Abstract
Some 30% to 80% of male sub-fertility may be associated with oxidative stress that damages spermatozoa and can decrease success of in vitro fertilization (IVF) techniques. This multicenter, longitudinal, prospective study aimed to investigate whether oral antioxidant supplementation improved the reproductive competence of men who had had low fertilization rates in their previous intracytoplasmic sperm injection (ICSI) cycles without azoospermia or severe oligozoospermia or any identifiable andrological disease. Seventy-seven men from couples who had an ICSI attempt with unexplained <60% fertilization rate took an antioxidant mix of myo-inositol, alpha-lipoic acid, folic acid, coenzyme Q10, zinc, selenium, and vitamins B2, B6, and B12. Semen parameters were analyzed before (T0) and after 90 days (T90) of treatment, and outcomes of the paired T0 and T90 cycles were compared. After the treatment there was an increase in sperm concentration (p = 0.027), total motile sperm count (p = 0.003), progressive motility (p < 0.0001), and a decreasing trend of DNA-fragmented spermatozoa. Embryological outcomes (fertilization, embryo quality, blastocyst development) were significantly higher in T90 than T0 cycles. No T0 cycle resulted in an evolutive pregnancy. Conversely, in T90 cycles 29 singleton clinical pregnancies were obtained. No negative neonatal outcomes were recorded in newborns after antioxidant treatment. Diet supplementation of men who have had low fertilization rates in their previous ICSI cycles with a combination of myo-inositol, alpha-lipoic acid, folic acid, coenzyme Q10, zinc, selenium, betaine, and vitamins may improve semen reproductive potential and ICSI clinical outcome.
Highlights
We previously reported that a mixture of nutraceuticals significantly improved sperm parameters in subfertile men [15]
Fertilization failure in in vitro fertilization (IVF) treatments has mainly been attributed to oocyte activation deficiencies that can be caused by both oocyte and sperm related factors [20]
We proved that combined treatment with myo-inositol, alpha-lipoic acid, folic acid, betaine, and vitamins of sub-fertile men significantly improved their sperm parameters [15]
Summary
Alterations in sperm number, motility, and morphology may be related to various factors, i.e., varicocele, cryptorchidism, hypogonadism, infections, traumas, tumors, smoke, or exposure to environmental agents. Such conditions are associated with decreased fertility (e.g., up to 10% of patients with unilateral undescended testis will develop infertility, and varicoceles occur in about 40% of infertile males) because they burden testicular function, negatively affecting sperm quality and spermatogenesis overall. 25–30% of infertile patients’ etiology is not clear [1], and between 30% to 80% of male sub-fertility may be associated with oxidative stress (OS) [2]
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