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Oxidative Stress in the Male Germline: A Review of Novel Strategies to Reduce 4-Hydroxynonenal Production. Antioxidants (Basel) 2018; 7:antiox7100132. [PMID: 30282920 PMCID: PMC6209867 DOI: 10.3390/antiox7100132] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 09/25/2018] [Accepted: 09/26/2018] [Indexed: 12/22/2022] Open
Abstract
Germline oxidative stress is intimately linked to several reproductive pathologies including a failure of sperm-egg recognition. The lipid aldehyde 4-hydroxynonenal (4HNE) is particularly damaging to the process of sperm-egg recognition as it compromises the function and the stability of several germline proteins. Considering mature spermatozoa do not have the capacity for de novo protein translation, 4HNE modification of proteins in the mature gametes has uniquely severe consequences for protein homeostasis, cell function and cell survival. In somatic cells, 4HNE overproduction has been attributed to the action of lipoxygenase enzymes that facilitate the oxygenation and degradation of ω-6 polyunsaturated fatty acids (PUFAs). Accordingly, the arachidonate 15-lipoxygenase (ALOX15) enzyme has been intrinsically linked with 4HNE production, and resultant pathophysiology in various complex conditions such as coronary artery disease and multiple sclerosis. While ALOX15 has not been well characterized in germ cells, we postulate that ALOX15 inhibition may pose a new strategy to prevent 4HNE-induced protein modifications in the male germline. In this light, this review focuses on (i) 4HNE-induced protein damage in the male germline and its implications for fertility; and (ii) new methods for the prevention of lipid peroxidation in germ cells.
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Henkel R, Sandhu IS, Agarwal A. The excessive use of antioxidant therapy: A possible cause of male infertility? Andrologia 2018; 51:e13162. [PMID: 30259539 DOI: 10.1111/and.13162] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/22/2018] [Accepted: 09/04/2018] [Indexed: 12/18/2022] Open
Abstract
Reactive oxygen species and oxidative stress are closely associated with various pathologies such as neurodegenerative diseases, ageing and male infertility. Hence, antioxidants such as vitamin C, vitamin E, N-acetyl cysteine, L-carnitine and folic acid are regularly used in various treatment regimens to protect cells from the damage induced by free radicals. However, given their over-the-counter availability at unnaturally high concentrations and also the fact that they are commonly added to various food products, patients may run a risk of consuming excessive dosages of these compounds, which may then be toxic. The few studies that have assessed antioxidant overuse and the associated adverse effects found that large doses of dietary antioxidant supplements have varying-if any-therapeutic effects even though free radicals clearly damage cells-a phenomenon that has been termed the "antioxidant paradox." Furthermore, overuse of antioxidants such as vitamin C, vitamin E, N-acetyl cysteine may lead to reductive stress, which is reported to be as dangerous to cells as oxidative stress and can be the cause of diseases such as cancer or cardiomyopathy. Therefore, we feel that there is a need for more elaborate research to establish the clear benefits and risks involved in antioxidant therapy for male infertility.
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Affiliation(s)
- Ralf Henkel
- Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa
| | | | - Ashok Agarwal
- American Centre for Reproductive Medicine, Cleveland Clinic, Cleveland, Ohio
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Majzoub A, Agarwal A. Systematic review of antioxidant types and doses in male infertility: Benefits on semen parameters, advanced sperm function, assisted reproduction and live-birth rate. Arab J Urol 2018; 16:113-124. [PMID: 29713542 PMCID: PMC5922223 DOI: 10.1016/j.aju.2017.11.013] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 11/11/2017] [Accepted: 11/22/2017] [Indexed: 01/28/2023] Open
Abstract
Objective To explore the current evidence concerning the effect of oral antioxidant supplementation on various male fertility outcomes, as antioxidants are widely available compounds that are commonly used for the treatment of male infertility. Materials and methods PubMed, Medline and Cochrane electronic databases were searched according to a modified Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines looking for studies investigating the effect of antioxidant therapy on infertile men. The studies were explored looking for antioxidants: (i) types and doses; (ii) mechanism of action and rationale for use; and (iii) effect on the different outcome measures reported. Results In all, 26 studies reported a significant positive effect of antioxidant therapy on basic semen parameters, advanced sperm function, outcomes of assisted reproductive therapy, and live-birth rate. Vitamin E, vitamin C, carnitines, N-acetyl cysteine, co-enzyme Q10, zinc, selenium, folic acid and lycopene were most commonly used. The vitamins’ mechanism of action and reported doses is presented in Table 1, Table 2. Conclusion Antioxidants generally have a favourable effect on male fertility. Further studies are needed to identify the optimal antioxidant regimen that can be used safely and efficiently in clinical practice.
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Key Words
- ART, assisted reproductive therapy
- Antioxidants
- DDS, DNA degraded sperm
- ICSI, intracytoplasmic sperm injection
- IVF, in vitro fertilisation
- LAC, l-acetyl carnitine
- LC, l-carnitine
- Male infertility
- MeSH, Medical Subject Heading
- NAC, N-acetyl cysteine
- OAT, oligoasthenozoospermia
- OS, oxidative stress
- PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses
- ROS, reactive oxygen species
- Reactive oxygen species
- SDF, sperm DNA fragmentation
- Semen analysis
- Sperm DNA fragmentation
- coQ10, co-enzyme Q10
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Affiliation(s)
- Ahmad Majzoub
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
- Corresponding author at: Department of Urology, Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
| | - Ashok Agarwal
- American Center for Reproductive Medicine, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation, OH, USA
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Arab A, Rafie N, Mansourian M, Miraghajani M, Hajianfar H. Dietary patterns and semen quality: a systematic review and meta-analysis of observational studies. Andrology 2017; 6:20-28. [PMID: 29024507 DOI: 10.1111/andr.12430] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 08/29/2017] [Accepted: 09/03/2017] [Indexed: 11/29/2022]
Abstract
A number of studies have examined the association between dietary patterns and semen quality, but the findings have been inconclusive. Herein, we conducted a systematic review and meta-analysis of observational studies to assess the association between dietary patterns and semen quality. PubMed, Cochrane library, Science direct, Scopus, Google Scholar, and ISI web of science databases were searched up to August 2016 for observational studies assessing the association between common dietary patterns and sperm quality markers. Data were pooled by the generic inverse variance method with random effects and expressed as mean differences with 95% confidence intervals (CIs). Heterogeneity was assessed (Cochrane Q-statistic) and quantified (I2 -statistic). The Newcastle-Ottawa Scale assessed study quality. Six eligible studies, involving 8207 participants, were included in our systematic review and meta-analysis. The pooled mean difference of sperm concentration for the healthy dietary pattern versus unhealthy dietary pattern intake was mean difference: 0.66; 95% CI, 0.305-1.016; p < 0.001. In comparison with those who had the highest adherence to healthy dietary pattern, individuals in the lowest adherence had significantly lower level of sperm concentration. However, no significant association was seen between eating patterns and other semen quality. Healthy dietary pattern seems to be associated with elevated sperm concentration level. Further longitudinal studies are needed to clarify this relationship.
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Affiliation(s)
- A Arab
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - N Rafie
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - M Mansourian
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - M Miraghajani
- National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - H Hajianfar
- Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
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Abstract
Introduction: Idiopathic oligoasthenoteratozoospermia (iOAT) is commonly encountered during the evaluation of men with infertility. Antioxidants have been utilized empirically in the treatment of iOAT based on their ability to reverse oxidative stress (OS)-induced sperm dysfunction often encountered in this patient population. Methods: A literature search was performed using MEDLINE/PubMed, focusing on publications of antioxidant therapies for iOAT. The main objective of our review article was to report the rationale and available evidence supporting the use of antioxidants. Results: Antioxidants such as glutathione, vitamins E and C, carnitines, coenzyme-Q10, N-acetylcysteine, selenium, zinc, folic acid, and lycopene have been shown to reduce OS-induced sperm damage. While rigorous scientific evidence in the form of double-blind, placebo-controlled clinical trials is limited, recent systematic reviews and meta-analyses have reported a beneficial effect of antioxidants on semen parameters and live birth rates. Conclusion: Additional randomized controlled studies are required to confirm the efficacy and safety of antioxidant supplementation in the medical treatment of idiopathic male infertility as well as the dosage required to improve semen parameters, fertilization rates, and pregnancy outcomes in iOAT.
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Affiliation(s)
- Ahmad Majzoub
- Department of Urology, Hamad Medical Corporation, Doha, Qatar
| | - Ashok Agarwal
- Center for Reproductive Medicine, Cleveland Clinic, Cleveland, USA
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Ahmadi S, Bashiri R, Ghadiri-Anari A, Nadjarzadeh A. Antioxidant supplements and semen parameters: An evidence based review. Int J Reprod Biomed 2016. [DOI: 10.29252/ijrm.14.12.729] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Sofimajidpour H, Ghaderi E, Ganji O. Comparison of the Effects of Varicocelectomy and Oral L-carnitine on Sperm Parameters in Infertile Men with Varicocele. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH : JCDR 2016; 10:PC07-10. [PMID: 27190879 DOI: 10.7860/jcdr/2016/18464.7557] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 02/29/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Varicocele is defined as dilated and twisted veins of the pampiniform plexus in the spermatic cord. It is the most common cause of male infertility. There are various medical and surgical procedures for the treatment of this disease. AIM This study was aimed to compare the effects of oral administration of L-Carnitine and varicocelectomy on spermogram parameters. MATERIALS AND METHODS This study was conducted as a double blind clinical trial without randomization. Inclusion criteria were, all married infertile men with varicocele. Patients chose their treatment personally and spermogram was carried out for all patients before and after the third and sixth months of treatment. Then, the sperm parameters of the two groups were compared using repeated measures ANOVA. RESULTS In our study, trend of sperm count in the surgery group changed from 22 to 28.61 million (vs 34.6 to 45.37 in L-Carnitine group), motility changed from 21.74 to 35.38 percent (vs 33.9 to 47.48 in L-Carnitine group), normal sperm morphology changed from 46.25 to 60 percent (vs 56.61 to 69.7 in L-Carnitine group) and volume of semen changed from 3.5 to 4.17 cc (vs 2.95 to 4.33 in L-Carnitine group). These values were not statistically different between the two groups. CONCLUSION Based on the results of this study, we can say that medicinal treatment by administration of oral L-Carnitine is as effective as varicocelectomy in improving semen parameters and can be used as an alternative to surgery for varicocele grade II.
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Affiliation(s)
- Heshmatollah Sofimajidpour
- Associate Professor, Department of Urology, Faculty of Medicine, Kurdistan University of Medical Sciences , Sanandaj, Iran
| | - Ebrahim Ghaderi
- Assistant Professor, Department of Epidemiology, Faculty of Medicine Kurdistan University of Medical Sciences , Sanandaj, Iran
| | - Omid Ganji
- General Physician, School of Medicine, Kurdistan University of Medical Sciences , Sanandaj, Iran
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Giahi L, Mohammadmoradi S, Javidan A, Sadeghi MR. Nutritional modifications in male infertility: a systematic review covering 2 decades. Nutr Rev 2016; 74:118-30. [PMID: 26705308 PMCID: PMC4892303 DOI: 10.1093/nutrit/nuv059] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 07/09/2015] [Accepted: 08/01/2015] [Indexed: 11/13/2022] Open
Abstract
CONTEXT Studies suggest that appropriate nutritional modifications can improve the natural conception rate of infertile couples. OBJECTIVES The purpose of this study was to review the human trials that investigated the relation between nutrition and male infertility. DATA SOURCES A comprehensive systematic review of published human studies was carried out by searching scientific databases. Article selection was carried out in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The American Dietetic Association Research Design and Implementation Checklist was also used for quality assessment. DATA EXTRACTION A total of 502 articles were identified, of which 23 studies met the inclusion criteria. DATA SYNTHESIS Results indicated that a healthy diet improves at least one measure of semen quality, while diets high in lipophilic foods, soy isoflavones, and sweets lower semen quality. CONCLUSION The role of daily nutrient exposure and dietary quality needs to be highlighted in male infertility. Mechanistic studies addressing the responsible underlying mechanisms of action of dietary modifications are highly warranted. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2013: CRD42013005953. Available at: http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42013005953.
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Affiliation(s)
- Ladan Giahi
- L. Giahi is with the Reproductive Biotechnology Research Center, Avicenna Research Institute, Academic Center for Education, Culture and Research, Tehran, Iran. S. Mohammadmoradi and A. Javidan are with the Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, Kentucky, USA. M.R. Sadeghi is with the Monoclonal Antibody Research Center, Avicenna Research Institute, Academic Center for Education, Culture and Research, Tehran, Iran.
| | - Shayan Mohammadmoradi
- L. Giahi is with the Reproductive Biotechnology Research Center, Avicenna Research Institute, Academic Center for Education, Culture and Research, Tehran, Iran. S. Mohammadmoradi and A. Javidan are with the Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, Kentucky, USA. M.R. Sadeghi is with the Monoclonal Antibody Research Center, Avicenna Research Institute, Academic Center for Education, Culture and Research, Tehran, Iran
| | - Aida Javidan
- L. Giahi is with the Reproductive Biotechnology Research Center, Avicenna Research Institute, Academic Center for Education, Culture and Research, Tehran, Iran. S. Mohammadmoradi and A. Javidan are with the Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, Kentucky, USA. M.R. Sadeghi is with the Monoclonal Antibody Research Center, Avicenna Research Institute, Academic Center for Education, Culture and Research, Tehran, Iran
| | - Mohammad Reza Sadeghi
- L. Giahi is with the Reproductive Biotechnology Research Center, Avicenna Research Institute, Academic Center for Education, Culture and Research, Tehran, Iran. S. Mohammadmoradi and A. Javidan are with the Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, Kentucky, USA. M.R. Sadeghi is with the Monoclonal Antibody Research Center, Avicenna Research Institute, Academic Center for Education, Culture and Research, Tehran, Iran
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Droździk M, Oronowicz K, Piasecka M, Kazienko A, Rosiak A, Gill K, Dziedziejko V, Safranow K, Kurzawa R, Kurzawski M. Organic cation/carnitine transporter OCTN2 (SLC22A5) -207C>G (rs2631367) polymorphism is not associated with male infertility. Reprod Biol 2015; 15:178-83. [PMID: 26370461 DOI: 10.1016/j.repbio.2015.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 05/05/2015] [Accepted: 06/06/2015] [Indexed: 10/23/2022]
Abstract
Carnitine is an important factor in the initiation of progressive sperm motility and end stage of sperm maturation. The compound is transported by an organic cation/carnitine transporter (OCTN2), which is expressed in the male reproductive system. OCTN2 is encoded by SLC22A5 gene with proven -207C>G functional polymorphism. The aim of the case-control study was to investigate a potential association between the -207C>G SLC22A5 polymorphism and male infertility. The -207C>G SLC22A5 polymorphism was determined by means of TaqMan assay in 206 infertile Caucasian males and 256 ethnically matched controls. Besides genotyping study, sperm mitochondrial function was assessed using NADH-dependent NBT assay. The distribution of SLC22A5 genotypes in infertile men was as follows: CC - 29.6%, CG - 53.9%, GG - 16.5% and in fertile men: CC - 32.0%, CG - 50.0%, GG - 18.0%, and was comparable in both evaluated groups. Likewise, the studied polymorphism did not affect sperm mitochondrial function. The results of the current study demonstrated that -207C>G polymorphism of the SLC22A5 gene is not associated with male infertility.
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Affiliation(s)
- Marek Droździk
- Department of Experimental and Clinical Pharmacology, Pomeranian Medical University, Powstańców Wlkp. 72, 70-111 Szczecin, Poland
| | - Katarzyna Oronowicz
- Department of Obstetrics and Gynecology, County Hospital, Mączna 4, 70-780 Szczecin, Poland
| | - Malgorzata Piasecka
- Department of Histology and Developmental Biology, Pomeranian Medical University, Żołnierska 48, 71-210 Szczecin, Poland
| | - Anna Kazienko
- Department of Reproductive Medicine and Gynecology, Pomeranian Medical University, Siedlecka 2, Police, Poland
| | - Aleksandra Rosiak
- Department of Histology and Developmental Biology, Pomeranian Medical University, Żołnierska 48, 71-210 Szczecin, Poland; VitroLive Fertility Clinic, Kasprzaka 2A, 71-074 Szczecin, Poland
| | - Kamil Gill
- Department of Histology and Developmental Biology, Pomeranian Medical University, Żołnierska 48, 71-210 Szczecin, Poland
| | - Violetta Dziedziejko
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Powstańców Wlkp. 72, 70-111 Szczecin, Poland
| | - Krzysztof Safranow
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Powstańców Wlkp. 72, 70-111 Szczecin, Poland
| | - Rafał Kurzawa
- Department of Reproductive Medicine and Gynecology, Pomeranian Medical University, Siedlecka 2, Police, Poland; VitroLive Fertility Clinic, Kasprzaka 2A, 71-074 Szczecin, Poland
| | - Mateusz Kurzawski
- Department of Experimental and Clinical Pharmacology, Pomeranian Medical University, Powstańców Wlkp. 72, 70-111 Szczecin, Poland.
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Garg H, Kumar R. Empirical Drug Therapy for Idiopathic Male Infertility: What is the New Evidence? Urology 2015; 86:1065-75. [PMID: 26255035 DOI: 10.1016/j.urology.2015.07.030] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 07/25/2015] [Accepted: 07/28/2015] [Indexed: 01/08/2023]
Abstract
Idiopathic male infertility is empirically managed using a number of drugs. We reviewed 64 articles published in the last 10 years on such drug therapy. There was severe heterogeneity in data along with poor definition of outcome parameters. Pregnancy or live birth rate was not reported in many studies. Antiestrogens appear to improve pregnancy rates while there is some data supporting the use of aromatase inhibitors. Antioxidants significantly increase the rate of both live birth and pregnancy but the data are limited. However, valid end-points based on data are limited for the empirical use of drugs in idiopathic male infertility.
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Affiliation(s)
- Harshit Garg
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajeev Kumar
- Department of Urology, All India Institute of Medical Sciences, New Delhi, India.
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Protective effects of l-carnitine on astheno- and normozoospermic human semen samples during cryopreservation. ZYGOTE 2015; 24:293-300. [DOI: 10.1017/s0967199415000180] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
SummaryThis study was conducted to determine the effects of l-carnitine (LC), as an antioxidant, in preventing spermatozoa damage during the freezing–thawing process in both astheno- and normozoospermic human semen samples. Seventy semen samples (37 asthenozoospermic and 33 normozoospermic) were involved in this study. Cryopreservation medium supplemented with 1.0 g/l LC was mixed with semen at a ratio of 1:1 (v/v). Controls were cryopreserved with freezing medium only. Assessment of motility, viability (VIA), mitochondrial membrane potential (MMP) and DNA fragmentation index (DFI) were performed on aliquots of fresh semen, frozen–thawed control and frozen–thawed LC treated samples. Supplementation of the cryopreservation medium with LC induced a significant improvement in post-thaw sperm parameters in both the asthenozoospermic and normozoospermic semen samples, compared with those of the control, regarding sperm fast forward motility, forward motility, total motility and VIA. LC showed better protective effects towards asthenozoospermia for DFI (F = 115.85, P < 0.01) and VIA (F = 67.14, P < 0.01) than did normozoospermic semen samples. We conclude that supplementation with LC prior to the cryopreservation process reduced spermatozoa cryodamage in both asthenozoospermic and normozoospermic semen samples. LC had better protective effects for asthenozoospermic human semen samples. Future research should focus on the molecular mechanism for and the different protective effects of LC between asthenozoospermic and normozoospermic semen samples during cryopreservation.
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Nada EA, El Taieb MA, Ibrahim HM, Al Saied AERA. Efficacy of tamoxifen andl-carnitine on sperm ultrastructure and seminal oxidative stress in patients with idiopathic oligoasthenoteratozoospermia. Andrologia 2014; 47:801-10. [DOI: 10.1111/and.12333] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2014] [Indexed: 01/04/2023] Open
Affiliation(s)
- E. A. Nada
- Department of Dermatology, Venereology and Andrology; Aswan Faculty of Medicine; Aswan University; Aswan Egypt
| | - M. A. El Taieb
- Department of Dermatology, Venereology and Andrology; Qina Faculty of Medicine; South Valley University; Qina Egypt
| | - H. M. Ibrahim
- Department of Dermatology, Venereology and Andrology; Qina Faculty of Medicine; South Valley University; Qina Egypt
| | - A. E.-R. A. Al Saied
- Department of Clinical Pathology; Qina Faculty of Medicine; South Valley University; Qina Egypt
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Belloc S, Hazout A, Zini A, Merviel P, Cabry R, Chahine H, Copin H, Benkhalifa M. How to overcome male infertility after 40: Influence of paternal age on fertility. Maturitas 2014; 78:22-9. [DOI: 10.1016/j.maturitas.2014.02.011] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 02/19/2014] [Accepted: 02/21/2014] [Indexed: 12/13/2022]
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Tang M, Liu BJ, Wang SQ, Xu Y, Han P, Li PC, Wang ZJ, Song NH, Zhang W, Yin CJ. The role of mitochondrial aconitate (ACO2) in human sperm motility. Syst Biol Reprod Med 2014; 60:251-6. [DOI: 10.3109/19396368.2014.915360] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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65
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Abdel-Khal A, Zaghlool H, Gabr SA. Performance and Semen Traits of Friesian Bulls Administrated with Free L-Carnitine
as Metabolic Regulator. ACTA ACUST UNITED AC 2014. [DOI: 10.3923/ajas.2015.13.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Showell MG, Mackenzie-Proctor R, Brown J, Yazdani A, Stankiewicz MT, Hart RJ. Antioxidants for male subfertility. Cochrane Database Syst Rev 2014:CD007411. [PMID: 25504418 DOI: 10.1002/14651858.cd007411.pub3] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Between 30% to 80% of male subfertility cases are considered to be due to the damaging effects of oxidative stress on sperm and 1 man in 20 will be affected by subfertility. Antioxidants are widely available and inexpensive when compared to other fertility treatments and many men are already using these to improve their fertility. It is thought that oral supplementation with antioxidants may improve sperm quality by reducing oxidative stress. Pentoxifylline, a drug that acts like an antioxidant, was also included in this review. OBJECTIVES This Cochrane review aimed to evaluate the effectiveness and safety of oral supplementation with antioxidants for subfertile male partners in couples seeking fertility assistance. SEARCH METHODS We searched the Cochrane Menstrual Disorders and Subfertility Group Specialised Register, CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO and AMED databases (from inception until January 2014); trial registers; sources of unpublished literature and reference lists. An updated search was run in August 2014 when potentially eligible studies were placed in 'Studies awaiting assessment'. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing any type or dose of antioxidant supplement (single or combined) taken by the subfertile male partner of a couple seeking fertility assistance with a placebo, no treatment or another antioxidant. DATA COLLECTION AND ANALYSIS Two review authors independently selected eligible studies, extracted the data and assessed the risk of bias of the included studies. The primary review outcome was live birth; secondary outcomes included clinical pregnancy rates, adverse events, sperm DNA fragmentation, sperm motility and concentration. Data were combined, where appropriate, to calculate pooled odds ratios (ORs) or mean differences (MD) and 95% confidence intervals (CIs). Statistical heterogeneity was assessed using the I(2) statistic. We assessed the overall quality of the evidence for the main outcomes using GRADE methods. MAIN RESULTS This updated review included 48 RCTs that compared single and combined antioxidants with placebo, no treatment or another antioxidant in a population of 4179 subfertile men. The duration of the trials ranged from 3 to 26 weeks with follow up ranging from 3 weeks to 2 years. The men were aged from 20 to 52 years. Most of the men enrolled in these trials had low total sperm motility and sperm concentration. One study enrolled men after varicocelectomy, one enrolled men with a varicocoele, and one recruited men with chronic prostatitis. Three trials enrolled men who, as a couple, were undergoing in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) and one trial enrolled men who were part of a couple undergoing intrauterine insemination (IUI). Funding sources were stated by 15 trials. Four of these trials stated that funding was from a commercial source and the remaining 11 obtained funding through non-commercial avenues or university grants. Thirty-three trials did not report any funding sources.A limitation of this review was that in a sense we had included two different groups of trials, those that reported on the use of antioxidants and the effect on live birth and clinical pregnancy, and a second group that reported on sperm parameters as their primary outcome and had no intention of reporting the primary outcomes of this review. We included 25 trials reporting on sperm parameters and only three of these reported on live birth or clinical pregnancy. Other limitations included poor reporting of study methods, imprecision, the small number of trials providing usable data, the small sample size of many of the included studies and the lack of adverse events reporting. The evidence was graded as 'very low' to 'low'. The data were current to 31 January 2014.Live birth: antioxidants may have increased live birth rates (OR 4.21, 95% CI 2.08 to 8.51, P< 0.0001, 4 RCTs, 277 men, I(2) = 0%, low quality evidence). This suggests that if the chance of a live birth following placebo or no treatment is assumed to be 5%, the chance following the use of antioxidants is estimated to be between 10% and 31%. However, this result was based on only 44 live births from a total of 277 couples in four small studies.Clinical pregnancy rate: antioxidants may have increased clinical pregnancy rates (OR 3.43, 95% CI 1.92 to 6.11, P < 0.0001, 7 RCTs, 522 men, I(2) = 0%, low quality evidence). This suggests that if the chance of clinical pregnancy following placebo or no treatment is assumed to be 6%, the chance following the use of antioxidants is estimated at between 11% and 28%. However, there were only seven small studies in this analysis and the quality of the evidence was rated as low.Miscarriage: only three trials reported on this outcome and the event rate was very low. There was insufficient evidence to show whether there was a difference in miscarriage rates between the antioxidant and placebo or no treatment groups (OR 1.74, 95% CI 0.40 to 7.60, P = 0.46, 3 RCTs, 247 men, I(2) = 0%, very low quality evidence). The findings suggest that in a population of subfertile men with an expected miscarriage rate of 2%, use of an antioxidant would result in the risk of a miscarriage lying between 1% and 13%.Gastrointestinal upsets: there was insufficient evidence to show whether there was a difference in gastrointestinal upsets when antioxidants were compared to placebo or no treatment as the event rate was very low (OR 1.60, 95% CI 0.47 to 5.50, P = 0.46, 6 RCTs, 429 men, I(2) = 0%).We were unable to draw any conclusions from the antioxidant versus antioxidant comparison as not enough trials compared the same interventions. AUTHORS' CONCLUSIONS There is low quality evidence from only four small randomised controlled trials suggesting that antioxidant supplementation in subfertile males may improve live birth rates for couples attending fertility clinics. Low quality evidence suggests that clinical pregnancy rates may increase. There is no evidence of increased risk of miscarriage but this is uncertain as the evidence is of very low quality. Data were lacking on other adverse effects. Further large well-designed randomised placebo-controlled trials are needed to clarify these results.
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Affiliation(s)
- Marian G Showell
- Obstetrics and Gynaecology, University of Auckland, Park Road Grafton, Auckland, New Zealand.
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Abstract
Nutraceuticals are food products that that can provide medical or health benefits by preventing or treating disease processes. The high costs associated with assisted reproductive techniques for male infertility have led consumers to find less expensive alternatives for potential treatment. Nutraceuticals are widely available and have many antioxidant properties. This articles reviews the current English literature regarding readily available nutraceuticals and their potential effects on male infertility and potential side effects with excess intake.
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Down-regulation of CatSper1 channel in epididymal spermatozoa contributes to the pathogenesis of asthenozoospermia, whereas up-regulation of the channel by Sheng-Jing-San treatment improves the sperm motility of asthenozoospermia in rats. Fertil Steril 2013; 99:579-87. [DOI: 10.1016/j.fertnstert.2012.10.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 10/11/2012] [Accepted: 10/17/2012] [Indexed: 01/05/2023]
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Hamada AJ, Montgomery B, Agarwal A. Male infertility: a critical review of pharmacologic management. Expert Opin Pharmacother 2012; 13:2511-31. [DOI: 10.1517/14656566.2012.740011] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Blanco JM, Cabo González JA. Evaluación de un compuesto de antioxidantes sobre los parámetros seminales de concentración, movilidad y morfología espermática en pacientes con oligoastenoteratozoospermia idiopática. Rev Int Androl 2011. [DOI: 10.1016/s1698-031x(11)70021-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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The role of antioxidant therapy in the treatment of male infertility: an overview. Asian J Androl 2011; 13:690-7. [PMID: 21685925 DOI: 10.1038/aja.2010.183] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
In recent years, many studies have focused on the effect of oxidative stress, reactive oxygen species (ROS) and antioxidants on the male eproductive system. Under physiological conditions, sperm produces small amounts of ROS, which are needed for fertilisation, acrosome reaction and capacitation. However, if an increased production of ROS is not associated with a similar increase in scavenging systems, peroxidative damage of the sperm plasma membrane and loss of DNA integrity typically occur, which leads to cell death and reduced fertility. Furthermore, since there is no linear correlation between sperm quality and pregnancy rates, an improvement in semen parameters should not be the sole outcome considered in studies of antioxidant therapies. A definitive conclusion regarding the benefit of these therapies is difficult to obtain, as most of the previous studies lacked control groups, considered different antioxidants in different combinations and doses, or did not evaluate pregnancy rates in previously infertile couples. Even if beneficial effects were reported in a few cases of male infertility, more multicentre, double-blind studies performed with the same criteria are necessary for an increased understanding of the effects of various antioxidants on fertility.
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73
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Gharagozloo P, Aitken RJ. The role of sperm oxidative stress in male infertility and the significance of oral antioxidant therapy. Hum Reprod 2011; 26:1628-40. [DOI: 10.1093/humrep/der132] [Citation(s) in RCA: 331] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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Zini A, Al-Hathal N. Antioxidant therapy in male infertility: fact or fiction? Asian J Androl 2011; 13:374-81. [PMID: 21516118 DOI: 10.1038/aja.2010.182] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Infertile men have higher levels of semen reactive oxygen species (ROS) than do fertile men. High levels of semen ROS can cause sperm dysfunction, sperm DNA damage and reduced male reproductive potential. This observation has led clinicians to treat infertile men with antioxidant supplements. The purpose of this article is to discuss the rationale for antioxidant therapy in infertile men and to evaluate the data on the efficacy of dietary and in vitro antioxidant preparations on sperm function and DNA damage. To date, most clinical studies suggest that dietary antioxidant supplements are beneficial in terms of improving sperm function and DNA integrity. However, the exact mechanism of action of dietary antioxidants and the optimal dietary supplement have not been established. Moreover, most of the clinical studies are small and few have evaluated pregnancy rates. A beneficial effect of in vitro antioxidant supplements in protecting spermatozoa from exogenous oxidants has been demonstrated in most studies; however, the effect of these antioxidants in protecting sperm from endogenous ROS, gentle sperm processing and cryopreservation has not been established conclusively.
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Affiliation(s)
- Armand Zini
- Division of Urology, Department of Surgery, Royal Victoria Hospital, McGill University, Montreal, Que. H3T 1M5, Canada.
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75
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Hwang K, Walters RC, Lipshultz LI. Contemporary concepts in the evaluation and management of male infertility. Nat Rev Urol 2011; 8:86-94. [PMID: 21243017 PMCID: PMC3654691 DOI: 10.1038/nrurol.2010.230] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Infertility in men is a common condition. At the core of the medical evaluation of the male partner in a couple who are unable to conceive is the history and physical examination. Special attention should be directed to the patient's developmental history and any use of testosterone products. The physical examination focuses on the genitals, and includes assessments of the size and consistency of the testicles, epididymis, vas deferens, and presence of varicoceles. Although many sophisticated tests are available, semen analysis is still the most important diagnostic tool used to assess fertility, and includes parameters such as sperm count, motility and viability. Treatment of male factor infertility can involve targeted agents, in the case of specific conditions such as hypogonadotropic hypogonadism, or it can be empirical-using medical therapy or assisted conception techniques-for patients in whom no underlying cause has been identified. Although an all-encompassing treatment for male factor infertility has not yet been developed, the field offers many promising avenues of research.
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Affiliation(s)
- Kathleen Hwang
- Scott Department of Urology, Baylor College of Medicine, 6624 Fannin Street, Suite 1700, Houston, TX 77030, USA
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76
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Abstract
BACKGROUND Between 30% to 80% of male subfertility cases are considered to be due to the damaging effects of oxidative stress on sperm. Oral supplementation with antioxidants may improve sperm quality by reducing oxidative stress. OBJECTIVES This Cochrane review aimed to evaluate the effect of oral supplementation with antioxidants for male partners of couples undergoing assisted reproduction techniques (ART). SEARCH STRATEGY We searched the Cochrane Menstrual Disorders and Subfertility Group Register, CENTRAL (The Cochrane Library), MEDLINE, EMBASE, CINAHL, PsycINFO and AMED databases (from their inception until Febuary 2010), trial registers, sources of unpublished literature, reference lists and we asked experts in the field. SELECTION CRITERIA We included randomised controlled trials comparing any type or dose of antioxidant supplement (single or combined) taken by the male partner of a couple seeking fertility assistance with placebo, no treatment or another antioxidant. The outcomes were live birth, pregnancy, miscarriage, stillbirth, sperm DNA damage, sperm motility, sperm concentration and adverse effects. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion and trial quality, and extracted data. MAIN RESULTS We included 34 trials with 2876 couples in total. Live birth: three trials reported live birth. Men taking oral antioxidants had an associated statistically significant increase in live birth rate (pooled odds ratio (OR) 4.85, 95% CI 1.92 to 12.24; P = 0.0008, I(2) = 0%) when compared with the men taking the control. This result was based on 20 live births from a total of 214 couples in only three studies.Pregnancy rate: there were 96 pregnancies in 15 trials including 964 couples. Antioxidant use was associated with a statistically significant increased pregnancy rate compared to control (pooled OR 4.18, 95% CI 2.65 to 6.59; P < 0.00001, I(2) = 0%).Side effects: no studies reported evidence of harmful side effects of the antioxidant therapy used. AUTHORS' CONCLUSIONS The evidence suggests that antioxidant supplementation in subfertile males may improve the outcomes of live birth and pregnancy rate for subfertile couples undergoing ART cycles. Further head to head comparisons are necessary to identify the superiority of one antioxidant over another.
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Affiliation(s)
- Marian G Showell
- Obstetrics and Gynaecology, University of Auckland, Park Road Grafton, Auckland, New Zealand
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77
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Abstract
The causes of male infertility may be identified, with the possibility of drugs treatment, or they may be idiopathic, for which treatments are at the research stage. The treatments available aim to increase the quantity and quality of spermatozoa produced by increasing their fertilising capacity and protecting their nuclear structure. Hormone treatments - recombinant FSH, purified FSH - give different results depending on whether studies examine semen parameters or fertilisation and pregnancy rates. In the case of non-hormone treatments (folates, zinc, vitamins E or C, selenium, glutathione and carnitine), the data in the literature is also contradictory and there is no clear consensus of opinion. However, the studies make use of highly variable methodologies and many of them are non-randomised. In terms of hygiene and dietary measures, tobacco, alcohol and excess weight have a negative effect on semen parameters and it is relevant to encourage patients to adopt a healthier lifestyle.
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Affiliation(s)
- P Fauque
- Service d'histologie-embryologie et biologie de la reproduction, groupe hospitalier Cochin - Saint-Vincent-de-Paul, 123, boulevard de Port-Royal, 75674 Paris cedex 14, France.
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Ross C, Morriss A, Khairy M, Khalaf Y, Braude P, Coomarasamy A, El-Toukhy T. A systematic review of the effect of oral antioxidants on male infertility. Reprod Biomed Online 2010; 20:711-23. [DOI: 10.1016/j.rbmo.2010.03.008] [Citation(s) in RCA: 131] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2009] [Revised: 12/09/2009] [Accepted: 02/04/2010] [Indexed: 12/25/2022]
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79
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Nieschlag E, Kamischke A. Empirical Therapies for Idiopathic Male Infertility. Andrology 2010. [DOI: 10.1007/978-3-540-78355-8_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kong XB, Ma HG, Li HG, Xiong CL. Blockade of epithelial sodium channels improves sperm motility in asthenospermia patients. ACTA ACUST UNITED AC 2009; 32:330-6. [DOI: 10.1111/j.1365-2605.2008.00864.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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LACKNER J, MARK I, SATOR K, HUBER J, SATOR M. Effect of leukocytospermia on fertilization and pregnancy rates of artificial reproductive technologies. Fertil Steril 2008; 90:869-71. [DOI: 10.1016/j.fertnstert.2007.07.1310] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2007] [Revised: 07/10/2007] [Accepted: 07/10/2007] [Indexed: 10/22/2022]
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82
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Abstract
Although reports have suggested the benefit of antioxidant treatment of infertile men, many studies also show no effect. Most studies in the literature are not randomized, placebo controlled, or double blinded in design, which makes it difficult to differentiate regression toward the mean from true positive treatment effects. The small patient sample sizes and varying male populations also add to the difficulty in comparing studies. Pregnancy, the most relevant outcome parameter, is rarely reported. Ideally, patients would be selected based on oxidative stress levels, and improvement in these levels would be correlated to improvement in pregnancy rates. Until those studies are performed, the use of antioxidants for the treatment of male infertility remains empiric.
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Affiliation(s)
- Sutchin R Patel
- The Warren Alpert Medical School of Brown University, Division of Urology, Rhode Island Hospital, Box G-A Providence, RI 02912, USA
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83
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Jorsaraei SGA, Yousefnia YR, Zainalzadeh M, Moghadamnia AA, Beiky AA, Damavandi MR. The effects of methanolic extracts of ginger (Zingiber officinale) on human sperm parameters; an in vitro study. Pak J Biol Sci 2008; 11:1723-7. [PMID: 18819626 DOI: 10.3923/pjbs.2008.1723.1727] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This study was conducted on Zingiber officinale or ginger on motility, grading and morphological aspects of human sperm. Thirty human semen samples were obtained from the local hospital. The samples were swim up by Ham's F10. The samples (0.9 mL) were treated by 0.1 mL of ginger methanolic extracts (0.1, 0.2, 0.4 and 0.6% concentration). Sperm motility, grading and morphology parameters were assessed using light microscope at 0, 2, 4, 8 and 24 h after treatment. Dose and time-dependent decreases in motility accompanied by concomitant decrease in grading 3 and 4 were noticed. Morphologic profiles of the sperms were changed under different doses of ginger on the basis of time of assess. These data indicate that some exhibits a lower percentage of motility and grading when methanolic ginger is added to semen fluid. According to the results it would be concluded that ginger can induce the toxic effects on sperm parameters.
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Affiliation(s)
- S G A Jorsaraei
- Department of Fertility and Infertility, Fateme Zahra Hospital, Babol University of Medical Sciences, Babol, Iran
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