From: Utility of antioxidants during assisted reproductive techniques: an evidence based review
Antioxidant | Study type | Patient population | Intervention (daily dose x duration) | Control group (daily dose) | Study outcome (effect on sperm parameters) | Reference |
---|---|---|---|---|---|---|
Vitamin E | Double blind, placebo cross-over, RCT | Healthy men with high seminal ROS levels (n = 30) | 600 mg vitamin E x 3 months (n = 15) | Placebo (n = 15) | Improved in vitro sperm function (improved zona-binding assay) | Kessopoulou et al. [101] |
Vitamin E | Double blind, placebo-controlled | Men with (n = 110) asthenozoospermia or oligoasthenozoospermia | 300 mg vitamin E x 6 months (n = 52) | Placebo (n = 55) | 1. Reduced MDA concentration (less LPO in spermatozoa) | Suleiman et al. [102] |
2. Improved sperm motility | ||||||
3. 20% of those on therapy achieved pregnancy | ||||||
Vitamin E + Anti-Estrogen (Clomiphene citrate) | Prospective, placebo-controlled RCT | Infertile men with idiopathic oligozoospermia (n = 60) | 400 mg vitamin E +25 mg clomiphene citrate x 6 months (n = 30) | Placebo (n = 30) | 1. Improved sperm count and progressive motility | Ghanem et al. [103] |
2. Partners had higher incidence of pregnancy | ||||||
Vitamin E + selenium | Open, randomized | Volunteers and infertile men (n = 54) | 400 mg vitamin E +225 μg selenium x 3 months (n = 28) | 4.5 g vitamin B x 3 months (n = 26) | 1. Reduced MDA concentration (less LPO in spermatozoa) | Keskes-Ammar et al. [104] |
2. Improved sperm motility | ||||||
Vitamin E + selenium | Observational study | Infertile men with idiopathic asthenozoospermia (n = 690) | 400 IU vitamin E +200 μg selenium x 100 days | None | 1. Improvement in sperm motility/morphology or both (53%) | Moslemi & Tavanbakhsh [105] |
2. Increased spontaneous pregnancy rates (11%) | ||||||
Vitamin E + Vitamin C | Double blind, placebo-controlled, RCT | Men (n = 31) with asthenozoospermia or moderate oligoasthenozoospermia | 1000 mg vitamin C +800 mg vitamin E x 8 weeks (n = 15) | Placebo (n = 16) | No improvement in sperm parameters | Rolf et al. [106] |
No improvement in 24Â h sperm survival rate | ||||||
Vitamin E + Vitamin C | Observational study, double-blind | Men with elevated sperm DNA fragmentation (≥15%) who have unexplained infertility | 1000 mg vitamin C +1000 mg vitamin E x 2 months (n = 32) | Placebo (n = 32) | Reduced percentage of DNA-fragmented sperm (TUNEL test) | Greco et al. [107] |
Vitamin E + Vitamin C | Observational study involving assisted conception treatment | Men with elevated sperm DNA fragmentation (≥15%) who failed their 1st ICSI attempt | 1000 mg vitamin C +1000 mg vitamin E x 2 months (n = 38) | None | 1. Reduced percentage of DNA-fragmented sperm (TUNEL test) | Greco et al. [108] |
2. Marked improvement in implantation and clinical pregnancy rates in the 2nd ICSI attempt vs 1st attempt | ||||||
Vitamin C |  | Men with sperm agglutination (>25%) (n = 30) | 200 mg vitamin C or 1000 mg vitamin C | Placebo | Improved sperm motility, viability, morphology after 4 weeks (more prominent improvement in 1000 mg vitamin C vs. 200 mg vitamin C) | Dawson et al. [109] |
Vitamin C |  | Men who are heavy smokers (n = 75) with normal reproductive function | 200 mg vitamin C or 1000 mg vitamin C | Placebo | 1. Improved sperm agglutination | Dawson et al. [110] |
2. Improved 24Â h viability | ||||||
3. Improved sperm morphology | ||||||
Folic acid + zinc sulphate | Double blind, placebo-controlled, RCT | Fertile (n = 108) and subfertile men (n = 103) | 5 mg folic acid, 66 mg zinc sulphate or 5 mg folic acid +66 mg zinc sulphate x 26 weeks | Placebo or placebo + placebo | Increased sperm concentration in subfertile and fertile males after combined treatment | Wong et al. [111] |
Folic acid + zinc sulphate | Double blind, placebo-controlled | Fertile (n = 47) and subfertile men (n = 40) | 5 mg folic acid +66 mg zinc sulphate x 26 weeks | Placebo | Increased sperm concentration in infertile males, but not fertile males | Ebisch et al. [112] |
Folic acid + zinc sulphate | Double blind, placebo controlled, RCT | Subfertile men with OAT (n = 83) | 5 mg folic acid +220 mg zinc sulphate x16 weeks | Placebo | Zinc sulfate + folic acid did not improve sperm quality in men with OAT (severely compromised sperm parameters) | Raigani et al. [113] |
Folic acid + zinc sulphate | Prospective, randomized controlled | Men with palpable varicocele (grade III) who underwent surgical repair of varicocele (n = 160) | 5 mg folic acid (n = 26), 66 mg zinc sulphate (n = 32) or 5 mg folic acid +66 mg zinc sulphate (n = 29) x 6 months | Placebo (n = 25) | 1. Zinc sulfate + folic acid improved sperm parameters and improved varicocelectomy outcomes | Azizollahi et al. [114] |
2. Improved protamine content and halo formation rate | ||||||
Coenzyme Q 10 | Systematic review and meta-analysis (3 RCTs) | Infertile men | CoQ10 (n = 149) | Controls (n = 147) | 1. Improved seminal CoQ10 levels | Lafuente et al. [115] |
2. Increased sperm concentration | ||||||
3. Increased sperm motility | ||||||
4. No increase in pregnancy rates | ||||||
5. Data on live births were lacking | ||||||
Coenzyme Q 10 | Double blind, placebo-controlled, RCT | Men with iOT (n = 60) | 200 mg CoQ10 x 3 months (n = 30) | Placebo (Lactose) (n = 30) | 1. Increased levels of CoQ10 in seminal plasma | Nadjarzadeh et al. [116] |
2. Decreased 8-isoprostane levels (biomarker of LPO) (attenuation of OS in seminal plasma) | ||||||
3. Increased sperm forward and total motility | ||||||
4. Increased catalase, SOD activity | ||||||
Coenzyme Q 10 | Double blind, placebo-controlled, RCT | Men with iOAT (n = 47) | 200 mg CoQ10 x 12 weeks | Placebo | 1. Reduced TBARS (reduced plasma MDA levels) | Nadjarzadeh et al. [117] |
2. Increased TAC in seminal plasma | ||||||
Coenzyme Q 10 | Double blind, placebo-controlled, RCT | Men with iOAT (n = 228) | 200 mg ubiquinol x 26 weeks (n = 114) | Placebo (n = 114) | Improved sperm quality (density, motility, normal strict morphology) | Safarinejad et al. [118] |
Coenzyme Q 10 | Double blind, placebo-controlled, RCT | Men with idiopathic infertility (n = 60) | 200 mg CoQ10 x 6 months | Placebo | 1. Increase in CoQ10 and ubiquinol in seminal plasma and spermatozoa | Balercia et al. [119] |
2. Increase in spermatozoa motility | ||||||
Coenzyme Q 10 | Prospective | Men with iOAT (n = 212) | 300 mg CoQ10 x 26 weeks (n = 106) | Placebo (n = 106) | 1. Improved sperm density, motility, normal strict morphology | Safarinejad [120] |
2. Improved acrosome reaction | ||||||
Coenzyme Q 10 | Open-label, prospective | Men with iOAT (n = 287) | 600 mg CoQ10 x 12 months (n = 106) | None | 1. Improved sperm quality (concentration, progressive motility, normal morphology) | Safarinejad [121] |
2. Improved pregnancy rates |