Male Infertility

Male factors contribute to roughly half of all infertility cases, most often through low sperm count, poor motility or abnormal shape. Causes include varicocele, hormonal problems, heat exposure, smoking, heavy alcohol use, obesity and some medications. A semen analysis is the essential first test. Coenzyme Q10 (200-300 mg daily for 3-6 months) has the most consistent trial evidence for improving motility; zinc, folate and omega-3s show smaller, mixed effects. Because sperm take about 74 days to develop, any intervention needs at least three months before retesting.

Evidence synthesis: CoQ10 has the strongest supplement evidence base for male infertility, with meta-analyses showing improvements in sperm concentration and motility, though trials have not consistently demonstrated increased pregnancy or live birth rates. Ashwagandha has small randomised trials showing improved semen parameters in stressed or infertile men, though study quality is moderate and industry funding is common. Zinc and folate combination therapy showed no benefit in the large, well-conducted FAZST trial, tempering earlier enthusiasm. Lifestyle factors - smoking, obesity, alcohol, heat exposure to the testes - have robust observational links to impaired spermatogenesis. Exogenous testosterone and anabolic steroids reliably suppress sperm production, often for months after cessation.