Mora-Esteves, C., & Shin, D. (2013). Nutrient supplementation: improving male fertility fourfold. Seminars in Reproductive Medicine, 31(4), 293-300. https://doi.org/10.1055/s-0033-1345277
Mora-Esteves C, Shin D. Nutrient supplementation: improving male fertility fourfold. Semin Reprod Med. 2013;31(4):293-300. doi:10.1055/s-0033-1345277
Mora-Esteves, Cesar, and David Shin. "Nutrient supplementation: improving male fertility fourfold." Seminars in Reproductive Medicine, vol. 31, no. 4, 2013, pp. 293-300.
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Division of Urology, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
Linked to ROR, the Research Organization Registry
RRM Academy Synopsis
Male antioxidants may raise pregnancy odds in assisted reproduction
Pregnancy odds were 4.18 times higher across 15 assisted reproduction trials of male antioxidants, in a Cochrane analysis cited by a 2013 urology review. The analysis pooled 34 randomized trials in 2,876 couples. The authors say larger trials are needed.
Study at a glance, narrative review of 2,876 couples: A review cites Cochrane data on male antioxidants and pregnancy odds. Source: Mora-Esteves C et al., 2013, PMID 23775385.
Key Findings
The Cochrane analysis combined 34 randomized trials covering 2,876 couples. Its main result was live birth per couple.
Live birth odds with antioxidants versus placebo: pooled odds ratio 4.85 (95% CI 1.92 to 12.24, p = 0.0008), from three trials.
Pregnancy odds in couples having assisted reproduction: pooled odds ratio 4.18 (95% CI 2.65 to 6.59, p < 0.0001), from 15 trials with 96 pregnancies among 964 couples.
Cochrane rated the evidence on sperm quality as low quality and drew no conclusions about it.
The review's authors write that a definitive conclusion cannot be drawn from the heterogeneous literature and that more randomized trials are needed.
Interpretation
The paper is a narrative review that summarizes earlier studies. Its headline numbers come from one Cochrane meta-analysis, a pooled analysis of randomized trials in couples having assisted reproduction where the male partner had reduced fertility. The live birth result rests on three trials, and its confidence interval is wide. An odds ratio compares the odds of an outcome between two groups. The authors add that most drug therapies for male infertility are not standardized because randomized evidence to support them is lacking. Antioxidants stay in use because of low cost and relatively low toxicity.
RRM Context
The trials tracked couples having assisted reproduction, which bypasses the question of why sperm function is low. The review reports a male factor in around 40% of couples and no identifiable cause in nearly 25%. Restorative reproductive medicine asks the cause question for both partners. Oxidative stress in semen is one possible answer to investigate.
Our editorial summary of this paper, not the article's abstract.
Abstract
Oxidative stress can contribute to impairment in spermatogenesis leading to male-factor infertility. The effectiveness of various antioxidants (such as carnitine, vitamin C, vitamin E, selenium, carotenoids, glutathione, N-acetylcysteine, zinc, folic acid, and coenzyme Q10) is variable with respect to improving semen parameters and pregnancy rates. A recent Cochrane review determined that men taking antioxidants had a statistically significant increase in both live birth rates and pregnancy rates. For those undergoing assisted reproduction, the odds ratio that antioxidant use would improve pregnancy rates was 4.18, with a 4.85-fold improvement in live birth rate also noted. Further investigation with randomized, controlled clinical trials is needed to confirm the safety and efficacy of antioxidant supplementation in the medical management and treatment of male infertility.
