Add a Coenzyme Q10 Supplement Although a multivitamin is the best starting point, there are additional antioxidants you can add for greater protection of sperm quality. The most useful is probably CoQ10—a vital antioxidant molecule found in just about every cell in the body. It is particularly beneficial for sperm quality because it is not just an antioxidant but also a critical component of energy production. Researchers have known for many years that there is a link between sperm quality and the level of CoQ10 naturally present in semen. Men with lower CoQ10 levels tend to have a lower sperm count and poor motility.513 In recent years, several different randomized, double-blind, placebo-controlled studies have determined that taking a CoQ10 supplement improves sperm concentration, motility, and morphology.514 A recent study also found that the combination of CoQ10, antioxidants, and vitamin B12 not only improved traditional semen parameters but also significantly improved the integrity of DNA in sperm.515 One way in which CoQ10 is thought to improve sperm quality is by increasing the activity of antioxidant enzymes.516 It also enhances cellular energy production. Sufficient energy in the form of a molecule called ATP is absolutely critical for sperm production and motility. Cells can only make ATP when they have enough CoQ10. Although not yet proven, it is therefore likely that CoQ10 supplements improve sperm quality by optimizing energy production. What has been proven is that CoQ10 can prevent oxidative damage to DNA in sperm,517 providing reason enough to add this supplement. When choosing a brand of CoQ10, a good form to take is known as ubiquinol (as explained in chapter 6), and the usual recommended dose is 200 mg per day.518 For couples with particularly severe fertility issues, a dose of 400 mg may be more effective. Advanced Sperm Quality Supplements In cases where sperm quality is known to be an issue, or there is a history of failed IVF cycles or recurrent miscarriage, it is likely helpful to go further and add several additional supplements that have been found to improve sperm quality. The most effective supplements are Alpha-lipoic acid Omega-3 fats (in fish oil) L-carnitine Each of these supplements is backed up by clear scientific evidence. As just one example, a randomized, double-blind, placebo-controlled study found that when men took alpha-lipoic acid each day for 12 weeks, there was a significant improvement in the total sperm count, sperm concentration, and motility levels.519 The recommended dose is 600 milligrams per day for a standard alpha-lipoic acid supplement. If you choose a supplement that is in the form of R-alpha lipoic acid, it is likely sufficient to take 200 to 300 milligrams per day. Double-blind, placebo-controlled trials have also found that omega-3 fish oil supplements improve sperm quality, with a particular improvement in DNA damage.520 In a 2016 study, when men took a fish oil supplement for three months, the average percentage of sperm with DNA damage decreased from 22 percent to 9 percent.521 The dose used in this study was 1500 mg of fish oil, containing 990 mg of DHA and 135 mg of EPA per day. For a similar dose, take two capsules of Nordic Naturals DHA Xtra. Where testing shows that sperm motility is a concern, another useful supplement is L-carnitine. Randomized studies have found that on average, L-carnitine can improve motility by 8 percent and morphology by 5 percent.522 Yet in men with a significant degree of oxidative damage to sperm, carnitine has a much greater impact. In those cases, it can increase the total number of motile sperm by more than two-fold.523 As a result, carnitine appears to be especially effective in men with poor sperm quality caused by varicocele.524 The recommended dose is 1000 mg per day. There is an alternative form of carnitine available in supplement form, called acetyl-l-carnitine. The body naturally maintains an equilibrium between the two forms and studies have found that taking either can improve sperm quality.525 L-carnitine may be preferred simply because it has been studied more extensively. Although taking all of these supplements for several months is no doubt inconvenient, it can make a dramatic difference to the chance of success. It is often well worth the sacrifice in order to save your partner from the physical and emotional toll of yet another failed IVF cycle or pregnancy loss. Boost Your Antioxidant Levels Through Diet To take full advantage of the power of antioxidants to boost sperm quality, it is a good idea to also maximize the antioxidants in your diet. The value in doing so is borne out by years of scientific research finding that men with a diet higher in antioxidants are more likely to produce sperm with the correct number of chromosomes and tend to have improved semen parameters such as sperm count and motility.526 As just one example, a recent study found that men with higher fruit and cereal intake had better sperm quality.527 One of the nutrients likely to be responsible for this benefit is folate, which is found in particularly large amounts in fruit, vegetables, and fortified cereal. While all women trying to conceive are told to take folate supplements, researchers now understand that folate is imperative for men too. It plays a critical role in protecting sperm DNA.528 A recent study in California revealed that other antioxidants found in food may even prevent or reverse the increase in sperm DNA damage associated with aging. The study, which involved men having no known fertility problems, found that men with the highest total intake of vitamin C, vitamin E, zinc, and folate (from food and supplements) had much less sperm DNA damage.529 In fact, the men with the highest intake of these had sperm DNA quality similar to the younger men. This extraordinary finding suggests that we may be able to prevent a large part of the decline in fertility and increased risk of miscarriage and birth defects as men age. A nutritious diet is important because it is likely that the specific antioxidants found in multivitamins are just a small percentage of the vast array of antioxidants found naturally in food. One additional antioxidant shown to be helpful for sperm quality but unlikely to be present in your typical multivitamin is lycopene.530 This powerful antioxidant is found in tomatoes and becomes particularly concentrated once tomatoes are cooked, such as in tomato paste. Other powerful antioxidants include anthocyanins, which give berries their dark purple color, and beta-carotene, found in sweet potatoes and carrots. Additional well-known sources of antioxidants are green tea and dark chocolate, although little is known about how these antioxidants relate to sperm quality. Until we know more about which antioxidants are most beneficial, the best approach is to eat a wide variety of fruits and vegetables, with a particular focus on the most brightly colored varieties, which are typically higher in antioxidants. It is also particularly useful to choose fruits and vegetables that are naturally lower in pesticide residues. This includes papaya, pineapple, mango, honeydew melon, avocado, cabbage, onion, peas, and broccoli. In a recent study by researchers at the Harvard School of Public Health, men who ate more of these low-pesticide fruits and vegetables had a 169 percent higher total sperm count and a 173 percent higher sperm concentration.531 Beyond antioxidants, a persuasive body of research also indicates that the dietary factors discussed in detail in chapter 13 apply to men too. In particular, the studies show that reducing sugar and red meat intake, while eating more fish and unrefined whole grains, can have powerful benefits for male fertility.