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The Effect of Antioxidants on Sperm Quality Parameters and Pregnancy Rates for Idiopathic Male Infertility: A Network Meta-Analysis of Randomized Controlled Trials.
Li, KP, Yang, XS, Wu, T
Frontiers in endocrinology. 2022;13:810242
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Male infertility has gradually increased in recent years and is thought to be an equal contributor alongside female infertility in fertility issues. An imbalance in reactive oxygen species, which can damage sperm cells and the protective antioxidants is thought to be a major contributor to male infertility. This meta-analysis of randomised control trials aimed to determine which antioxidants have the most beneficial effect on sperm quality and count and pregnancy rates. The results showed that 10 antioxidants have been researched; L-carnitine (LC), L-carnitine+L-acetylcarnitine (LAC), coenzyme Q10 (Q10), omega-3 fatty acids (O-3), selenium (Se), zinc (Zn), vitamin E+vitamin C (VEC), folic acid (FAC), and N-acetylcysteine (NAC). LC was the most effective at improving sperm motility and morphology with reducing effectiveness for Q10, O-3, LAC, and Se. Four antioxidants improved sperm concentration starting with the most effective being 0-3, then Q10, Se, and LC. There were no effects of antioxidants on pregnancy rate. It was concluded that LC was the most effective at improving sperm motility and morphology and O-3 was the most effective at increasing sperm concentration, however this did not translate into improvements in pregnancy rate. This study could be used by healthcare professionals to understand that LC and O-3 may help to improve sperm quality and concentration, but this may not be sufficient to improve male fertility.
Expert Review
Conflicts of interest:
None
Take Home Message:
- Consider antioxidant rich diets and increase awareness of the benefits of antioxidants and nutritional interventions in improving fertility rates
- Lifestyle modifications such as maintaining a healthy weight, regular exercise and avoiding harmful substances can enhance the positive effects of antioxidants on fertility
- Patients facing infertility should consider visiting a healthcare professional including nutritional therapists or fertility specialists
- Patients should approach interventions including antioxidant use with a long term perspective.
Evidence Category:
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X
A: Meta-analyses, position-stands, randomized-controlled trials (RCTs)
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B: Systematic reviews including RCTs of limited number
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C: Non-randomized trials, observational studies, narrative reviews
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D: Case-reports, evidence-based clinical findings
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E: Opinion piece, other
Summary Review:
Introduction
The aim of this study was to investigate the impact of antioxidants on sperm quality parameters and pregnancy rates in cases of idiopathic male infertility. The focus was on randomised controlled trials (RCTs) to provide a comprehensive analysis of existing evidence.
Methods
- Utilized a network meta-analysis approach to synthesise data from 23 RCTs with 1917 patients and 10 different antioxidants
- Included studies with a diverse range of antioxidants and placebo/control groups
- Sample size varied across included studies, with a total number of participants analysed for each outcome.
Results
- L-Carnitine, L-carnitine+L-acetylcarnitine, coenzyme-Q10, ω-3 fatty acid, and selenium were more effective than placebo in improving sperm quality parameters
- L-Carnitine showed the most pronounced improvement in terms of sperm motility and sperm morphology (WMD 6.52% [95% CI: 2.55% to 10.05%], WMD 4.96% [0.20% to 9.73%])
- ω-3 fatty acid had the most significant improvement in terms of sperm concentration (WMD 9.89 × 106/ml, [95% CI: 7.01 to 12.77 × 106/ml])
- None of these supplements showed a statistical significant improvement on pregnancy rates compared to placebo.
Conclusion
- L-Carnitine showed significant improvement in terms of sperm motility and morphology
- Omega-3 fatty acids significantly improved sperm concentration
- Co-Q10 has shown to effectively improve sperm motility and concentration
- No statistically significant result was observed in terms of pregnancy rate compared to placebo.
Clinical practice applications:
- Prescribing antioxidants should be considered for patients with idiopathic male infertility
- L-Carnitine can significantly improve sperm motility and morphology
- CoQ10 has shown to improve sperm motility and concentration
- Omega-3 improved sperm concentration
- Considering the patient’s needs, practitioners can tailor the antioxidant for most significant improvement and desired outcomes.
Considerations for future research:
- Investigate the synergistic effects of combining various antioxidants to improve sperm quality and pregnancy rates
- More studies to be conducted to assess the effect of antioxidant combinations on pregnancy outcomes
- Pharmacogenomics investigations could help tailor the interventions to provide individualised medicine
- Investigate the integration of antioxidant formulations with therapeutic interventions, lifestyle modifications, hormonal interventions etc.
Abstract
PURPOSE Male infertility is a global public health issue recognized by the WHO. Recently, antioxidants are increasingly used to treat idiopathic male infertility. However, the lack of available evidence has led to the inability to rank the effects of antioxidants on the sperm quality parameters and pregnancy rate of infertile men. This network meta-analysis studied the effects of different antioxidants on the sperm quality and pregnancy rate of idiopathic male infertility. METHODS We searched PubMed, Embase, Web of Science, and Cochrane Library databases for randomized controlled trials (RCTs). The weighted mean difference (WMD) and odds ratio (OR) were applied for the comparison of continuous and dichotomous variables, respectively, with 95% CIs. The outcomes were sperm motility, sperm concentration, sperm morphology, and pregnancy rate. RESULTS A total of 23 RCTs with 1,917 patients and 10 kids of antioxidants were included. l-Carnitine, l-carnitine+l-acetylcarnitine, coenzyme-Q10, ω-3 fatty acid, and selenium were more efficacious than placebo in sperm quality parameters. l-Carnitine was ranked first in sperm motility and sperm morphology (WMD 6.52% [95% CI: 2.55% to 10.05%], WMD 4.96% [0.20% to 9.73%]). ω-3 fatty acid was ranked first in sperm concentration (WMD 9.89 × 106/ml, [95% CI: 7.01 to 12.77 × 106/ml]). In terms of pregnancy rate, there was no significant effect as compared with placebo. CONCLUSIONS l-Carnitine was ranked first in sperm motility and sperm morphology. ω-3 fatty acid was ranked first in sperm concentration. Coenzyme-Q10 had better effective treatment on sperm motility and concentration. Furthermore, high-quality RCTs with adequate sample sizes should be conducted to compare the outcomes of different antioxidants.
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Effects of Antioxidants on Pain Perception in Patients with Fibromyalgia-A Systematic Review.
Fernández-Araque, A, Verde, Z, Torres-Ortega, C, Sainz-Gil, M, Velasco-Gonzalez, V, González-Bernal, JJ, Mielgo-Ayuso, J
Journal of clinical medicine. 2022;11(9)
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Fibromyalgia (FM) is characterised by widespread chronic pain, fatigue, sleep disturbances, and cognitive impairment. As a result of oxidative stress, reactive oxygen species (ROS) are produced and improperly disposed of, resulting in peripheral and central sensitisations, and a reduction of the pain threshold in FM patients. It is well known that antioxidants are protective against oxidative stress and that reducing antioxidant levels can result in increased pain in patients with FM. An overview of 17 studies was conducted to evaluate the effect of antioxidant supplementation on pain perception and the appropriate duration of treatment for FM patients in this systematic review. This systematic review found that supplementation with Fibromyalgine® (Fib) (that contains vitamin C, acerola ginger root, and freeze-dried royal jelly), 300-400 gm/d of coenzyme Q10 alone in combination with Pregabalin, ferric carboxymaltose, vitamin C, E, and Nigella sativa, magnesium + amitriptyline, acetyl L-carnitine, and Sun Chlorella™ green algae are effective in reducing pain perception in FM patients. In patients with FM, alpha-lipoic acid supplementation significantly reduced pain scores. 80% of FM patients reported reduced pain after supplement treatment for at least six weeks. There is a need for further robust long-term studies to confirm the effectiveness and clinical applicability of antioxidants in the management of FM, as well as to identify the pathophysiology of FM. This research may, however, be used by healthcare professionals to gain a better understanding of the potential benefits of antioxidants in the treatment of pain associated with FM.
Abstract
In recent years, antioxidant supplements have become popular to counteract the effects of oxidative stress in fibromyalgia and one of its most distressing symptoms, pain. The aim of this systematic review was to summarize the effects of antioxidant supplementation on pain levels perceived by patients diagnosed with fibromyalgia. The words used respected the medical search terms related to our objective including antioxidants, fibromyalgia, pain, and supplementation. Seventeen relevant articles were identified within Medline (PubMed), Scopus, Web of Science (WOS), the Cochrane Database of Systematic Review, and the Cochrane Central Register of Controlled Trials. This review found that antioxidant supplementation is efficient in reducing pain in nine of the studies reviewed. Studies with a duration of supplementation of at least 6 weeks showed a benefit on pain perception in 80% of the patients included in these studies. The benefits shown by vitamins and coenzyme Q10 are remarkable. Further research is needed to identify the effects of other types of antioxidants, such as extra virgin olive oil and turmeric. More homogeneous interventions in terms of antioxidant doses administered and duration would allow the effects on pain to be addressed more comprehensively.
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Impact of Mediterranean diet on metabolic syndrome, cancer and longevity.
Di Daniele, N, Noce, A, Vidiri, MF, Moriconi, E, Marrone, G, Annicchiarico-Petruzzelli, M, D'Urso, G, Tesauro, M, Rovella, V, De Lorenzo, A
Oncotarget. 2017;8(5):8947-8979
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There is a growing link between being overweight or obese and the onset of certain cancers. The latest research shows that 30-35% of cancers may have a link to diet, and that metabolic syndromes involving obesity encourage the body to store metabolically active ‘sick fats’ in adipose tissue, which in turn causes inflammation and creates an environment for cancer to thrive. The Mediterranean diet (MD) is considered one of the healthiest in the world and rates of cancer and metabolic syndrome are lower in the Mediterranean region versus Northern Europe suggesting it may be helpful in prevention of obesity and cancer. The MD is characterised as a balanced combination of fruit and vegetables, fish, cereals, and polyunsaturated fats (such as olive oil), with a reduced consumption of meat and dairy products and moderate intake of alcohol, primarily red wine. The nutrients that are found in abundance in the MD have a mixture of anti-cancer, anti-inflammatory, and anti-obesity properties thanks to antioxidant elements, fibre and healthy polyunsaturated fats. Studies show these nutrients can help support multiple metabolic markers such as blood pressure, cholesterol, inflammation, and insulin sensitivity. In 2010, UNESCO proclaimed the MD as “World Cultural Heritage”. This diet represents a behavioural model, a “way of life”, that can ensure longer life expectancy and improve quality of life itself.
Abstract
Obesity symbolizes a major public health problem. Overweight and obesity are associated to the occurrence of the metabolic syndrome and to adipose tissue dysfunction. The adipose tissue is metabolically active and an endocrine organ, whose dysregulation causes a low-grade inflammatory state and ectopic fat depositions. The Mediterranean Diet represents a possible therapy for metabolic syndrome, preventing adiposopathy or "sick fat" formation.The Mediterranean Diet exerts protective effects in elderly subjects with and without baseline of chronic diseases. Recent studies have demonstrated a relationship between cancer and obesity. In the US, diet represents amount 30-35% of death causes related to cancer. Currently, the cancer is the second cause of death after cardiovascular diseases worldwide. Furthermore, populations living in the Mediterranean area have a decreased incidence of cancer compared with populations living in Northern Europe or the US, likely due to healthier dietary habits. The bioactive food components have a potential preventive action on cancer. The aims of this review are to evaluate the impact of Mediterranean Diet on onset, progression and regression of metabolic syndrome, cancer and on longevity.