Letters to the Editor

Case Report: Treatment of Male Subfertility with Dietary Supplements



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Am Fam Physician. 2012 Nov 1;86(9):798-802.

to the editor: A 40-year-old man with cryptorchidism that was corrected at 12 years of age presented in November 2010 with a four-year history of infertility. In November 2008, his sperm concentration was 3 million per mL, and motility was 30 percent. Microscopy revealed 2 percent normal morphology with a round cell count of 2 million per mL. Testicular ultrasonography and hormone levels were normal.

The patient was prescribed clomiphene (Clomid), 25 mg per day. Four months later, sperm concentration was 5 to 7 million per mL. Thirteen months after discontinuing clomiphene, bilateral varicoceles were diagnosed. At that time, sperm concentration was 4 million per mL, and motility was 63 percent.

Varicocelectomy and in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) were recommended. The patient and his 27-year-old wife consulted a physician who recommended dietary supplements. In November 2010, the patient began taking a formulation containing vitamin C, 1,000 mg; vitamin E, 400 IU; vitamin D, 800 IU; l-carnitine, 2,000 mg; l-arginine, 1,500 mg; vitamin B complex (containing folic acid, 1,600 mcg; vitamin B12, 1,000 mcg; niacin, 200 mg; biotin, 400 mcg; vitamin B6, 160 mg; and 100 mg each of thiamin, riboflavin, pantothenic acid, and paraaminobenzoic acid), and ginseng, 1,000 mg (Panax quinquefolius, dried root, Hsu Ginseng Enterprises, United States). All supplements were taken in divided doses twice daily.

After three months of treatment, sperm concentration normalized to 47 million per mL, and motility was 45 percent. In March 2011, co-enzyme Q10, 60 mg per day; zinc, 30 mg per day; and selenium, 100 mcg per day, were added to the regimen.

Pregnancy was confirmed in May 2011 and resulted in a successful cesarean delivery.

Subfertility affects one in every 20 men.1 One-half (51.2 percent) of infertility cases are associated with male factor infertility.2 A recent Cochrane systematic review of eight randomized controlled trials including 607 patients found no benefit to surgical varicocele treatment for subfertility.3 Conversely, a Cochrane review of 34 randomized controlled trials found that oral antioxidants were associated with a statistically significant increase in pregnancy rate (pooled odds ratio = 4.18; 95% confidence interval, 2.65 to 6.59).4

This case illustrates a couple who were advised to undergo surgical procedures but successfully achieved pregnancy with a mixture of benign, inexpensive supplements. Based on the existing evidence, perhaps other infertile couples should be offered a trial of dietary supplements before considering expensive and invasive procedures.

Author disclosure: Dr. Fugh-Berman is the author of a textbook on herbal and dietary supplements.

REFERENCES

1. Tremellen K. Oxidative stress and male infertility—a clinical perspective. Hum Reprod Update. 2008;14(3):243–258.

2. Tournaye H. Evidence-based management of male sub-fertility. Curr Opin Obstet Gynecol. 2006;18(3):253–259.

3. Evers JH, Collins J, Clarke J. Surgery or embolization for varicoceles in subfertile men. Cochrane Database Syst Rev. 2009(1):CD000479.

4. Showell MG, Brown J, Yazdani A, Stankiewicz MT, Hart RJ. Antioxidants for male subfertility. Cochrane Database Syst Rev. 2011(1):CD007411.

Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: afplet@aafp.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.

Please include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.

Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the American Academy of Family Physicians permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.


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