Impact of Antioxidant Therapy on Natural Pregnancy Outcomes and Semen Parameters in Infertile Men: A Systematic Review and Meta-Analysis of Randomized Controlled Trials - Archive ouverte HAL Accéder directement au contenu
Article Dans Une Revue The World Journal of Men's Health Année : 2023

Impact of Antioxidant Therapy on Natural Pregnancy Outcomes and Semen Parameters in Infertile Men: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Ramadan Abdou Saleh
Ahmed M. Harraz
Hussein Kandil
  • Fonction : Auteur
Gianmaria Salvio
Shinnosuke Kuroda
  • Fonction : Auteur
Ala'a N. Farkouh
  • Fonction : Auteur
Amarnath Rambhatla
  • Fonction : Auteur
Armand S. Zini
  • Fonction : Auteur
Giovannimaria Colpi
  • Fonction : Auteur
Murat Gül
  • Fonction : Auteur
Parviz Keikhosrow Kavoussi
  • Fonction : Auteur
Taha Abo Almagd Abdel Meguid Hamoda
Edmund Yuey Kun Ko
Gökhan Calik
Tuncay Toprak
  • Fonction : Auteur
Germar Michael Pinggera
Hyunjun Park
Ramy Ghayda
  • Fonction : Auteur
Suks S. Minhas
  • Fonction : Auteur
Gian Maria Busetto
Mustafa Emre Bakircioǧlu
Ateş Kadioglu
  • Fonction : Auteur
Eric Chung
  • Fonction : Auteur
Giorgio Ivan Russo
Aldo E. Calogero
Rafael Favero Ambar
  • Fonction : Auteur
Channa N.L. Jayasena
Rupin S. Shah
  • Fonction : Auteur

Résumé

Purpose: Seminal oxidative stress (OS) is a recognized factor potentially associated with male infertility, but the efficacy of antioxidant (AOX) therapy is controversial and there is no consensus on its utility. Primary outcomes of this study were to investigate the effect of AOX on spontaneous clinical pregnancy, live birth and miscarriage rates in male infertile patients. Secondary outcomes were conventional semen parameters, sperm DNA fragmentation (SDF) and seminal OS. Materials and Methods: Literature search was performed using Scopus, PubMed, Ovid, Embase, and Cochrane databases. Only randomized controlled trials (RCTs) were included and the meta-analysis was conducted according to PRISMA guidelines. Results: We assessed for eligibility 1,307 abstracts, and 45 RCTs were finally included, for a total of 4,332 infertile patients. We found a significantly higher pregnancy rate in patients treated with AOX compared to placebo-treated or untreated controls, without significant inter-study heterogeneity. No effects on live-birth or miscarriage rates were observed in four studies. A significantly higher sperm concentration, sperm progressive motility, sperm total motility, and normal sperm morphology was found in patients compared to controls. We found no effect on SDF in analysis of three eligible studies. Seminal levels of total antioxidant capacity were significantly higher, while seminal malondialdehyde acid was significantly lower in patients than controls. These results did not change after exclusion of studies performed following varicocele repair. Conclusions: The present analysis upgrades the level of evidence favoring a recommendation for using AOX in male infertility to improve the spontaneous pregnancy rate and the conventional sperm parameters. The failure to demonstrate an increase in live-birth rate, despite an increase in pregnancy rates, is due to the very few RCTs specifically assessing the impact of AOX on live-birth rate. Therefore, further RCTs assessing the impact of AOX on live-birth rate and miscarriage rate, and SDF will be helpful.
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Dates et versions

hal-04122365 , version 1 (22-06-2023)

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Ashok K. Agarwal, Rossella Cannarella, Ramadan Abdou Saleh, Ahmed M. Harraz, Hussein Kandil, et al.. Impact of Antioxidant Therapy on Natural Pregnancy Outcomes and Semen Parameters in Infertile Men: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. The World Journal of Men's Health, 2023, 41 (1), pp. 14-48. ⟨10.5534/wjmh.220067⟩. ⟨hal-04122365⟩
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