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Medications that alter stomach acid, such as proton pump inhibitors (PPIs) and H2 blockers, as well as the diabetes medication Metformin, can significantly impair the absorption of B12 in the digestive tract

Livshits Z, Lugassy DM, Shawn LK, Hoffman RS

189 In an uncontrolled trial that included 119 men with idiopathic infertility, supplementation with a multi-nutrient cocktail containing vitamins, minerals, and several antioxidants twice daily for three months led to significant improvements in sperm concentration, motility, morphology, and DNA fragmentation compared with pretreatment analyses

However, for most people, the results of B12 injections last for around a week

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Improved insulin sensitivity lowers hyperinsulinemia-induced ovarian androgen production, which is a central driver of menstrual irregularity in many with PCOS