Training Planning a family &
Content Key message Introduction Product information Key benefits Target group Posology & administration Ingredients Good to know What is infertility? Complementary treatment References
1. Key message • A man’s fertility generally relies on the quantity and quality of his sperm. • If the number of sperm a man ejaculates is low or if the sperm is of a poor quality, it will be difficult, and sometimes impossible, for him to cause a pregnancy. • In most cases, there are no obvious signs of infertility. Intercourse, erections and ejaculation will usually happen without difficulty. Also quantity and appearance of semen generally appear normal to the naked eye. • cover the recommended daily intake of all important micronutrients for normal spermatogenesis and support male fertility. &
2. Introduction • Unlike women, some men remain fertile into their 60s and 70s. But as men age, they might begin to have problems with the shape and movement of their sperm. 1 • Men also have a slightly higher risk of sperm gene defects. Or they might produce no sperm or too few sperm. 1 • It is estimated that 1 in 20 men has some kind of fertility problem with low quality and/or quantity of sperm.2
4. Key benefits • 1 stick fertilo forte Denk or 2 capsules fertilo forte caps Denk cover the recommended daily intake of all important micronutrients for normal spermatogenesis. • Support the production of sperm for ideal count and density. • Support male fertility and reproductive health. • Two different dosage forms • capsules • direct sticks with fruity orange taste • Easy consumption on the go without water.
5. Target group FOR ALL MEN PLANNING A FAMILY
6. Posology & administration * 15 mg / 0.671 = 22.4 IU ** No recommendation available
6. Posology & administration • INTAKE • The recommended daily intake is 1 stick or 2 capsules per day taken after a meal. • fertilo forte Denk: easy consumption without water. • fertilo forte caps Denk: without synthetic sweeteners & flavours. • INTAKE PERIOD • Minimum intake period is 3 months in order to optimize spermatogenesis. It takes several weeks for a sperm cell to fully develop. However a mature male can produce up to 1500 sperms per second.
7. Ingredients SELENIUM contributes to normal spermatogenesis and to protection from oxidative stress.3 ZINC contributes to normal fertility and reproduction and increases the testosterone level which is essential for sperm cell maturation. 3 FOLATE has a positive effect on sperm quality - especially sperm count and density.3 VITAMIN E can improve the motility of sperms and contributes to the protection of cells from oxidative stress.3 L- ARGININE AND L-CARNITINE can improve sperm cell motility.4 COENZYM Q10 has antioxidant properties. 5 SELENIUM ZINC FOLATE VITAMIN E L-ARGININE L-CARNITINE COENZYME Q10
7. Ingredients SELENIUM • A deficiency of dietary selenium leads to reduced sperm motility, increased sperm rupture and infertility. 6, 7 • The sperm mitochondrial capsule selenoprotein has a structural as well as an enzymatic role and it is responsible for both • maintenance of motility and • structural integrity of the tail of the sperm. 7 • Moreover, selenoproteins protect against oxidative damage to spermatozoa throughout the process of sperm maturation. 8
7. Ingredients ZINC • Zinc plays an important role in reproduction in males and females. • Low dietary zinc status has been associated with low circulating concentrations of several hormones including testosterone. The original description of zinc deficiency in humans included lack of pubertal development. 9, 10 • Spermatogenesis is a zinc dependent process and seminal fluid is particularly rich in zinc. 9, 10 • Moreover, zinc can increase testosterone level and sperm count. 11
7. Ingredients FOLATE • Folate plays a vital role in normal spermatogenesis and hence male reproduction. 12 • Low folatelevels in seminalplasmaareassociatedwithreducedspermconcentrationandimpairedspermatogenesis. 12 • The negative effectsoffolatedeficiency on spermatogenesismaypartlybe due to inhibiting the expressionofthreekeymolecules (Esr1, Cav1 and Elavl1) essential forspermproduction. 12
7. Ingredients VITAMIN E • The lipid composition of the plasma membrane of spermatozoa is highly specific. The membranes contain high levels of polyunsaturated fatty acids. 13 • However, these membrane lipids are also highly susceptible to damage induced by excessive ROS levels because they are the primary substrate for lipid peroxidation. 13 • Lipid peroxidation causes an impairment of membrane function, including decreased membrane fluidity and sperm motility. 13 • Vitamin E is an antioxidantthatisable to protectcellsfrom oxidative stress and was shown to • significantlydecreaselipidperoxidation in spermatozoaand • improvespermmotility. 14
7. Ingredients • L-carnitine acts as an essential co-factor for the transport of long-chain fatty acids within the mitochondrial matrix in order to facilitate the oxidative processes and to enhance cellular energy production. 15 • Interestingly, L-carnitine is found in high concentrations in the male reproductive tract, especially in the epididymis, suggesting its crucial role in energy metabolism and inmaturation of spermatozoa. 16 • Several clinical studies investigated the effect of L-carnitine on semen parameters. L-carnitine was shown to • improve sperm quality 17 • increase sperm concentration 18 • improve sperm motility 19, 20, 21 L-CARNITINE
7. Ingredients • L-arginine is a precursor to nitric oxide (NO), an important molecule that promotes vasodilation (relaxation of the blood vessels). • Therefore, the amino acid L-arginine supports blood circulation to genitals. 22 • → Blood flow rich in oxygen and nutrients is very important to support reproductive health and can have a positive impact on the strength and mobility of sperm. 23, 24 L-ARGININE
7. Ingredients COENZYME Q10 • Coenzyme Q10 (CoQ10) is an antioxidant molecule, component of the respiratory chain. 13 • Therefore, numerous studies have been performed to investigate whether supplementing infertile men with antioxidants can improve seminal parameters. 13 • It was shown that supplementing infertile men with CoQ10 is able to • improve sperm concentration • improve sperm motility. 13
8. Good to know Did you know, that…? …the development of mature sperm cell from the stem cell stage takes about 70 days? 25 Zinc and folic acid are essential for healthy cell replication. 27, 28 …the average man will produce 525 billion sperm cells over his lifetime? 26
8. Good to know • A low sperm count decreases the likelihood that one of these sperms is able to fertilize the partner's egg. 29 • A low sperm count is defined as: fewer than 15 million sperm per milliliter of semen or fewer than 39 million per ejaculate. 29 • SPERMIOGRAM Test (normal sperm quality) 29
9. What is infertility? • Infertility means that a couple is not able to achieve a pregnancy after 1 year of trying. 30 • After one year of having unprotected sex, about 10-15 % of couples are unable to get pregnant. 31 • About a third of the time, infertility can be traced to the woman. 32 • In another third of cases, it is because of the man. 32 • The rest of the time, it is because of both partners or no cause can be found.32
9. What is infertility? • QUICK FACTS ABOUT (IN)FERTILITY 33 • Sperm quality disorders have nothing to do with impotence. • Sperm must be functional and able to move. If motility or function of the sperm is abnormal the sperm may not be able to reach or penetrate the partner's egg. • In approximately 40 percent of infertile couples the male partner is either the sole cause or a contributing cause of infertility. • Seek expert opinion: Sperm quality test with an urologist – the sooner sperm quality information is acquired the sooner steps can be taken to successfully conceive a child. Unmanly? Not at all!
9. What is infertility? REASONS FOR MALE INFERTILITY 34 Blockage of sperm transport Sperm production problems Sperm antibodies Reasons for male infertility Hormonal problems Sexual problems Unknown causes Psychological reasons Lifestyle causes
10. Complementary treatment FOR FATHERS TO-BE FOR MOTHERS TO-BE may change your (family) life
11. References 1 National Institutes of Health (2017): Understanding Infertility. 2 OVUM (2017): Male infertility. 3 European Comission (2012): Commission Regulation (EU) No 432/2012. 4 Battaglia C (2002): Adjkuvant L-Arginine treatment in controlled ovarian hyperstimulation: a double-blind, randomized study. Hum Reprod. 17 (3): 659-665. 5 Prakash S (2010): Role of coenzyme Q10 as an antioxidant. Indian J Pharmacol. 42 (6): 334-337. 6Hawkes WC (2001): Effect of Dietary Selenium on Sperm Motility in Healthy Men. J Androl. 22 (5) 764-772. 7 Bates J (2005): Selenium. In: Encyclopedia of human nutrition. 2nd edition. 8 Ashan U (2014): Role of selenium in male reproduction-A review. Elsevier. 146 (1-2). 55-62. 9 Prasad AS (1996): Zinc status and serum testosterone levels of healthy adults. Nutrition. 12 (5). 244-348. 10 Freake HC (2006): Zinc: Physiology. In: Encyclopedia of human nutrition. 2nd edition. 11Jalali GR (2010): Impact of oral zinc therapy on the level of sex hormones in male patients on hemodialysis. Renal Failure. 32: 4. 517-419. 12Yuan HF (2017): Effect of folate deficiency on promotor methylation and gene expression of Esr1, Cav1, and Elavl1, and its influence on spermatogenesis. Oncotarget. 8 (15). 24130-24141.
11. References 13 LafuenteR (2013): Coenzyme Q10 and male infertility. J Assist reprod Genet. 30: 1147-1156. 14 Suleiman SA (1996): Lipid peroxidation and human sperm motility: protective role of vitamin E. 17 (5): 530-537. 15 Agarwal A (2004): carnitines and male infertility. Reprod Biomed Online. 8 (4). 376-384. 16 Lenzi A (1992): Metabolism and action of L-carnitine: its possible role in sperm tail function. Arch Ital UrolNefrolAndrol. 64 (2). 187-196. 17 Moncada ML (1992): Effect of acetylcarnitine treatment in oligoasthenospermic patients. ActaEurFertil. 23. 221-224. 18 Costa M (1994): L-carnitine in idiopathic asthenozoospermia: a multicenter study. J Androl. 26 (3). 155-159. 19 Vitali G (1995): Carnitine supplementation in human idiopathic asthenospermia: clinical results. Drugs ExpClin Res. 21 (4). 157-159. 20Lenzi A (2004): A placebo-controlled double-blind randomized trial of the use of combined L-carnitine and L-acetyl-carnitine treatment in men with asthenozoospermia. FertilSteril. 81 (6): 1578-1584. 21Garolla A (2005): Oral carnitine supplementation increases sperm motility in asthenozoospermic men with normal sperm phospholipid hydroperoxide glutathione peroxidase levels. FertilSteril. 83 (2): 355-361. 22 WebMD (2009): L-Arginine. 23 Scibona M (1994): L-arginine and male infertility. Minerva UrolNefrol. 46 (4): 251 – 253.
11. References 24Schachter A (1973): Treatment of oligospermia with the amino acid arginine. J Urol. 110 (3): 311-313. 25Gilbert SF (2000): Spermatogenesis. Developmental Biology. 6th edition. 26http://www.livescience.com/32437-why-are-250-million-sperm-cellsreleased- during-sex.html 27EFSA Journal (2010): 8(19):1760 28EFSA Journal (2010): 8(10):1819 29Cooper TG (2010): WHO reference values for human semen characteristics. Hum Reprod Update. 16 (3). 231-245. 30WHO (2018): Sexual and reproductive health. Infertility definitions and terminology. 31Moslemi MK (2011): selenium-vitamin E supplementation in infertile men – effects on semen parameters and pregnancy rate. Int J Gen Med. 23 (4): 99-104. 32National Institutes of Health (2017): How common is infertility? 33American Society for Reproductive Medicine (2018): Male Infertility. 34Mayo Clinic: Diseases and Conditions. Male infertility.
11. References 35Virtual Medical Center (2016): Male Reproductive System (Male Urogenital System) 36Ramaswamy S (2014): Endocrine control of spermatogenesis: Role of FSH and LH/testosterone. Spermatogenesis. 4 (2): e996025. 37Mescher AL (2010): Spermatogenesis. Junqueira‘s Basic Histology. 12th Edition. 38Medscape (2015): Seroli-Cell-Only Syndrome. 39Tesarik J (1999): Assisted reproduction for testicular failure: management of germ cell maturation arrest. CurrOpinObstet Gynecol. 11 (3): 283 – 288. 40Hauser R (2005): Severe Hypospermatogenesis in Cases of Nonobstructive Azoospermia: Should We Use Fresh or Frozen Testicular Spermatozoa? J Androl. 26 (6). 772-778.
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