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You want to know about efficacy (still strong or effective?) and sterility (bacteria?)

Studies have shown treatment of germ cells with selenium can increase GPX4 expression, maintain spermatozoal motility, and increase germ cell proliferation, indicating the xCT/GPX4 system plays a role in male infertility [80, 81]

The nitric-oxide and circulation-support ingredients (L-Citrulline, Grape Seed Extract) generally need consistent intake to build any meaningful effect on blood flow

Vomiting follows a similar pattern

The SDF-1/CXCR4 axis is required for proliferation and maturation of human fetal pancreatic endocrine progenitor cells