Antioxidants in Male factor subfertiklity -How useful ??

 

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 we select out of eight commonly recognized antioxidants which one is will help one particular person??Unfortunately, answer is not known to us. Admittedly many of us empirically supplement antioxidants. For instance, in cases say 10^th per centile motility, as a solo abnormality or say a case of  combined with 15th per centile morphology-what antioxidant will be most suitable if no obvious cause is detected and couple is too young for IUI /ART?  Ans: Before  initiating on antioxidants we have to exclude, as far as possible ,  that there is no environmental, smoking habit, H/O Kochs, Local injury , other infective cause , hydrocele , hernia, epididymitis, varicocele,  Prostatitis, normal reproductive hormones like normal serum  FSH  Tetsos/E ratio are normal. This is because in most cases no obvious cause is found for subnormal seminal parameters (one parameter or two parameter defect) and 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 to prescribe 1)L- carnitine,2)  Astaxanthin,3)  Vitamin E, 4) Vitamin C,  5) Co-Q, 6) Zn, 7) Lycopene, 8) Selenium, 9) L-arginine, 10) Alpha- Calcidol, 11) Omega-3 Fatty acids, 12) DHA and 13) 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 thereby evidence based 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 to 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 kind of 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.

 

What about Pentoxyphylline?? Ans:     Pentoxyphylline, a drug that acts like an antioxidant, was proved to be useful ..

 

Take home message:-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. Many subfertile men who are part of a couple undergoing fertility treatments 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?