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. 2021 Jul;39(3):470-488.
doi: 10.5534/wjmh.210025. Epub 2021 Apr 1.

A Global Survey of Reproductive Specialists to Determine the Clinical Utility of Oxidative Stress Testing and Antioxidant Use in Male Infertility

Ashok Agarwal  1 , Renata Finelli  2 , Manesh Kumar Panner Selvam  2   3 , Kristian Leisegang  4 , Ahmad Majzoub  5   6 , Nicholas Tadros  7 , Edmund Ko  8 , Neel Parekh  9 , Ralf Henkel  2   10   11 , Damayanthi Durairajanayagam  12 , Giovanni M Colpi  13 , Chak Lam Cho  14 , Hassan N Sallam  15 , Hyun Jun Park  16   17 , Ramadan Saleh  18 , Sava Micic  19 , Rafael F Ambar  20   21 , Armand Zini  22 , Kelton Tremellen  23 , Juan G Alvarez  24 , Ayad Palani  25 , Mohamed Arafa  2   26   27 , Marcello M Gava  20   21 , Sunil Jindal  28 , Edouard Amar  29 , Zsolt Kopa  30 , Mohammad Reza Moein  31 , Gian Maria Busetto  32 , Pallav Sengupta  33 , Parviz Kavoussi  34 , Israel Maldonado  35 , Jamal Fikri  36 , Edson Borges  37 , Marlon Martinez  38 , Djordje Bojovic  39 , Osvaldo Rajmil  40 , Kaan Aydos  41 , Sijo Parekattil  42 , Joel L Marmar  43 , Omar Sefrioui  44 , Andreas Jungwirth  45 , Marcelo Gabriel Rodriguez Peña  46 , Emerson B Cordts  47 , Haitham Elbardisi  5 , Taymour Mostafa  27 , Marjan Sabbaghian  48 , Mohammad Ali Sadighi Gilani  48 , Yoshiharu Morimoto  49 , Marco G Alves  50 , Aleksandra Spasic  51 , Uros Kenic  52 , Jonathan Ramsay  53 , Ebenezer Oluwole Akande  54 , Amina Oumeziane  55 , Dmitri Dozortsev  56 , Eric Chung  57 , Ernestine Gwet Bell  58 , Adolfo Allegra  59 , Vasilios Tanos  60 , Moïse Fiadjoe  61 , Timur Gurgan  62 , Michel Abou-Abdallah  63 , Hazem Al-Rumaih  64 , Ivana Oborna  65 , Hesham Arab  66 , Sandro Esteves  67   68 , Medhat Amer  27 , Ates Kadioglu  69 , Oleksandr Yuzko  70 , Vladislav Korsak  71 , Rupin Shah  72
Affiliations

A Global Survey of Reproductive Specialists to Determine the Clinical Utility of Oxidative Stress Testing and Antioxidant Use in Male Infertility

Ashok Agarwal et al. World J Mens Health. 2021 Jul.

Abstract

Purpose: The use of antioxidants is common practice in the management of infertile patients. However, there are no established guidelines by professional societies on antioxidant use for male infertility.

Materials and methods: Using an online survey, this study aimed to evaluate the practice pattern of reproductive specialists to determine the clinical utility of oxidative stress (OS) testing and antioxidant prescriptions to treat male infertility.

Results: Responses from 1,327 participants representing 6 continents, showed the largest participant representation being from Asia (46.8%). The majority of participants were attending physicians (59.6%), with 61.3% having more than 10 years of experience in the field of male infertility. Approximately two-thirds of clinicians (65.7%) participated in this survey did not order any diagnostic tests for OS. Sperm DNA fragmentation was the most common infertility test beyond a semen analysis that was prescribed to study oxidative stress-related dysfunctions (53.4%). OS was mainly tested in the presence of lifestyle risk factors (24.6%) or sperm abnormalities (16.3%). Interestingly, antioxidants were prescribed by 85.6% of clinicians, for a duration of 3 (43.7%) or 3-6 months (38.6%). A large variety of antioxidants and dietary supplements were prescribed, and scientific evidence were mostly considered to be modest to support their clinical use. Results were not influenced by the physician's age, geographic origin, experience or training in male infertility.

Conclusions: This study is the largest online survey performed to date on this topic and demonstrates 1) a worldwide understanding of the importance of this therapeutic option, and 2) a widely prevalent use of antioxidants to treat male infertility. Finally, the necessity of evidence-based clinical practice guidelines from professional societies is highlighted.

Keywords: Antioxidants; Male infertility; Oxidative stress; Reproduction, physicians; Survey.

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Conflict of interest statement

The authors have nothing to disclose.

Figures

Fig. 1
Fig. 1. Tests of oxidative stress that are commonly ordered by participants in the evaluation of male infertility.
Fig. 2
Fig. 2. Indication for oxidative stress testing based on (A) clinical conditions and (B) lifestyle risk factors. SDF: sperm DNA fragmentation, ART: assisted reproduction techniques, IUI: intrauterine insemination, IVF: in vitro fertilization, ICSI: intracytoplasmic sperm injection.
Fig. 3
Fig. 3. Percentage of patients recommended for AOX treatment by the participants to the survey. AOX: antioxidant.
Fig. 4
Fig. 4. Oxidative stress testing based on the geographic origin of the participants and training in male infertility.
Fig. 5
Fig. 5. Antioxidant prescription based on the age, geographic origin, experience of the participants and their training in male infertility.
See this image and copyright information in PMC

References

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