Intervention Review

Antioxidants for male subfertility

  1. Marian G Showell1,*,
  2. Julie Brown1,
  3. Anusch Yazdani2,
  4. Marcin T Stankiewicz3,
  5. Roger J Hart4

Editorial Group: Cochrane Menstrual Disorders and Subfertility Group

Published Online: 19 JAN 2011

Assessed as up-to-date: 22 AUG 2010

DOI: 10.1002/14651858.CD007411.pub2

Database Title

Additional Information

How to Cite

Showell MG, Brown J, Yazdani A, Stankiewicz MT, Hart RJ. Antioxidants for male subfertility. Cochrane Database of Systematic Reviews 2011, Issue 1. Art. No.: CD007411. DOI: 10.1002/14651858.CD007411.pub2.

Author Information

  1. 1

    University of Auckland, Obstetrics and Gynaecology, Auckland, New Zealand

  2. 2

    University of Queensland, Queensland Fertility Group Research Foundation, Brisbane, Queensland, Australia

  3. 3

    Flinders Reproductive Medicine, Reproductive Medicine, Bedford Park, Australia

  4. 4

    The University of Western Australia, King Edward Memorial Hospital and Fertility Specialists of Western Australia, School of Women's and Infants Health, Subiaco, Western Australia, Australia

*Marian G Showell, Obstetrics and Gynaecology, University of Auckland, Park Road Grafton, Auckland, New Zealand. m.showell@auckland.ac.nz.

Publication History

  1. Publication Status: Edited (no change to conclusions), comment added to review
  2. Published Online: 19 JAN 2011

SEARCH

ARTICLE TOOLS

View Full Article (HTML) Summary (59K)Standard (1873K)Full (2313K)
 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Resumen

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 methods

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EMBASE, CINAHL, PsycINFO and AMED databases (from their inception until Febuary 2010), trial registers, sources of unpublished literature, reference lists and we asked experts in the field.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 a 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 a statistically significant increase in live birth rate (pooled odds ratio (OR) 4.85, 95% CI 1.92 to 12.24; P = 0.0008, I2 = 0%) when compared with the men taking the control. However, this result was based on only 20 live births from a total of 214 couples in three small 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, I2 = 0%).

Side effects: no studies reported evidence of harmful side effects of the antioxidant therapy used.

Authors' conclusions

Preliminary evidence from three small randomised controlled trials suggests that antioxidant supplementation in subfertile males may improve live birth rates for subfertile couples undergoing ART cycles. However, further large well-designed randomised placebo-controlled trials are needed to confirm this.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Resumen

Antioxidants for male subfertility

Oxidative stress may cause sperm cell damage. This damage can be reduced by the body's own natural antioxidant defences. Antioxidants can be part of our diet and taken as a supplement. It is believed that in many cases of unexplained subfertility, and also in instances where there may be a sperm-related problem, taking an oral antioxidant supplement may increase a couple's chance of conceiving when undergoing fertility treatment. This review identified 34 randomised controlled trials involving 2876 couples. Pooled findings from three small trials suggest an increase in live birth rates for the partners of subfertile men taking an antioxidant supplement as part of an assisted reproductive program. However, further well-designed large randomised placebo-controlled trials are needed to confirm these findings.

 

Resumen

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. Resumen

Antecedentes

Antioxidantes para la subfertilidad masculina

Se considera que entre el 30% y el 80% de los casos de subfertilidad masculina se debe a los efectos perjudiciales del estrés oxidativo sobre el esperma. La administración oral de suplementos con antioxidantes puede mejorar la calidad del esperma al reducir el estrés oxidativo.

Objetivos

Esta revisión Cochrane tiene como objetivo evaluar el efecto de la administración oral de suplementos con antioxidantes para los miembros masculinos de las parejas tratadas con técnicas de reproducción asistida (TRA).

Estrategia de búsqueda

Se hicieron búsquedas en el Registro Especializado de Ensayos Controlados del Grupo Cochrane de Trastornos Menstruales y Subfertilidad (Cochrane Menstrual Disorders and Subfertility Group), CENTRAL (Cochrane Library), MEDLINE, EMBASE, CINAHL, PsycINFO y AMED databases (desde su inicio hasta febrero 2010), registros de ensayos, fuentes de literatura no publicada, listas de referencias y se preguntó a expertos en el área.

Criterios de selección

Se incluyeron ensayos controlados con asignación aleatoria que compararan cualquier tipo o dosis de suplemento antioxidante (solo o combinado) administrado al miembro masculino de la pareja que solicita fertilidad asistida con placebo, ningún tratamiento u otro antioxidante. Las medidas de resultado fueron nacido vivo, embarazo, aborto espontáneo, mortinatos, daño al ADN de los espermatozoides, motilidad de los espermatozoides, concentración de espermatozoides y efectos adversos.

Obtención y análisis de los datos

Dos autores de la revisión, de forma independiente, evaluaron los estudios para su inclusión, analizaron la calidad de los mismos y extrajeron los datos.

Resultados principales

Se incluyeron 34 ensayos con 2 876 parejas en total.

Nacidos vivos: tres ensayos informaron nacidos vivos. Los hombres que recibieron antioxidantes orales tuvieron un aumento asociado estadísticamente significativo en la tasa de nacidos vivos (odds ratio agrupado [OR] 4,85, IC del 95%: 1,92 a 12,24; P = 0,0008, I2 = 0%) en comparación con los hombres del grupo control. Este resultado se basó en 20 nacidos vivos de 214 parejas en sólo tres estudios.

Tasa de embarazo: hubo 96 embarazos en 15 ensayos que incluyeron 964 parejas. El uso de antioxidantes se asoció con un aumento estadísticamente significativo en la tasa de embarazo (OR agrupado 4,18, IC del 95%: 2,65 a 6,59; P < 0,00001, I2 = 0%).

Efectos secundarios: ningún estudio informó pruebas de efectos secundarios perjudiciales del tratamiento con antioxidantes utilizado.

Conclusiones de los autores

Las pruebas indican que la administración de suplementos con antioxidantes a los hombres con subfertilidad puede mejorar los resultados de nacidos vivos y la tasa de embarazo en parejas con subfertilidad a las que se les realizan ciclos de TRA. Se necesitan comparaciones directas adicionales para identificar la superioridad de un antioxidante sobre otro.

Traducción

Traducción realizada por el Centro Cochrane Iberoamericano

View Full Article (HTML) Summary (59K)Standard (1873K)Full (2313K)