1. Lifestyle levers first
- 7–9 hours of quality sleep; treat sleep apnea
- Weight optimization; regular exercise (avoid extreme volume)
- Avoid heat: prolonged hot tubs, laptops on the lap, saunas
- Stop smoking and vaping; moderate alcohol; avoid recreational drugs
- Reduce endocrine-disruptor exposure (BPA, phthalates)
2. Rule out the treatable
Semen analysis (x2), hormonal panel (T, LH, FSH, prolactin, estradiol), and scrotal exam. Varicocele repair improves parameters in appropriate candidates. Avoid exogenous testosterone — it suppresses sperm production.
3. Antioxidant-focused nutrition
- CoQ10 — 200 mg/day, studied for motility
- L-carnitine / acetyl-L-carnitine — motility and concentration
- Zinc — supports testicular function
- Selenium — antioxidant defense in sperm
- Folate + B12 — DNA synthesis and integrity
- Omega-3 EPA/DHA — sperm membrane fluidity
- Vitamin D — correct deficiency
4. Timeline
Recheck semen analysis at 3 months. Ongoing sub-optimal parameters warrant reproductive urology and, when appropriate, ART discussion.