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Moreover, smooth-fitting curve analysis identified a threshold effect: below 358.7 pg/mL, each 10 pg/mL increase in vitamin B12 was associated with a 4.4% increase in clinical pregnancy rate (OR = 1.04, P = 0.03), beyond which no further benefit was observed

NICE-aligned management typically involves: Addressing modifiable risk factors (smoking cessation, weight loss, increased physical activity, alcohol reduction) Optimising management of underlying conditions (diabetes, hypertension, depression) Trial of PDE5 inhibitor therapy Referral to specialist services (urology/andrology) if first-line treatments fail or where structural/neurological/endocrine causes are suspected Consideration of psychosexual therapy where appropriate Men should be reassured that ED is a medical condition with effective treatments, and seeking help through proper channels ensures safety, appropriate investigation of underlying causes, and access to evidence-based therapies

Keep vials upright, protected from light (wrap in aluminum foil or use amber vials if available), and away from the freezer compartment