, reproductive medicine
, pregnancy outcomes
, folic acid and zinc supplementation trial
, semen quality
This is a multi-center, double-blinded, randomized placebo-controlled clinical trial to assess the effects of folic acid and zinc dietary supplementation in males on semen quality and fertility rates among couples trying to conceive and seeking assisted reproduction.
The primary objective of the study is to assess the impact of folic acid and zinc dietary supplementation in males on semen quality and indirectly fertility outcomes (i.e., live birth rate) among couples attempting to conceive and seeking assisted reproduction. A double-blind, placebo-controlled randomized trial of folic acid and zinc dietary supplementation will be conducted. Following a screening/randomization visit, participants will return at baseline, 2, 4, and 6 months. The rate of adverse events will be noted throughout the double-blind trial.
Principle Investigator: Ahmad Hammoud
Principle Department: Obstetrics And Gynecology (Dept)
Co Investigator: Douglas Carrell
Co Investigator: Erica Johnstone
Couples Inclusion Criteria:
Heterosexual couples in a committed relationship with a female partner aged 18-45 years and male partner aged 18 years and older attempting to conceive and seeking assisted reproduction at participating fertility clinics.
Couples actively trying to conceive.
Couples who are planning OI, natural fertility optimization methods, or IUI should be willing to be on the study dietary supplement for at least 3 weeks before starting the next assisted reproduction cycle or attempting pregnancy.
Male Inclusion Criteria:
Willing to provide semen samples according to the proposed schedule at baseline, 2, 4, and 6 months of follow-up.
Able to complete regular study questionnaires and daily journals aimed at capturing ejaculation, sexual intercourse and lifestyle factors considered to affect male fecundity (e.g., cigarette smoking, fever, high temperature environment and other environmental exposures) and other data collection instruments (e.g., physical activity, food frequency questionnaire, stress).
Couples Exclusion Criteria:
Female partner unwilling to participate (e.g., no abstraction of her assisted fertility treatment record or unwilling to complete baseline visit).
Couples using donor, cryopreserved sperm, or sperm obtained via microsurgical or percutaneous epididymal sperm aspiration.
Couples attempting to conceive with a gestational carrier (surrogate) or a known egg donor.
Positive urine pregnancy test at baseline.
Male Exclusion Criteria:
Unwilling to abstain from use of non-study approved dietary supplements or medications containing folic acid or oral preparations containing zinc throughout the study.
Diagnosis of anemia at screening. All participants will be screened at baseline for anemia and any men that screen positive (Hemoglobin <13 gm/dL) will be excluded.
Diagnosis of Vitamin B12 deficiency or pericious anemia
Any other diagnosis of anemia within the last 5 years that has not bee successfully treated.
Consuming a vegan diet.
A known genetic cause of male factor subfertility, including chromosomal disorders related to subfertility (e.g., Y chromosome deletions).
Current use of drugs known to interact with folic acid or interfere with the biosynthesis of folic acid including all dihydrofolate reductase inhibitors, including but not limited to Trimethoprim, Triamterene, Bactrim, Iclaprim, and Sulfonamides including diuretics, such as Hydrochlorothiazide (HCTZ), Metolazone, Indapamide, Lasix, Bumex, Torsemide, Chlorthalidone, Acetazolamide, Mefruside, Xipamide; Sulfonylureas such as Glipizide and Glyburide; Cox-2 inhibitors, such as Celecoxib; Probenecid; Sulfasalazine; Sumatriptan; Mafenide; Acetazolamide; Ethoxzolamide; Sulfiram; Zonisamide; optic agents including Dorzolamide and Dichlorphenamide; Valproic acid; Fluorouracil; Capecitabine; Methotrexate, or other drugs known to interact with folic acid.
Current poorly controlled chronic diseases such as heart disease, diabetes mellitus, hypertension, cancer, inflammatory diseases, autoimmune, thyroid disease, endocrine dysfunction, liver disease, kidney disease, or HIV/AIDS or other immune-insufficient related illnesses.
Crohn's disease, celiac disease, ulcerative colitis, gastric bypass surgery, lap band surgery or history of intestinal surgery to remove a portion of small bowel. History of diseases/symptoms that require folic acid dietary supplementation, such as megaloblastic anemia, homocystinemia, and homocystinuria.
History of alcohol dependency disorder and/or other drug/substance dependency in the past 180 days.
History of psychoses or other mental condition that would result in cognitive impairment and inability to participate in any part of this study including the informed consent process, as diagnosed by a physician within the past year.
i. History of vasectomy without reversal, obstructive azoospermia such as CBAVD, or ejaculatory duct obstruction.
j. Known allergy to folic acid or zinc dietary supplementation.
Female Exclusion Criteria:
Age <18 or >45.