Male Fertility Supplements in India: Which Ones Work and Which to Buy

Male fertility supplements: what the evidence shows

Supplements are heavily marketed in India for male fertility, often at significant cost. Here is what the best available evidence says.

The Cochrane review

A systematic review of antioxidants for male subfertility pooled 90 randomised trials covering 10,303 subfertile men and 20 different antioxidants.

On live birth: antioxidants may increase live birth — odds ratio 1.43. If 16 out of 100 couples would have a baby without them, between 17 and 27 would with them.

Then the part that rarely appears in marketing:

> When studies at high risk of bias were removed from the analysis, there was no evidence of increased live birth.

The remaining eight better-quality trials showed an odds ratio of 1.22 with a confidence interval crossing no effect (0.85 to 1.75, P = 0.27). The apparent benefit came from the weakest studies.

The authors rated the live birth evidence very low certainty and concluded that subfertile couples should be advised the current evidence is inconclusive based on serious risk of bias.

On clinical pregnancy: low-certainty evidence of an increase, from around 15% to between 20% and 30%.

On semen parameters: the pooled analyses were unreliable — heterogeneity between studies was extremely high.

On which product: insufficient evidence supporting any one type, dose or combination over another. So even if you decide to take something, the evidence does not tell you what.

On downsides: no evidence of increased miscarriage risk. Possibly more mild gastrointestinal discomfort — roughly 2% without, 2 to 7% with.

The AUA/ASRM guideline reaches a consistent position: the benefits of supplements are of questionable clinical utility in treating male infertility, and existing data are inadequate to recommend any specific agent.

An India-specific caution

The Cochrane authors note that most antioxidant supplements are uncontrolled by regulation. Unregulated products have been found to contain undeclared ingredients — and gym supplements in particular are a recognised hidden source of anabolic steroids, which suppress sperm production and can cause azoospermia.

If you are being investigated for infertility, disclose everything you take, including anything bought informally or online.

What has better evidence

Stopping smoking. Moderating alcohol. Reaching a healthier weight. Treating diabetes and other chronic conditions. Reducing heat exposure. Stopping testosterone and anabolic steroids.

Allow three months before judging any change — sperm production takes roughly 72 to 90 days.

The practical position

Antioxidant supplements are cheap, low-risk and possibly useless. If you want to take them, the harm is likely minimal. What you should not do is take them instead of getting assessed, or expect them to substitute for the measures above.

A semen analysis is inexpensive and should come first.