As folic acid has become almost mandatory for women before and during pregnancy, is it such a stretch to think that supplements could also help male fertility?
A panel of experts will tackle that question during a point-counterpoint debate Tuesday, titled Is There a Role for Nutraceuticals in Male Infertility? Mark A. Moyad, MD, MPH, Director of Complementary and Alternative Medicine in the Urology Department at the University of Michigan Medical Center, will moderate the 20-minute discussion, which begins at 8:40 a.m. during the Plenary I program in Hall A in the San Diego Convention Center.
“We have already accepted that a supplement can help one gender and the outcome, so why is it so crazy to think that it can help men who need it, too?” Dr. Moyad said. “I don’t think it’s crazy.”
However, he acknowledged that quality control issues dog the $30 billion a year supplement industry, with regulators still finding products with contaminants and non-advertised ingredients. The bottom line for urologists, he said, is that they need to be cautious about which supplements they recommend for male infertility, especially considering what the field has learned about the potential link between vitamin E and prostate cancer.
“You better do your homework,” Dr. Moyad said. “You have to be able to say that in the worst case scenario it does nothing, and in the best case scenario it helps you. But it’s not going to make you worse.”
Dr. Moyad said one of the most promising areas for supplement use is combating oxidative stress, which some estimates say is responsible for as much as 80 percent of male infertility cases. He cited the results of a meta-analysis, published two years ago, of 48 clinical trials that studied the use of antioxidants for male infertility. The most common antioxidants studied in the clinical trials were vitamin E, vitamin C, carotenoids, ubiquinol, and the micronutrients folate and zinc.
The “jaw dropper” from the analysis, Dr. Moyad said, was the suggestion that antioxidants may improve live birth rates for couples attending fertility clinics. However, the authors acknowledged the data were low quality, and the meta-analysis lacked specific recommendations, in part because so many types of antioxidants could help.
“So what I tried to say was, ‘Let’s look at the ones that are safe,’” Dr. Moyad said.
That group, he said, includes multi-nutrient fertility supplements and Coenzyme Q10. Vitamin E has also shown promise in treating male infertility, Dr. Moyad added, but its potential link to prostate cancer makes it a “tough call” as a front-line recommendation.
He also noted that N-acetyl cysteine (NAC) is such an effective antioxidant that it is commonly used in emergency rooms to treat Tylenol® poisoning. NAC is a drug in some countries, but it is treated as a supplement in the United States at lower doses.
There is hope, Dr. Moyad said, that antioxidants can help treat oligoasthenoteratozoospermia, a term used to describe semen that contains an abnormally low number of sperm, an abnormally low level of sperm with good motility and/or an abnormally low level of sperm of a healthy shape.
“Couples desperate to conceive might be the biggest winners in this area of study, and many are willing to raid their retirement accounts for expensive fertility therapies,” Dr. Moyad said.
“You have to recognize these drug costs and these fertility costs are embarrassingly high,” he said. “On the other hand, we have to recognize there are a lot of contaminated products, and there are a lot of supplements that are proving to be dangerous to completely healthy people.”
Plenary I Preview
Is There a Role for Nutraceuticals in Male Infertility?
Moderator: Mark A. Moyad, MD, MPH
8:40 – 9 a.m. Tuesday
Hall A, San Diego Convention Center