Role of Micronutrients in the

Management of Male Infertility

Final Diagnostic Categories in a Male Infertility Clinic

Diagnosis No %

Varicocele

Idiopathic

Obstruction

Normal/Female factor

Cryptorchidism

Immunologic

Ejaculatory dysfunction

Testicular failure

Drug/Radiation

Endocrinologic

Infection

Sexual dysfunction

Systemic disease

Sertoli -cell-only

Ultrastructural defect

Genetic

Testis cancer

603

324

205

113

49

36

18

18

16

16

13

4

4

3

3

2

2

42.2

22.7

14.3

7.9

3.4

2.6

1.3

1.3

1.1

1.1

0.9

0.3

0.3

0.2

0.2

0.1

0.1

Total 1,430 100.0 (Stigman et al. 1997)(Stigman et al. 1997)

Treatment of Male InfertilityTreatment of Male Infertility

1. Medical Therapy

2. Surgical Therapy Varicocelectomy

Vasovasostomy Vasoepididymostomy

TUR of ejaculatory duct

obstruction

3. Assisted Reproductive Technology (ART)

Sperm processing, IUI, IVF

4. Artificial Insemination

of Donor (AID)

Medical TherapyMedical Therapy

I.I. According to evidence According to evidence dependencydependency

Specific Medical TherapySpecific Medical Therapy Non-specific Empirical Medical Non-specific Empirical Medical

TherapyTherapy

II. According to drugII. According to drug Hormonal therapyHormonal therapy Non-hormonal therapyNon-hormonal therapy

Criteria for SuccessCriteria for Success• Duration : 3~6 months, at least one full spermatogenic cycleDuration : 3~6 months, at least one full spermatogenic cycle• Parameter : Semen analysis & hormonal assayParameter : Semen analysis & hormonal assay

: Criteria -: Criteria - count 30%, motility 20% (Lee et al. 1986)count 30%, motility 20% (Lee et al. 1986)

VolumeVolume >2.0ml>2.0ml

pHpH >7.2>7.2

Sperm concentrationSperm concentration >20×10>20×1066/ml /ml >15 million>15 million

Total sperm countTotal sperm count >40×10>40×1066/ejaculate/ejaculate

MotilityMotility >50% (grade a+b) or >25% (grade a)>50% (grade a+b) or >25% (grade a)

MorphologyMorphology >15% by strict criteria >15% by strict criteria 10%10%

ViabilityViability >75%>75%

WBCWBC <1×10<1×1066/ml/ml

WHO criteria of normal semen, 1999WHO criteria of normal semen, 1999

Specific Medical TherapySpecific Medical Therapy

Endocrine Disorder

Pyospermia

Immunologic Infertility with Antisperm Ab

Retrograde Ejaculation

Nonspecific Empirical Medical TherapyNonspecific Empirical Medical Therapy

Hormonal TherapyHormonal TherapyGnRHGnRH

GonadotropinGonadotropin

TestosteroneTestosterone

AntiestrogenAntiestrogen

Aromatase inhibitorAromatase inhibitor

Growth hormone Growth hormone

Iatrogenic oligospermiaIatrogenic oligospermia

Refractory to specific medical therapyRefractory to specific medical therapy

Adjuvant therapy before and after 1Adjuvant therapy before and after 1stst line therapeutic modality line therapeutic modality

Preliminary therapy prior to ARTsPreliminary therapy prior to ARTs

Non-hormonal TherapyNon-hormonal TherapyCarnitineCarnitine

KallikreinKallikrein

PentoxyphyllinePentoxyphylline

NSAIDsNSAIDs

αα-blocker-blocker

ClonidineClonidine

MisellaneousMisellaneous

Difficult Cases for Empirical Medical Treatment

1. Shrunken testicle (volume < 10ml)1. Shrunken testicle (volume < 10ml)

2. Histopathological findings of testis biopsy2. Histopathological findings of testis biopsy

: Sertoli cell only syndrome: Sertoli cell only syndrome

Severe maturation arrest (Johnson score 3-4)Severe maturation arrest (Johnson score 3-4)

3. Azoospermia or severe oligospermia (1.0 3. Azoospermia or severe oligospermia (1.0

× 10× 1066ml)ml)

: especially, Increased FSH to twice normal: especially, Increased FSH to twice normal

Pitfall in Comparison among Results of Empirical Medical Therapy

• No placebo controlled double blind trials No placebo controlled double blind trials

• Heterogenous patients population Heterogenous patients population

• Variable dosages, treatment period and follow-up Variable dosages, treatment period and follow-up

• Tremendous fluctuation in an individual Tremendous fluctuation in an individual

semen parameter semen parameter

• Different criteria for success Different criteria for success

Newer concepts

Reactive Oxygen Species in Male InfertilityReactive Oxygen Species in Male Infertility

I. ROS generation in semenI. ROS generation in semen

: About 40% in infertile men (Iwasaki & Gagnon, 1992): About 40% in infertile men (Iwasaki & Gagnon, 1992)

II. Harmful action mechanism of ROS on spermII. Harmful action mechanism of ROS on sperm

by overwhelming endogenous antioxidant defensesby overwhelming endogenous antioxidant defenses

1. Cause sperm membrane lipid peroxidation1. Cause sperm membrane lipid peroxidation

2. Decrease membrane fluidity2. Decrease membrane fluidity

3. Reduce sperm motility3. Reduce sperm motility

4. Decrease sperm-oocyte fusion capability4. Decrease sperm-oocyte fusion capability

5. Impair fertilizing capacity5. Impair fertilizing capacity

ROS and Male Infertility

Reactive Oxygen Species isone of the majorcontributors to male Infertility & cause Damage to the sperm

• Cell membrane

• DNA molecules

• Lipids

• Proteins

Urology. 1996;48(6):835–850.

Endogenous ROS Formation and Direct Scavenging Endogenous ROS Formation and Direct Scavenging Effect of Antioxidant in Sperm CellEffect of Antioxidant in Sperm Cell

antioxydantantioxydantInfectionRadiationChemotherapypollution

Intrinsic antioxidant : SOD, catalase, ascorbate, tocopherolIntrinsic antioxidant : SOD, catalase, ascorbate, tocopherolManagement 1) Extrinsic antioxidant : Vit A, C, E, glutathione, selenium, Management 1) Extrinsic antioxidant : Vit A, C, E, glutathione, selenium, rebamipiderebamipide 2) Sperm washing with culture media including antioxidant 2) Sperm washing with culture media including antioxidant to removal leukocyteto removal leukocyte

Genetic Causes

• DNA damage and mutations in mitochondrial DNA have

been linked to poor sperm motility and male subfertility.

• A genetic factor located at Yq11 has been established to

be important for male germ cell development and Yq11

damage may lead to male infertility.

• Deletions of AZFa, AZFb and AZFc (Microdeletions in the

Y-chromosome) can result in male infertility.

• Klinefelter’s syndrome, Kallman’s syndrome can also

result in male infertilityIndian J Med Res. 2008;127:124-132.J. Biosci. 2001;26(4):492-435.

Environmental Causes

Various environmental factors can result in male infertility. The factors

are as follows:

• Infection

• Excessive heat

• Radiation exposure

• Heavy metal toxicity

• Cigarette smoking

• Xeno-estrogen exposure

• Pesticides and other chemicals

Altern Med Rev. 2000;5(1):28-38.

Human Reproduction, 2001;16(8):1768-1776.

http://www.gfmer.ch/Endo/Fellows_11/Pdf/Infertility_environment.pdfHuman Reproduction, 2001;16(8):1768-1776.

Occupationally Free time

Physical activity Prolonged sitting

Thermoregulation of scrotumelevation of scrotal temperature

HEAT EXPOSURE

Spermatogenesis

Quality and quantity of sperm production(count, morphology, motility, delayed coception)

Sedentary lifestyle

Environmental Causes

Nutritional Considerations

Various micronutrients are

associated with male

fertility.

Deficiency of these

micronutrients may result

in infertility.

Nutritional Factors

Free radical scavengers

L-Carnitine

Lycopene

Coenzyme Q10

Vitamin C

Zinc Vitamin E

Arginine Glutathione

Vitamin B12

Selenium

Altern Med Rev. 2000;5(1):28-38.

Role of Micronutrients in Fertility

Nutrition plays vital role in maintaining male fertility:

• Involved in the successful maturation of sperm

• Provides nutrition for motility of sperm

• Improvement in sperm count and motility

• Helps in production of sex hormones

• Prevents sperm damage

Altern Med Rev. 2000;5(1):28-38.

Non hormonal TherapyNon hormonal Therapy

: To improvement of Sperm motility : To improvement of Sperm motility

Sperm fertilizing capacitySperm fertilizing capacity

Sperm metabolismSperm metabolism

Testicular microcirculationTesticular microcirculation

1. Carnitine1. Carnitine

2. Kallikrein2. Kallikrein

3. Pentoxyphylline3. Pentoxyphylline

4. NSAIDs4. NSAIDs

5. 5. αα-blocker-blocker

6. Clonidine6. Clonidine

7. Miscellaneous 7. Miscellaneous

• CoQ10 is a naturally-occurring compound found in every cell in the body.

• Coenzyme Q10 (CoQ10) is concentrated in the mitochondrial mid-piece

• CoQ10's alternate name is ubiquinone

• It is found in foods, particularly in fish and meats

• Coenzyme Q10 (CoQ10) acts as an electron carrier in the mitochondrial respiratory chain.*

*CLIN. CHEM. 41/2, 217-219 (1995) **Chem Scripta 1987;27:145-58

Co enzyme Q10

Free Radical

Scavenger

Energizer

CLIN. CHEM. 41/2, 217-219 (1995)

Co enzyme Q10 - Mechanism

• In sperm cells, coenzyme Q10 (CoQ10) is

concentrated in the mitochondria.

• Coenzyme Q10 is responsible for energy for movement and all other energy-dependent processes in the sperm cell.

• Reduction in levels of CoQ10 is observed in sperm cells and seminal plasma of idiopathic (IDA) and varicocele- associated (VARA) asthenozoospermic patients.*

• It is observed that sperm cells, characterized by low motility and abnormal morphology, have low levels

of CoQ10.*Andrologia 34 (2002), 107–111.

Co enzyme Q10 - Mechanism

• Administration of CoQ10 increased the pregnancy rate by 36% and with improvement of sperm

count and functional sperm concentration in 70% and 60%

individuals, respectively.

• Sperm motility and sperm motility index improved in 54% and 46 % while 38 % showed improvement

in sperm morphology.

Folia Med (Plovdiv).2005;47(1):26–30.

Coenzyme Q10: Clinical Trials

Improvement in sperm motility, motilityIndex and sperm morphology

Sperm Morphology

Motilityindex

Sperm Motility

• Patients – 22 infertile men with idiopathic asthenozoospermia.

• Coenzyme Q10 - 200 mg for 6 months

• A significant increase was also found in sperm cell motility

Conclusion:

• The exogenous administration of CoQ(10) may play a positive role in the treatment of asthenozoospermia.

• This is probably the result of its role in mitochondrial bioenergetics and its antioxidant properties.Fertil Steril. 2004

Jan;81(1):93-8.

Coenzyme Q10: Clinical Trials

Coenzyme Q10: Clinical Trials

Lewin et al. showed that Coenzyme Q10 results in improvement in sperm functions in asthenospermic men

35.7

19.1

0

10

20

30

40

Imp

rove

men

t (%

)

Coenzyme Q10 Control group

Mean increase in motility: Coenzyme Q10 vs. control group

Coenzyme Q10: Improvement in fertilization rate

0

5

10

15

20

25

30

Baseline Day 103

Impr

ovem

ent (

%)

Mol Aspects Med 1997;18 S213-S219.

Coenzyme Q10: Clinical Trials

According to a review conducted by Langade et al. Coenzyme Q10 significantly increased sperm motility within 6 months.

Coenzyme Q10 and improvement in sperm motility

02468

1012141618

Baseline After 6 months

Impr

ovem

ent (

%)

Bombay hospital journal.

http://www.bhj.org/journal/april2005/htm/reveiw_coenzyme_145.htm

Non hormonal Therapy Non hormonal Therapy Carnitine Carnitine ::

◈◈ L- carnitine &L- carnitine & acetylcarnitineacetylcarnitine

◈◈ Intracellular energy metabolismIntracellular energy metabolism

Stabilization of cell wallStabilization of cell wall

◈◈

L-carnitine 2~3 gm/dayL-carnitine 2~3 gm/day

Acetylcarnitine 4 gm/dayAcetylcarnitine 4 gm/day

Change of L-carnitine & Acetylcarnitine in Seminal Plasma

I. In oligoasthenozoospermiaLower level of L-carnitine (Lewin et al, 1976)

Lower level of acetylcarnitine (Kohengkul et al, 1977)

II. Significant positive correlation between L-carnitine and sperm density & motility

(Menchini-Fabrisetal, 1984)

III. Reduction of acetylcarnitine/L-carnitine ratio

: low grade sperm motility (Bartelloni et al, 1987)

→ Rationale for using carnitine in the Tx of male infertility

L-Carnitine

• The main function of L-Carnitine in the epididymis is

to provide an energetic substrate for spermatozoa.

• May be involved in the successful maturation of

sperm.

• L-Carnitine is necessary for transport of fatty acids

into the mitochondria to produce energy.

• Low levels of L-Carnitine reduces fatty acid

concentrations within the mitochondria, leading to

decreased sperm motilityDrugs 1987;34:1-24.Arch Ital Urol Nefrol Androl 1992;64:187-196.

L-Carnitine

• Significantly high levels of free L-Carnitine is

observed in the seminal plasma of the fertile men

compared to the infertile men.

• The level of free L-Carnitine in the semen has positive

correlation with sperm concentration, sperm motility

and vitality of sperm cells

• L-Carnitine provides readily available energy for use

by spermatozoa, which positively affects sperm

motility, maturation and the spermatogenesis process. Folia Med (Plovdiv). 2005;47(1):26–30. . Zhonghua Nan Ke Xue. 2007;13(2):143–146.

L-Carnitine: Clinical Trials

According to a study conducted by Costa et al. L-carnitine

increased the sperm parameters drastically

10.8

28.4

3.73.1

142.4

1832.5

4.120.3

163.3

0

20

40

60

80

100

120

140

160

180

Baseline At 4 months

Motile spermatozoa (%)

Mean velocity (microns)

Linearity index

Spermatozoa with rapidlinear progression (%)

Number of ejaculatedspermatozoa

Andrologia.1994;26:155-159.

L- Carnitine for asthenospermia with varicocele

Carnitine

Placebo

Zhonghua Nan Ke Xue. 2004;10(9):671–672.

There was significant improvement in sperm count,motility and pregnancy rates in infertility due to varicocele.

Use of Carnitine therapy in selected cases of male factor infertility: A double-blind

crossover trial

• Patient(s): One hundred infertile patients

(ages 20–40 years) with the following baseline

sperm selection criteria: concentration, 10–20

X 106/mL; total motility, 10%–30%; forward

motility, <15%; atypical forms, <70%; velocity,

10–30 µ/s;

• Interventions : L-Carnitine therapy 2 g/day or

placebo;

• Duration : 4 monthsFERTILITY AND STERILITY VOL. 79, NO. 2, FEBRUARY 2003

Total motile sperm/mL

Carnitine

Placebo

FERTILITY AND STERILITY VOL. 79, NO. 2, FEBRUARY 2003

Forward motile sperm/mL

Carnitine

Placebo

FERTILITY AND STERILITY VOL. 79, NO. 2, FEBRUARY 2003

L- Carnitine in idiopathic asthenozoospermia: a multicenter study.

Italian Study Group on Carnitine and Male Infertility.

Andrologia 1994;26:155-159

N = 100 patients

L-carnitine - 3 g/day

Duration - 4 months.

Percentage of motile spermatozoa increased from 26.9 ± 1.1 to 37.7 ± 1.1 %.

Total number of spermatozoa per ejaculate also increased

Conclusion - Oral administration of L-Carnitine may improve sperm quality

Lycopene is a bright red

pigment and phytochemical

found in tomatoes and other

red fruits, water melon & guava.

Belongs to a class referred to as

carotenoids which are yellow,

orange, and red pigments

synthesized by plants

Lycopene

Lycopene possesses superior abilities in comparison to other carotenoids.

It has the ability to quench singlet oxygen and prevent oxidative damage to other molecules.

This is because of its unique structure of: 11 conjugated double bonds and no cyclic groups

Lycopene

The general mechanism by which Lycopene works is by preventing oxidative damage to sperms, which includes

• Damage to the cell membrane

• DNA molecules

• Lipids

• Proteins

Lycopene has been demonstrated to be the most potent antioxidant with the ranking: lycopene > α-tocopherol > α -carotene > β- carotene > lutein.

Lycopene – Biological activity

Lycopene supplementation in vivo & in

vitro protects cells from induced oxidative

damage

Lipid peroxidation is reduced by 80%

DNA oxidation is reduced by 75%

Matos et al, Arch Bioch Biophys 1999

Matos et al, Arch Bioch

Biophys 2000

Oral Lycopene supplementation protects

against ex vivo induced lymphocyte DNA

oxidation

DNA fragmentation (COMET assay) is

reduced by 40%Riso et al, Am J Clin Nutr

1999

Lycopene - Biological activity

Lycopene: Clinical Trials

66

5346

010203040506070

Impr

ovem

ent

(%)

Sperm

conc

entra

tion Mo

tility

Morph

ology

Lycopene in infertility

Int Urol Nephrol. 2002;34:369–372.

A Study evaluated

the effect of oral

lycopene therapy in

men with idiopathic

infertility.

Lycopene - 2000

mcg, twice a day

for three months

N - 30 Patients

Improvement in sperm concentration

Results

Improvement in sperm concentration - 20 patients

(66%)

Improved motility – 16 patients (53%)

Improvement in sperm morphology - 14 patients

(46%)

Associated with significant improvement and

resulted in six pregnancies in 26 patients (23%)

Conclusion - Lycopene therapy seems to have a

role in the management of idiopathic male

infertility

Zinc is a micronutrient abundantly present in meat and seafood and serves as a cofactor for more than 80 enzymes involved in DNA multiplication and protein synthesis

Zinc deficiency is associated with decreased testosterone levels & sperm count.

Zinc levels are generally lower in infertile men with diminished sperm count

Furthermore, zinc finger proteins are implicated in the genetic expression of steroid hormone receptors*, and zinc also has anti- apoptotic ** and antioxidant properties.***

*Endocr Rev 1992 :13,129–145. **Curr Drug Targets 2003:4,323–338. ***Free Radic Biol Med 31,266–274.

Zinc

Rev Prat. 1993;43:146-151.

Ann Nutr Metab. 1986;30:213-218.

The functions of zinc in male reproduction

Effects of zinc supplementation on subfertility

Zinc – Clinical Trials

N - 100 men with asthenozoospermia

Two groups--250 mg twice daily zinc therapy for 3 months and no therapy.

Duration – 6 months

There was significant improvement in the sperm quality; sperm count, progressive motility, fertilizing capacity

Conclusion: Zinc therapy has a role in improving sperm parameters in men with asthenozoospermia

Eur J Obstet Gynecol Reprod Biol. 1998 Aug;79(2):179-84.

• Netter et al. studied the effect of zinc

supplementation on testosterone,

dihydrotestosterone and sperm count.

• The results of the study were dramatic

Zinc – Clinical Trials

• 37 patients were studied• Testosterone and dihydrotestosterone levels

increased significantly • Nine wives became pregnant, six within 3 months

and three within 2 months

Zinc: Clinical Trials

According to study conducted by Tikkiwal et al.

zinc resulted in

• Significant improvement in sperm count,

• Number of progressively motile and normal

spermatozoa

• Normal acid phosphates activity. Indian J Physiol Pharmacol. 1987;31(1):30-34.

Arginine

• Arginine is thought to be essential for sperm motility.

• According to a study by Schachter et al. Arginine

significant improved sperm count and motility after

taking 4 g/day for three months.

• A recent study conducted in Italia also showed that

arginine is effective in male infertility

• However, the dosage of arginine is higher compared

to other micronutrients.J Urol 1973;110:311-313.Minerva Urol Nefrol 1994;46:251-253.

Selenium

• Selenium and glutathione are essential to the

formation of phospholipid hydroperoxide

glutathione peroxidase

• Deficiencies of selenium can lead to instability

of the mid-piece, resulting in defective motility

• However, it can be toxic if consumed in

excess.ArchAndrol. 1992;29:65-68. Science 1999;285:1393-1396.Environ Mol Mutagen. 2009 [Epub ahead of print]

Methylcobalamin

• Vitamin B12 is important in cellular replication,

especially for the synthesis of RNA and DNA, and

deficiency states have been associated with

decreased sperm count and motility.

• Various studies have shown that Methylcobalamine

improves the sperm parameters

• However, studies show that Methylcobalamine is

effective in only just over 20% of infertile men.Hinyokika Kiyo 1986;32:1177-1183.Hinyokika Kiyo. 1984;30:581-586.

Hinyokika Kiyo 1988;34:1109-1132.

Vitamin E

• Oral supplementation with vitamin E significantly

decreases the malondialdehyde concentration and

improves the sperm motility

• Although Invitro studies have prooved the efficacy of

vitamin E, human studies are lacking

• Although there are few human studies, they recruited

only few patients

Fertil Steril 1995;64:825-831.Biol Trace Elem Res 1996;53:65-83.Arch Androl 1992;29:65-68.

Nonhormonal Therapy Nonhormonal Therapy KallikreinKallikrein

· Kininogenase stimulate the release of kinins· Kininogenase stimulate the release of kinins

(bradykinin, kallidin, methionylkallidin) from (bradykinin, kallidin, methionylkallidin) from kininogenskininogens

→ → Increase vascular permeability, smooth m. Increase vascular permeability, smooth m. contraction contraction

& membrane glucose transport& membrane glucose transport

→ → Increase sperm motilityIncrease sperm motility

◈ ◈ 600 units/day, po600 units/day, po

Count 0~50% (25%)Count 0~50% (25%)

Motility 20~67% (43.5%)Motility 20~67% (43.5%)

Pregnancy 17~25% (16.3%)Pregnancy 17~25% (16.3%)

Nonhormonal Therapy Nonhormonal Therapy Penotoxifylline Penotoxifylline

Universal phosphodiesterase inhibitorUniversal phosphodiesterase inhibitor

: Inhibit the breakdown effect of c-AMP: Inhibit the breakdown effect of c-AMP

◈ ◈ 400mg, po, tid400mg, po, tid

Count 57%Count 57%

Motility 47%Motility 47%

Pregnancy 17%Pregnancy 17%

Nonhormonal Therapy Nonhormonal Therapy NSAIDsNSAIDs

◈◈ indomethacin, ketoprofen, diclofenac sodiumindomethacin, ketoprofen, diclofenac sodium◈◈ Inhibit prostaglandin with decreasing Inhibit prostaglandin with decreasing

testicular steroidogenesis, testicular steroidogenesis,

spermatogenesisspermatogenesis and sperm motilityand sperm motility◈◈ 150mg/day150mg/day

Nonhormonal TherapyNonhormonal Therapy αα-blocker-blocker

◈◈ Improve testicular circulationImprove testicular circulation

◈◈ Terazocin Terazocin 2~4mg/day , po2~4mg/day , po

doxazocindoxazocin

alfuzocinalfuzocin

Nonhormonal TherapyNonhormonal Therapy Clonidine Clonidine

◈ ◈ EEnhance secretion of Growth Hormonenhance secretion of Growth Hormone

◈ ◈ Clonidine 1.75mg/dayClonidine 1.75mg/day

◈◈ improvement 50%improvement 50%

Nonhormonal Therapy Nonhormonal Therapy Miscellaneous Miscellaneous

1. Bromocriptine mesylate, metergoline,

corticosteroids, thyroxine oxytocin

2. Folic acid, adenosine triphosphate (ATP) L-

glutamine

3. Serotonin

Clinical Effects of Nonspecific Medical TherapyClinical Effects of Nonspecific Medical Therapy

Drugs Drugs nono Improvement Improvement Pregnancy Pregnancy

nono %% nono %%

HCG + Amino acidsHCG + Amino acids

Folic acid & ZincFolic acid & Zinc

metergolinemetergoline

8585

103103

44

2626

7676

33

3131

7474

7575

1515 1818

L-arginineL-arginine

AlCAMINAlCAMIN

VitaminVitamin

SeleniumSelenium

4040

2929

5050

4545

1010

88

1414

44

2525

2828

2828

1111

55

55

66

1313

1717

1212

CarnitineCarnitine

KallikreinKallikrein

ClonidineClonidine

NSAIDsNSAIDs

αα-blocker-blocker

100100

6363

100100

1515

1818

3535

1515

3030

5050

3535

2525

1515

11

3535

1515

1414

5050

3535

2525

ClomipheneClomipheneTamoxifenTamoxifen

565699

181811

32321111

7711

13131111

The Quadruple of Atreya

• According to ancient sage Athreya, there are 4 components for a successful treatment

1. The Physician.

2. Drugs.

3. The Patient.

4. Attendants

It is told that all the 4 components have to be efficient to achieve successful treatment.

Charka Samhitha

Ideal Nutraceutical for Male Infertility

• Just like the Quadruple of Atreya, successful treatment of male

infertility should control all the aspects of sperm dysfunction

in infertile males.

An combination of L-Carnitine,

Coenzyme Q10, Lycopene and

Zinc can provide holistic approach to

male infertility

L-carnitine

Improves sperm motility by providing energy to the sperm cell through fatty acid metabolism

Zinc

Promotes sperm production & maturation testosterone synthesis & improves sperm morphology

Ideal Nutraceutical for Male Infertility

Coenzyme Q10

Improves sperm motility by providing energy through ATP generation in mitochondrion

Lycopene

Increases sperm count and improves morphology by reducing oxidative damage to sperm DNA and lipids

Thank you

What is an Ideal Choice in Male Infertility?