Antioxidants & supplements for male fertility
Cochrane 2022 + negative MOXI trial and balance
Last updated: October 2026 — Sources: Cochrane / EAU / ESHRE / WHO / CDC
Key takeaways
Antioxidants for men: big promises, weak evidence. Cochrane 2022 very low certainty; negative MOXI/SUMMER/FAZST balance it. CoQ10 improves surrogates (motility/conc.) but no proven live birth.
Cochrane 2022: live birth OR 1.43 but vanishes without high-bias (OR 1.22) — very low.
MOXI: no SDF/pregnancy diff; SUMMER 2024: ongoing 15.5% vs 21.5% placebo — negative.
FAZST: zinc+folate 6 mo no live-birth gain, slight SDF rise.
CoQ10 200–400 mg 3 mo improves conc/motility/SDF in reviews but no large pregnancy RCT.
When to evaluate?
- Low motility/high ROS after lifestyle fix (smoking/obesity/heat) — discuss antioxidant as option, not promise.
- Pre-ART with prior failure & high SDF — 3-mo trial possible with follow-up.
What not to do?
- Don't translate motility/conc. gain into pregnancy promise — WHO 2025 no general rec.
- Don't use high long doses unsupervised — FAZST showed SDF rise.
- Don't attribute Cochrane to a commercial product — 20 different ingredients, no single formula.
Healthcare-professional notice
This hub is independent of NPF products and does not promote them. It is informational only and does not replace individual clinical judgment. Surrogate outcomes (SDF, motility, HOMA, IIEF) are never converted into pregnancy/cure promises, and GRADE certainty is quoted as published.
Binding rule: surrogate outcomes are never converted into patient outcomes. Every certainty grade and limitation is quoted as published.
Deep dive
Why very low certainty?
90 trials but only 12 measured live birth — small, high bias, publication bias.
Without high-bias: no effect — prevents turning OR 1.89 clinical pregnancy into promise.
CoQ10: what we know?
Alahmar 2021: conc 8.2→12.5M & motility 10→15% with 200 mg 3 mo, TAC improves.
But no large pregnancy/live-birth RCT — report as ‘improves surrogates’ only.
Evidence in this domain
Each study broken into five questions: why it was run, who was studied, how it was done, the finding, and why it came out that way — then the clinical takeaway and limits, as published.
FAQ
How long?
At least 3 mo per spermatogenic cycle; re-check semen, don't continue without benefit.
Notice: this reference is informational only and not a substitute for medical advice. Consult your doctor before making any treatment decision.