Through The Microscope: A Global Survey of Reproductive Specialists to Determine the Clinical Utility of Oxidative Stress Testing and Antioxidant Use in Male Infertility
Male factor infertility contributes to approximately
50% of couple-infertility cases worldwide. Despite the increasing global trend of
male infertility, a considerable number of male infertility cases still remain
unexplained or idiopathic. In this context, oxidative stress (OS) has been
identified as a core etiology in various known and unidentified male
infertility causes. For this reason, antioxidants are often used in the
treatment of male infertility. Moreover, overuse of antioxidants may also
adversely affect male reproduction.
None of the professional societies have so
far issued guidelines on the use of antioxidants for the treatment of male
infertility. Thus, a global survey of Reproductive Specialists, with the
American Center for Reproductive Medicine (ACRM) of Cleveland Clinic, USA, under
the leadership of Professor Dr Ashok Agarwal, being at the nodal point, was conducted
in 2020 to determine the pattern of using OS tests and antioxidants
prescriptions in male infertility based on the experience of professionals in
the field of infertility from around the world.
For this global survey, a panel was formed,
constituting 58 reproductive specialists from 28 countries, including
clinicians, researchers, and scientists working in the fields of OS, antioxidants
and male infertility. From Malaysia, two scientists were selected for the
global specialists’ panel, Associate Professor Dr Damayanthi Durairajanayagam
from the Universiti Teknologi MARA and Associate Professor Dr Pallav Sengupta
from the MAHSA University.
This survey, the largest online one performed
to date on this topic, collated the perspectives of 1327 healthcare professionals
worldwide on the therapeutic value of antioxidants treatment for male
infertility. The majority of the respondents (85.4%) consider antioxidants to
be a good treatment option for male infertility, with 69.1% grounding
their decision on scientific evidence. The key interpretations of the study are
that OS testing should be undertaken to determine appropriate candidate for antioxidant
treatment; antioxidant therapy for 3-6 months is a long enough intervention
time to see a substantial effect on spermatogenesis; excessive use of
antioxidants should be avoided to prevent iatrogenic infertility caused by
reductive stress; and finally, there is still no global consensus on the
specific antioxidants to be used for male infertility. Based on physiological
considerations, it would appear reasonable to use antioxidant cocktails that address
several physiological processes of spermatozoa. The present clinical scenario
on the diagnosis of male OS infertility (MOSI) and the specific use of
antioxidants highlight the need of evidence-based clinical practice guidelines
from professional societies.
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