Role of antioxidants in male subfertility. How effective?? Any head to head trial with IUI??

If one intends to improve one or multiple parameter defect when no clinical abnormality is demonstrable then antioxidants is one modality of improving seminal parameters. What Antioxidants to improve seminal parameters and conception rate!!! do supplementary oral antioxidants improve fertility outcomes for subfertile men when compared with placebo, no treatment or another.

Antioxidants prescribed at right dose as male partner defect to counteract ROS in semen will cost approx Rs 110-150/- per day and given the earliest possible pregancy will be 80-90 days as spermatogenic cycle is somewhere 74 days. Given this equation, which one is cost effective ?? Any head to head trial ?? Te role of antioxidants in male subfertility. If one intends to improve one or multiple parameter defect when no clinical abnormality is demonstrable then antioxidants is one modality of improving seminal parameters. What Antioxidants to improve seminal parameters and conception rate!!! do supplementary oral antioxidants improve fertility outcomes for subfertile men when compared with placebo, no treatment or another.

There are many questions which remain unanswered. A) What element/ B) combination of elements to Supplemt and at C) what dosage? D) How long? E) How do you know out of eight antioxidants which one is will help him?? Ans Answer is not known to us .Admittedly sometimes we empirically supplement antioxidants. For instance, in cases say 10^th per centile motility, as a solo abnormality or combined with 15th per centile morphology?  Ans: Before  initiating on antioxidants we have to exclude, as far as possible ,  there is no environmental, smoking habit, H/O Kochs, Local injury , other infective cause , hydrocele , hernia, epididymitis, varicocele,  Prostatitis  with normal serum  FSH  Tetsos/E ratio are normal. Honestly speaking in fair no of cases no obvious cause is found for subnormal seminal parameters (one parameter or two parameter defect) it is a common practice to prescribe antioxidants for couple of months before proceeding for IUI or say IVF in elderly couple).

Any adverse effect induced by the antioxidants? Many doctors do prescribe carnitine, Astaxanthin, Vitamin E, Vitamin C, Co-Q, Zn, Lycopene, Selenium, L-arginine, Alpha- Calcidol, Omega-3 Fatty acids, DHA and F. Acid to promote fertilizing potential of ejaculated sperms. It is understandable that it is not clinically possible in day to day clinical practice to estimate and the deficiency of such products either in food, serum, testes or in ejaculated semen. So, as things stands these are often prescribed empirically To estimate which micronutrient / anti-oxidant going to help a particular subfertile man thus selection of such brand is often empirical. Quite often in the Indian market there are mixture of some of the agents ( To my mind there are about at least 30 Brands) which are liberally used as accelerate sperm potential if 2 or 3 seminal reports are suboptimal and trying time is < 2 yrs and couple is young , One will be surprised to note that in some studies between 30% to 80% of all male subfertility cases are considered to be due to the damaging effects of oxidative stress on sperm and 1 man in 20 will be affected by subfertility of this etiology . Antioxidants are widely available and inexpensive when compared to other fertility treatments and many men are already using these to improve their fertility. It is thought that oral supplementation with antioxidants may improve sperm quality by reducing oxidative stress. Pentoxyphylline, a drug that acts like an antioxidant, was proved to be useful .. There is low quality evidence from only four small randomised controlled trials suggesting that antioxidant supplementation in subfertile males may improve live birth rates for couples attending fertility clinics. Low quality evidence suggests that clinical pregnancy rates may increase. There is no evidence of increased risk of miscarriage but this is uncertain as the evidence is of very low quality. Data were lacking on other adverse effects. Further large well‐designed randomised placebo‐controlled trials are needed to clarify these results. Many subfertile men who are part of a couple undergoing fertility treatment are also taking dietary supplements in the hope of improving their fertility. It is important that these men have access to high quality evidence that informs them on the benefits and risks of taking an antioxidant. There are minimal RCT to assess whether oral antioxidants, minerals would increase the chances of a couple with a subfertile male partner achieving a clinical pregnancy and ultimately a live birth. The criteria should be  Live birth, Clinical pregnancy rate,. G I side effects, Miscarriage rate, congenital malformations. Many researchers remarked by concluding that they were unable to draw any conclusions from the antioxidant versus antioxidant comparison as not enough trials compared the same interventions. Do members have any special predilection or brand preference?