Advancing male fertility and sexual health: The role of nutraceuticals in uro-andrology and IVF settings—expert insights

Abstract

Background: Male infertility and sexual dysfunction are frequently linked to oxidative stress, endothelial impairment, and hormonal imbalances. Standard therapies for male infertility such as clomiphene citrate, aromatase inhibitors, and gonadotropins and treatment for sexual dysfunction, including PDE5 inhibitors and testosterone therapy, often produce variable outcomes, especially in idiopathic or unexplained cases, and may carry risks of adverse effects or contraindications. These limitations highlight the need for safer and more effective adjunctive treatment approaches. Objective: To evaluate the existing clinical evidence supporting the nutraceutical combination of Tribulus terrestris extract, Eisenia (Ecklonia) bicyclis extract, chitosan oligosaccharides, CoQ10, and myo-inositol in male infertility and sexual dysfunction, and to assess real-world experiences with its use in routine practice. Methods: This expert opinion paper is based on advisory board meetings held between February-December 2025 with urologists and andrologists across India, focusing on current clinical gaps and practical integration of the nutraceutical combination into management strategies of male infertility and male sexual dysfunction. Conclusion: The experts noted that the combination of Tribulus terrestris extract, Eisenia (Ecklonia) bicyclis extract, chitosan oligosaccharides, CoQ10, and myo-inositol targets key pathogenic mechanisms involved in male infertility and sexual dysfunction, including oxidative stress, endothelial dysfunction, hormonal imbalance, and impaired sperm function. Based on clinical experience, this combination may serve as a safe and effective adjunct to standard therapies for men with idiopathic or unexplained infertility, reduced libido, or mild-to-moderate erectile dysfunction.