www.imi.co.at

1. Imhof Martin
General Public Teaching Hospital Korneuburg/Vienna
Micronutritients
and
Male Subfertility

2. 9th International iCSi
Conference: Budapest 2008
replacement level and very low fertility1,24
1,27
1,31
1,31
1,31
1,32
1,32
1,33
1,34
1,35
1,35
1,35
1,38
1,39
1,40
1,41
1,43
1,47
1,55
1,64
1,65
1,70
1,83
1,84
1,84
1,85
1,90
1,93
2,00
2,05
1,0
1,1
1,2
1,3
1,4
1,5
1,6
1,7
1,8
1,9
2,0
2,1
Slovakia
Poland
Lithuania
Romania
Slovenia
Germany
Italy
CzechRepublic
Hungary
Latvia
Portugal
Spain
Bulgaria
Greece
Austria
Malta
Switzerland
Cyprus
Estonia
Belgium
Luxembourg
Netherlands
Denmark
Finland
UnitedKingdom
Sweden
Norway
Ireland
France
Iceland
TFR (Total fertility rate in 2006)
simple reproduction
lowest low fertility
low fertility

3. Developement of Sperm
Quality

4. Swan et. al. – National Institute of environmental health
sciences
•Review of 61 published studies
•Data collected over 52 years (1938 to 1990)
•Decline in average sperm density in U.S. and other Western
countries
Average annual decrease of
U.S. 1.5 mio/ml = minus 1.5%/year
Europa minus 3.1%/year


DECREASE IN SPERM QUALITY

5. Semen quality and sperm
DNA damage
in relation to urinary
bisphenol A
among men
from an infertility clinic.
Bisphenol A
John D. Meekera et al. Reproductive Toxicology 2010

6. Decline of Fertility
Environmental hormones
Oxidative stress
Change of life style
Change in nutrition habits
Lack of micronutritients

7. LACK OF MICRONUTRITIENS IN FOOD

8. MALE SUBFERTILITY AND NUTRITION

9. MALE SUBFERTILITY AND NUTRITION
Reduction of Sperm Quality
• No Disease?
• Defiency Syndrom?
Could therapy be Supplementation ?

10. LACK OF MICRONUTRITIENS IN FOOD
Guidelines on food fortification
with micronutrients
Lindsay Allen et al.
World Health Organization
2006
Male factor subfertility: possible causes and the
Impact of nutritional factors.
Wong WY et al.
Fertil Steril 2000 73:435-442

11. DECREASE IN SPERM QUALITY
Dietary intake of antioxidant nutrients is associated with
semen quality in young university students
Mínguez-Alarcón, Hum Reprod. 2012 Sep;27(9):2807-14
In this cross-sectional study, 215 young men
Our study suggests that some sperm parameters are sensitive
to dietary intake of antioxidant nutrients

12. EFFECT OF MICRONUTRITIENTS
Cochrane Database Syst Rev. 2011 Jan
19;1:CD007411.
Antioxidants for male subfertility.
Showell et al.
AUTHORS' CONCLUSIONS: The evidence suggests that
antioxidant supplementation in subfertile males may
improve the outcomes of live birth and pregnancy rate
for subfertile couples undergoing ART cycles….

13. SPERMIOGENESIS
Day 1 Day 18 Day 36 Day 54 Day 72
Spermiogenesis

14. 2x1 Capsule daily for 3 Month
 L-Carnitin 440 mg
 L-Arginine 250mg
 Vitamin E 120 mg
 Folic-acid 800 μg
 Zinc 40 mg
 Selenium 60 μg
 Glutathione 80 mg
 Coenzyme Q10 15 mg
Study Medication „PROFERTIL“

15. EFFECTS ON SPERMIOGENESIS
Hormonal
Regulation
Morphology/
Density
Energy/
Motility
Enzym/
Capazitation
L-Carnitin 440 mg
L-Arginine 250 mg
Vitamin E 120 mg
Folic-acid 800 ug
Zinc 40 mg
Selenium 60 ug
Glutathione 80 mg
Coenyme Q 10 15 mg

16. Inclusion – criteria
Infertility for > 1 years
2 pathological spermiograms
Informed consent
Exclusion - criteria
Varicosis
Infection
Aspermia
Hormonal disorder
CONTROLLED STUDY – STUDY SETTING

17. Therapy Group 132 men, age Ø 34 a (18-43)
2 Capsules/day MICRONUTRITIENTS (PROFERTIL) for 3 month
Control Group 73 men, age Ø 38 a (22-52)
No TREATMENT / CHANGE OF LIFE STYLE
CONTROLLED STUDY – STUDY SETTING

18. 2 path spermiogr.
Questionare Questionare
Treatment group
Profertil 2 capsules
Control group
Change life style
Observation period
Telephone
Follow up
End of study
12 month
Inclusion
3 month
Study period
6 month
Follow up

19. RESULTS OVERALL

20. Tot. Motility
47%
32%
20 %
10 %
50 %
40 %
30 %
RESULTS THERAPY GROUP
Prog. Motility
49%
30,5%
0 %
25 %
+83,1%
+36,4%

21. THERAPY COMPARED TO CONTROL

22. After 3 month treatment
Study Group Control Group
132 74
34 preg.(25,8%) 11 preg.(14,8%)
Improvement with Micronutritients
after 3 Month

24. DNA Fragmentation
sperm chromatin structure analysis
< 15% normal
15-30% IUI necessary
> 30% ICSI necessary

25. EFFECT OF MICRONUTRITIENTS
Cochrane Database Syst Rev. 2011 Jan
19;1:CD007411.
Antioxidants for male subfertility.
Showell et al.
AUTHORS' CONCLUSIONS: The evidence suggests that
antioxidant supplementation in subfertile males may
improve the outcomes of live birth and pregnancy rate
for subfertile couples undergoing ART cycles….

26. Oxidative DNA damage impairs global sperm DNA
methylation in infertile men.
Tunc O, J Assist Reprod Genet. 2009 Sep-Oct;26(9-10)
CONCLUSIONS:
..... while antioxidant supplementation appears to have
the potential to reduce DNA damage and normalize sperm
DNA methylation.
EFFECT OF MICRONUTRITIENTS

27. Antioxidants and sperm DNA damage: a clinical
perspective.
Zini A, J Assist Reprod Genet. 2009 Aug;26(8):427-32.
RESULTS: . the data suggest that dietary antioxidants may
be beneficial in reducing sperm DNA damage, particularly,
in men with high levels of DNA fragmentation ...
EFFECT OF MICRONUTRITIENTS

28. Schuetz a
, H. Kurz a
, M. Imhof b
67 sub-fertile males (active treatment group)
40 Sub-fertile men receiving no active treatment served as
controls
Main outcome measure was change in sperm-hyaluronan
binding assay indicating DNA fragmentation index after 3
months.
SPERM DNA FRAGMENTATION INDEX DECREASES AFTER
MICRONUTRIENT SUPPLEMENTATION

30. Micronutrients intake is associated with improved sperm
DNA quality in older men.
Schmid et al Fertil Steril 2012 Aug 23.
PATIENT(S): 22-80-year-old nonsmoking men (n = 80)
CONCLUSION(S): Men with higher dietary and supplement
intake of certain micronutrients may produce sperm with less
DNA damage, especially among older men.
DNA EFFECT OF MICRONUTRITIENTS

31. CONCLUSION
Sperm quality and male fertility is decreasing
Medical treatment of sperm quality unsuccessful
Decline of sperm quality may be a
defiency syndrome not a disease

32. CONCLUSION
Micronutritients are lacking in western countries
Change of life style may improve sperm quality
Micronutritients improve sperm quality in literature
Controlled prospective study prooves significant
improvement compared to control group
Micronutritients improve DNA sperm quality