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Smoking also increases risk by reducing blood flow to spinal structures and impairing tissue repair

Several coexisting conditions may falsely lower serum B 12 levels, including oral contraceptive use, multiple myeloma, pregnancy, and folate deficiency

Signs include feeling very tired, weak, and having nerve problems

Headache: Occasionally reported, usually mild

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116 As previously noted, in a randomized controlled trial in 468 men with infertility and sperm abnormalities, 600 mg NAC in combination with 200 mcg selenium daily improved semen quality, increased testosterone, LH, and inhibin B levels, and decreased FSH levels after 30 weeks