile dysfunction and performance problems. It is postulated that increased sexual activity, regularity and performance may also boost fertility.

Maca Root:

Maca root contains a variety of vitamins, amino acids, minerals, B complex vitamins, calcium and magnesium. It’s is rich in its protein content, dietary fiber and essential nutrients.

Maca root has been used to increase energy and stamina, decrease fatigue and balance hormone regulation in the body. It has been used to improve mood, positive thinking, reproductive and sexual function.

Maca root has been shown to improve sexual function in both men and women based on randomized controlled trials. Men taking maca reported increased sex drive, libido and performance, women reported increased sexual activity and desire. Overall, patients taking maca report increased energy levels, better muscle tone and overall well-being.

References for Maca Root:
Maca (L. meyenii) for improving sexual function: a systematic review. Shin BC. Com Alter Med. 2010.

A double-blind, randomized, pilot dose-finding study of Maca root (L. meyenii) for the management of SSRI-induced sexual dysfunction. Dording CM. Neuro Thera. 2008.

Lycopene:

Lycopene is a type of pigment that is naturally present in red vegetables and fruits. Even though it’s a type of carotene, it does not have any vitamin A activity. However, it has powerful antioxidant properties that protect the cells and tissues from harmful toxins and free radicals.

Based on a Mediterranean study, men who have higher intake of vitamin C, fiber and lycopene in their diet, typically have better sperm parameters. Additionally, supplementation of lycopene results in improvement of all sperm parameters, but more significantly higher sperm count and significantly better motility.

Lycopene is found in apricots, tomatoes, guavas, tomato paste, ketchup, tomato juice, grapefruit and watermelon.

References for Lycopene:
A low intake of antioxidant nutrients is associated with poor semen quality in patients attending fertility clinics. Mendiola J. Fert Steril. 2010.

Lycopene therapy in idiopathic male infertility--a preliminary report. Gupta NP. Inter Urol Neph. 2002.

L-Glutathione:

Glutathione is an antioxidant that protects cells from free oxygen radicals. Glutathione is involved in metabolic reactions such as DNA repair and synthesis. It’s synthesized in the liver and involved in the regulation of the immune, reproductive system and metabolism of toxins.

Glutathione levels have been reported to be lower in men with low sperm count and infertility. A randomized cross-over study suggests that glutathione supplementation improves sperm parameters.

References for Glutathione:
Glutathione in spermatozoa and seminal plasma of infertile men. Ochsendorf FR. Hum Reprod. 1998.

Placebo-controlled, double-blind, cross-over trial of glutathione therapy in male infertility. Lenzi Hum Reprod. 1993.

Fish Oil:

Fish oil is obtained from fatty/oily fish that typically live in cold waters. They are rich in polyunsaturated fats typically defined as Omega 3 fatty acids - docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Fish oil consumption has been suggested to improve cardiovascular health, lower blood pressure, balance the immune system, improve circulation and brain function, lower triglycerides and cholesterol levels.

Fish oil supplementation has been recommended for women with infertility and during pregnancy as well. Studies have shown that fish oil consumption during pregnancy can reduce the risk of certain medical disorders in children such as asthma. Also, children whose mothers used fish oil during pregnancy tend to do better in cognitive function, have better visual acuity and perform better in school. This may be due to better nervous system advancement and brain development during pregnancy.

References for Fish Oil:
Fish Oil–Derived Fatty Acids in Pregnancy and Wheeze and Asthma in Offspring. Hans Bisgaard. NEJM. 2016.

Cognitive assessment of children at age 2(1/2) years after maternal fish oil supplementation in pregnancy: a randomised controlled trial. Cognitive assessment of children at age 2(1/2) years after maternal fish oil supplementation in pregnancy: a randomised controlled trial. Dunstan JA. Archives of Disease in Childhood Fetal & Neonatal Edition. 2008.

Prenatal DHA Status and Neurological Outcome in Children at Age 5.5 Years Are Positively Associated. Victoria Escolano - Margarit M. Journal of Nutrition. 2011