ANTIOXIDANT THERAPY FOR MALE INFERTILITY – 3 MONTH OR 6 MONTHS: WHICH IS BETTER?

Abstract

Oxidative stress (OS) plays a pivotal role in the pathogenesis of male subfertility/infertility. Hence, oral supplementation with antioxidants (AOXs) is thought to improve sperm quality by reducing oxidative damage. Interestingly, a recent global survey of 1327 reproductive specialists from 88 countries indicated that AOXs are routinely prescribed by 85.6% of clinicians, for 3 months (43.7%) or between 3–6 months (38.6%). However, the impact of the duration of AOX therapy on reproduction is unclear. This study aims to investigate the effect of duration of AOX therapy on sperm parameters in subfertile men. We reviewed the scientific literature to include studies investigating the use of AOX therapy in male subfertility/infertility, regardless of the type of AOX or the dosage used, measuring sperm parameters before and after treatment. We statistically compared the changes in sperm parameters following AOX therapy at 3 and 6 months. Eight studies on various AOX components (vitamins C and E, L-carnitine, folic acid, Coenzyme Q10, zinc and selenium), with a total population of 278 subfertile men, were eligible for inclusion in the study. Five studies reported significant improvement in sperm concentration, motility, and morphology at 3 and 6 months compared to the base-line values. The average percentage change in parameters at 3 months vs 6 months was not statistically significant for sperm concentration (32.3% vs 53.8%, p=0.261), sperm motility (29.4 % vs 43.5%, p=0.190), progressive sperm motility (21.6% vs 36.7%, p=0.529), morphology (37.3% vs 38.9%, p=0.938). This study found no statistically significant difference in semen parameter when using AOX for 3 or 6 months. Hence, there seems to be no justification in using AOX therapy beyond 3 months in absence if no improvement in semen parameters is observed. However, studies have shown a non-statistical trend towards further improvement in semen parameters when therapy was continued for 6 months. Future studies utilizing serial measurements of oxidative stress during AOX treatment would be valuable in addressing this uncertainty.