Couple-Friendly Supplements for Fertility

On the evidence retrieved for this article, no supplement has been shown to raise live birth rates for couples, and the largest trial of the commonest male combination found nothing. In the Folic Acid and Zinc Supplementation Trial, 2,370 couples planning infertility treatment were randomised at four US centres; the male partner took either 5 mg folic acid with 30 mg elemental zinc or placebo daily for six months. Live birth occurred for 404 of 1,185 couples on the supplement and 416 of 1,185 on placebo — a risk difference of -0.9% (95% CI -4.7% to 2.8%). The authors' conclusion is that these findings do not support the use of folic acid and zinc supplementation by male partners in the treatment of infertility (Schisterman et al, JAMA 2020;323(1):35-48).

Pooled across every oral antioxidant and both partners, the picture is weak rather than absent. Cochrane's male review covers 90 studies and 10,303 subfertile men and reports live birth OR 1.43 (95% CI 1.07 to 1.91) on very low certainty evidence from 12 RCTs and 1,283 men — a result resting on 246 live births. Remove the trials at high risk of bias and the signal goes: Peto OR 1.22 (95% CI 0.85 to 1.75) from 8 RCTs and 827 men. The review's own summary is that the current evidence is inconclusive (de Ligny et al, Cochrane Database of Systematic Reviews 2022, CD007411).

The female review reaches the same place from 63 trials and 7,760 women: very low quality evidence on live birth (OR 1.81, 95% CI 1.36 to 2.43; 13 RCTs, 1,227 women), which against an expected live birth rate of 19% would put the rate with antioxidants between 24% and 36%, and a bottom line of limited evidence in support of supplemental oral antioxidants for subfertile women (Showell et al, Cochrane Database of Systematic Reviews 2020, CD007807).

This is the question that decides whether a claim means anything, because four different things get sold as one:

• Live birth — a baby. This is the outcome Cochrane treats as primary in both reviews, and the one where certainty is lowest in both.
• Clinical pregnancy — a pregnancy confirmed on scan, which is not the same as a birth. Antioxidants in men: OR 1.89 (95% CI 1.45 to 2.47) from 20 RCTs and 1,706 men, low certainty. In women: OR 1.65 (95% CI 1.43 to 1.89) from 35 RCTs and 5,165 women, low quality.
• Semen parameters — concentration, motility, morphology. A meta-analysis of randomised trials found selenium, zinc, omega-3 fatty acids and CoQ10 each raised sperm concentration, and selenium, zinc, omega-3, CoQ10 and carnitines each raised total motility, while cautioning that sample sizes were limited and between-study variation considerable (Salas-Huetos et al, Advances in Nutrition 2018;9(6):833-48). None of that is a pregnancy.
• Oocyte yield and embryo grading — laboratory counts from IVF cycles, which is where most of the CoQ10 evidence sits.

A supplement can move a semen number and change nothing that matters. That gap is the single most common way these pages mislead, and it is why the Cochrane finding on antioxidants and sperm quality is worth reading next to any product label.

Two guideline bodies address supplements directly, and both advise against them as a treatment add-on. ESHRE's 2023 evidence-based guideline on unexplained infertility states that adjunct oral antioxidant therapy is probably not recommended for women undergoing fertility treatment (recommendation 46, conditional) and probably not recommended for men (recommendation 47, conditional). It also states that inositol supplementation in women is probably not recommended (recommendation 49), and that testing for vitamin D deficiency in women is not recommended for diagnosing unexplained infertility (recommendation 33, strong). Its justification for the inositol recommendation is worth quoting in substance: the guideline group was unable to find convincing evidence of benefit and judged the evidence quality very low.

The AUA/ASRM guideline on diagnosis and treatment of infertility in men, published in 2020 and amended in 2024, puts it as statement 45: clinicians should counsel patients that the benefits of supplements such as antioxidants and vitamins are of questionable clinical utility in treating male infertility (Moderate Recommendation, Evidence Level Grade B).

What ESHRE does recommend, as good practice, is a healthy diet and regular exercise, supported by behavioural therapy where necessary (recommendation 51), and psychological support for patients when needed (recommendation 50). Neither comes in a bottle.

Yes — folic acid, for the woman, and what it does is prevent neural tube defects rather than treat infertility. Cochrane's review of periconceptional oral folate covers five trials and 7,391 women, and reports a risk ratio for neural tube defects of 0.31 (95% CI 0.17 to 0.58) across 6,708 births, graded high quality evidence. Recurrence fell with a risk ratio of 0.34 (95% CI 0.18 to 0.64) across four trials and 1,846 births. Subgroup analysis found the effect was not changed by the daily dose explored — 400 micrograms or higher — so more is not established as better (De-Regil et al, Cochrane Database of Systematic Reviews 2015, CD007950).

The same review found no evidence of an effect on cleft palate, cleft lip, congenital cardiovascular defects or miscarriage. So the honest framing is narrow and useful: folic acid is periconceptional care with a clear benefit to the baby, not a fertility treatment for either partner, and the 5 mg dose given to men in FAZST did nothing for semen quality.

One observational finding sits alongside this and should not be over-read. A secondary analysis of 2,370 couples in FAZST and a companion study found that multivitamin use by the female partner at baseline was associated with live birth (adjusted risk ratio 1.22, 95% CI 1.05 to 1.41) while use by the male partner was not (aRR 1.00, 95% CI 0.89 to 1.12), with the female association present only among couples who had no fertility treatment (aRR 1.44, 95% CI 1.00 to 2.08) (Sealy et al, Fertility and Sterility 2026;126(2):391-406). That is an association between who chooses to take a multivitamin and what happens next, not a randomised test of taking one. For where diet fits, what food changes have actually been measured on semen parameters is the closer question.

Thinner again, and in two cases actively unsafe. A scoping review mapped 125 randomised trials of botanicals and male fertility across 23 countries and reported that gossypol and extracts of Tripterygium wilfordii are harmful to the testis and to male fertility, while extracts of Withania somnifera and some traditional formulae might improve testosterone levels and semen parameters. Its conclusion is that it cannot recommend any specific botanical, and its reason is quality control: of the 32 trials published since 2018, only 9% to 23% reported voucher samples, chemical profiling, herbal authentication or extraction detail (Shepherd et al, Phytomedicine 2022;106:154398). In other words, for most of this literature you cannot tell what plant material was tested.

Taken plant by plant, the picture does not improve. A systematic review of maca found five studies — three randomised, two uncontrolled — and concluded that the number of trials, the total sample size and the risk of bias prevent firm conclusions (Lee et al, Maturitas 2016;92:64-9). The randomised, double-blind, placebo-controlled trial published since then enrolled 50 patients for 16 weeks and found no statistically significant effect on semen quality, with sperm concentration rising 40% on maca versus 76% on placebo, and a fall in free testosterone; the authors state the results are not sufficient to assess efficacy (Melnikovova et al, Phytotherapy Research 2021;35(11):6359-68).

Ashwagandha (Withania somnifera) is the most promising of them and still thin. The systematic review and meta-analysis identified four clinical trials, only one of them randomised, so no meta-analysis of randomised data was possible; the pooled observational comparisons were against participants' own pre-treatment values rather than a control group, and the authors describe the data as too limited to establish benefit in male infertility (Durg et al, Phytomedicine 2018;50:247-56). Vitex, red clover and Tribulus terrestris, all named in the previous version of this page, have no retrieved randomised evidence for a pregnancy outcome in either partner.

Less than the volume of it suggests, and this is checkable rather than a matter of opinion. Cochrane's female antioxidant review carries an editorial note published on 5 March 2026 concerning nine of its included studies: since publication, seven have been retracted and expressions of concern have been published on two more. Cochrane's editors applied their framework for assessing the impact of removing retracted studies, determined that removal makes no meaningful difference to the review's findings, retained confidence in its conclusions, and will exclude those nine studies at the next update.

The most-cited single CoQ10 fertility trial — El Refaeey, Selem and Badawy, in clomiphene-resistant polycystic ovary syndrome — was retracted outright in 2023 (retraction notice Reproductive BioMedicine Online 2023;47(5):103389), and is flagged as a retracted publication in PubMed. It still circulates on supplement pages. No claim here rests on it.

Funding is the other gap. Of the 63 trials in the Cochrane female review, only 27 reported a funding source at all, which makes industry involvement across this field unquantifiable rather than absent. An umbrella review of four meta-analyses reached the matching verdict: multiple micronutrients and antioxidants were associated with higher live birth rates (OR 2.59 and 1.81) on very low certainty evidence, and L-carnitine, CoQ10, melatonin, myo-inositol, N-acetylcysteine and vitamin D with higher clinical pregnancy rates on very low certainty evidence, but the available evidence is insufficient to recommend nutrient supplementation, with no indication that these nutrients pose a risk of significant harm (Pandey et al, Nutrients 2024;17(1):57).

Small, measured, and not zero. In the male Cochrane review, antioxidants may cause more mild gastrointestinal discomfort than placebo or no treatment (OR 2.70, 95% CI 1.46 to 4.99; 16 RCTs, 1,355 men, low certainty), based on 46 events in 1,355 men. In FAZST, abdominal discomfort or pain was reported by 66 of 1,185 men on folic acid and zinc versus 40 of 1,185 on placebo, nausea by 50 versus 24, and vomiting by 32 versus 17. Neither review found evidence of a difference in miscarriage: OR 1.46 (95% CI 0.75 to 2.83; 6 RCTs, 664 men) in the male review, and OR 1.13 (95% CI 0.82 to 1.55; 24 RCTs, 3,229 women) in the female one, both on low or very low certainty evidence.

The DNA fragmentation finding in FAZST is the one that deserves attention rather than alarm. Mean sperm DNA fragmentation was 29.7% in the folic acid and zinc group versus 27.2% on placebo, a mean difference of 2.4% (95% CI 0.5% to 4.4%) — statistically significant, of uncertain clinical meaning, and the opposite direction to what the supplement is sold to do.

Dose is where this page previously overreached and now declines to. The doses named above are the doses particular trials used: 5 mg folic acid with 30 mg elemental zinc daily for six months in FAZST; 400 micrograms or more of folic acid in the periconceptional folate trials; and, in a meta-analysis of 18 randomised trials reporting semen parameters rather than births, selenium at 100 to 200 micrograms a day, L-carnitine at 2 g with acetyl-L-carnitine at 1 g, and CoQ10 at 200 to 300 mg a day (Buhling et al, Reproductive BioMedicine Online 2019;39(2):269-79). No source retrieved here recommends a dose for a couple, and neither does this page.

Set against the claims usually made for couple-branded supplements, the retrieved sources do not support the following.

• That any supplement raises a couple's live birth rate. The one large randomised trial of the standard male combination found a difference of -0.9% (95% CI -4.7% to 2.8%), and both Cochrane reviews rate live birth evidence at the bottom of the certainty scale.
• That folic acid or zinc improves sperm. FAZST measured concentration, motility, morphology, volume, total motile count and DNA fragmentation at six months and found no improvement in any of them.
• That supplements improve egg quality. No retrieved trial measured egg quality as an outcome; what has been measured is oocyte yield, embryo grading and cancellation rates in IVF cycles.
• That a couple should take the same product. No retrieved trial randomised both partners to a combined regimen and measured live birth; the male and female literatures are separate, and the guideline advice against antioxidant add-ons is issued separately for each.
• That specific nutrients work together. The synergy claims in the previous version of this page — vitamin D with calcium, omega-3 with CoQ10, zinc with selenium — were not tested by any source retrieved here, and have been removed rather than rewritten.
• That herbal products are gentler or safer because they are plant-derived. A scoping review of 125 randomised trials identified two botanicals as harmful to the testis, and found that fewer than a quarter of recent trials documented what plant material they used.
• That there is a correct dose, or a correct duration. The durations in these trials were chosen by the investigators; FAZST ran six months, the maca trial 16 weeks, and no retrieved source compares durations head to head.

What is established is short: folic acid at 400 micrograms or more reduces neural tube defects; correcting a diagnosed deficiency is treating a deficiency; and diet and exercise carry a guideline recommendation that supplements do not. If the underlying question is whether anything can be changed before treatment, what lifestyle changes have measurable evidence and the narrow group in whom CoQ10 has been tested are the two honest places to start.