학술논문
Impact of Antioxidant Therapy on Natural Pregnancy Outcomes and Semen Parameters in Infertile Men: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Document Type
Article
Author
Agarwal Ashok; Cannarella Rossella; Saleh Ramadan; Harraz Ahmed M.; Kandil Hussein; Salvio Gianmaria; Boitrelle Florence; Kuroda Shinnosuke; Farkouh Ala’a; Rambhatla Amarnath; Zini Armand; Colpi Giovanni; Gül Murat; Kavoussi Parviz; Hamoda Taha Abo-Almagd Abdel-Meguid; Ko Edmund; Calik Gokhan; Toprak Tuncay; Pinggera Germar-Michael; Park Hyun Jun; Ghayda Ramy Abou; Minhas Suks; Busetto Gian Maria; Bakırcıoğlu Mustafa Emre; Kadioglu Ates; Chung Eric; Russo Giorgio Ivan; Calogero Aldo E.; Ambar Rafael F.; Jayasena Channa N.; Shah Rupin
Source
The World Journal of Men's Health, 41(1), pp.14-48 Jan, 2023
Subject
Language
English
ISSN
2287-4690
2287-4208
2287-4208
Abstract
Purpose: Seminal oxidative stress (OS) is a recognized factor potentially associated with male infertility, but the efficacy of antioxidant (AOX) therapy is controversial and there is no consensus on its utility. Primary outcomes of this study were to in-vestigate the effect of AOX on spontaneous clinical pregnancy, live birth and miscarriage rates in male infertile patients. Sec-ondary outcomes were conventional semen parameters, sperm DNA fragmentation (SDF) and seminal OS. Materials and Methods: Literature search was performed using Scopus, PubMed, Ovid, Embase, and Cochrane databases. Only randomized controlled trials (RCTs) were included and the meta-analysis was conducted according to PRISMA guide-lines. Results: We assessed for eligibility 1,307 abstracts, and 45 RCTs were finally included, for a total of 4,332 infertile patients. We found a significantly higher pregnancy rate in patients treated with AOX compared to placebo-treated or untreated con-trols, without significant inter-study heterogeneity. No effects on live-birth or miscarriage rates were observed in four studies. A significantly higher sperm concentration, sperm progressive motility, sperm total motility, and normal sperm morphology was found in patients compared to controls. We found no effect on SDF in analysis of three eligible studies. Seminal levels of total antioxidant capacity were significantly higher, while seminal malondialdehyde acid was significantly lower in patients than controls. These results did not change after exclusion of studies performed following varicocele repair. Conclusions: The present analysis upgrades the level of evidence favoring a recommendation for using AOX in male infertility to improve the spontaneous pregnancy rate and the conventional sperm parameters. The failure to demonstrate an increase in live-birth rate, despite an increase in pregnancy rates, is due to the very few RCTs specifically assessing the impact of AOX on live-birth rate. Therefore, further RCTs assessing the impact of AOX on live-birth rate and miscarriage rate, and SDF will be helpful.