Male Antioxidant Supplementation Improves Both Sperm and Embryo Quality

Home » Lifestyle » Male Antioxidant Supplementation Improves Both Sperm and Embryo Quality

Male Antioxidant Supplementation Improves Both Sperm and Embryo Quality

Oral Antioxidant Treatment of Men Significantly Improves the Reproductive Outcome of IVF Cycles

doi.org/10.3390/jcm10153254

Background

Highly reactive oxidizing agents, known as reactive oxygen species (ROS), are normally present in different parts of the human body, including seminal fluid. They are in fact vital for the proper functioning of sperm cells and have a natural balance of enzyme and non-enzyme related antioxidants. 

However in some males, due to clinical disorders, environmental factors or improper lifestyle and nutritional choices, this equilibrium is disturbed and leads to an abnormal concentration of ROS, described as ‘oxidative stress.’

A study in 2008 reported that elevated ROS in seminal fluid had a negative impact on fertilization rate, embryo development and pregnancy outcomes in IVF/ICSI (in vitro fertilisation / intracytoplasmic sperm injection) patients. Since then, several more studies have provided further evidence to support the theory that elevated accumulation of ROS has a detrimental effect of sperm parameters.

It is therefore quite rational that experts are looking into various ways of reducing ROS, especially through dietary supplementation. Unfortunately, to date very few studies have analysed the effect of antioxidant therapy on ICSI clinical outcomes.

Aim

To study oral antioxidant supplementation, in men with previously low fertilisation rates (ICSI), and its effect on embryological, clinical, and neonatal outcomes.

Methodology

A multicenter, longitudinal, prospective study was conducted in Roma, Italy. Couples were included as per the following criteria: 

  1. Female partner was less than 38 years old 
  2. History of ICSI with less than 60% unexplained fertilisation rate, using fresh oocytes and ejaculated sperm 
  3. More than 6 inseminated oocytes 
  4. Male sperm count was greater than 1×106/mL  
  5. No drug abuse 

With the following exclusion criteria:

  • Men suffering from severe oligospermia, azoospermia or any known cause of infertility
  • Women with diminished ovarian reserve, i.e. <6 retrieved oocytes in a previous IVF cycle, or raised early follicular phase follicle-stimulation hormone (FSH), or <1 ng/mL Anti-Mullerian Hormone concentration
  • Any male or females suffering from metabolic, autoimmune, endocrine disorders or tumours

The selected males were prescribed Gametogen tablets (2 per day), to be taken orally, for a duration of 90 days. 

2 Gametogen tablets contained: 

  • Myo-inositol (1000mg)
  • Alpha-lipoic acid (800mg)
  • Folic acid (400mg)
  • Coenzyme Q10 (200mg)
  • Zinc (15mg)
  • Selenium (83μg)
  • Vitamin B2 (2.8mg) 
  • Vitamin B6 (2.8mg)
  • Vitamin B12 (5μg)

Semen parameters was measured at baseline (T0), and at the end of treatment (T90), following 3 days of sexual abstinence. The ejaculates were then stored at room temperature for 30 minutes to liquefy, before being processed via a two-layer density gradient method, followed by conventional sperm analysis, according to WHO guidelines.

Sperm DNA fragmentation was measured via SCD (Sperm Chromatin Dispersion) using a Halo-sperm kit (Halotech DNA SL, Spain).

After antioxidant treatment, a second ICSI cycle was performed by each participating couple. Controlled ovarian hyperstimulation, oocyte recovery, ICSI, embryo culture and assessment was carried out according to established protocols.  

Embryo transfer (ET) was normally performed 72 hours (3 days) after the collection of oocytes except in cases where:

  1. The patient had only 1-2 fertilised oocytes, with ET done on day 2.
  2. The patient had at least 4 good quality embryos on day 3, then transfer at blastocyst stage (day 5) was considered.

Embryos that developed up to the blastocyst but were surplus to the requirements, were cryopreserved by vitrification.

Primary study outcome was clinical pregnancy rate. Fertilization rate, cleavage rate, quality of embryos, blastocyst development rate, implantation rate, live-birth rate, cumulative clinical pregnancy rate per couple, cumulative live-birth rate per couple and any adverse events were measured as secondary outcomes. Newborn birthweights were also analysed and compared with Italian neonatal charts.

Results

Of the 86 males, 77 completed the study, with 9 lost to follow-up or non-compliance.

Baseline measurements revealed 74% (57/77) of males had one or more abnormal sperm parameters according to WHO 2010 criteria. Among these 74% of males, 51% were diagnosed with oligospermia and asthenospermia combined, 19% with asthenospermia and 4% with oligospermia.

Analysis of semen parameters, at baseline (T0) and after 90 days (T90), revealed statistically significant improvements in sperm count, concentration, progressive motility and total motile sperm count.

 T0T90
Sperm concentration (×106/mL)27.227.5 
Number of sperm (×106 /mL)58.363.5
Progressive motility (%)27.6 34.6
Total motile sperm count (×106)26.833.1
Semen parameters, at baseline (T0), and after 90 days (T90) of antioxidant supplementation.

Antioxidant therapy also seemed to have a positive effect on DNA fragmentation with a 42% decrease in fragmentation, from 28.3% (T0) to 16.3% (T90). However, due to the low numbers of paired data, the trend was not statistically significant (P=0.08).

Initial analysis of ICSI outcomes confirmed the number of mature oocytes was similar to previous attempts (9.7 vs. 10.1), however the fertilization rate was significantly higher (72.9 vs. 39.8 %). This resulted in a significantly higher number of cleavage stage embryos per patient (3.3 vs. 2.1) and proportion of top quality embryos (82.7 vs. 64.8 %), with 47% of patients going on to develop at least one blastocyst compared to only 5% previously.

 T0T90
Top quality embryos (%)64.882.7
Patients who developed at least 1 blastocyst (n)436
Number of developed blastocysts per patient0.21.1
Signifcant ICSI laboratory outcomes, at baseline (T0), and after 90 days (T90) of antioxidant supplementation.

There were 2 spontaneous abortions from attempts at T0 following clinical pregnancy, however attempts at T90 following treatment resulted in a total of 25 successful singleton clinical pregnancies.

In comparison with baseline (T0), ICSI cycles done after antioxidant treatment showed significantly higher cumulative clinical pregnancy (38 vs. 1 %) and live birth rates (30 vs. 0 %) per couple.

 T0T90
Cycles with day 2-3 ET65/68 (96%)45/74 (61%)
Implantation2/124 (2%)15/85 (18%)
Pregnancy2/65 (3%)15/45 (33%)
Live-birth rate0/124 (0%)13/83 (16%)
Miscarriage2/2 (100%)0/15 (0%)
Cycles with day 5 ET3/68 (4%)29/73 (40%)
Implantation0/4 (0%)10/32 (31%)
Pregnancy0/3 (0%)10/29 (34%)
Live-birth rate0/4 (0%)10/32 (31%)
Miscarriage00/10 (0%)
No. ET in freeze-thaw cycles39
Implantation1/4 (25%)4/9 (44%)
Pregnancy1/3 (3%)4/9 (44%)
Live-birth rate0/1 (0%)#/9
Miscarriage1/1 (100%)1/4 (25%)
Cumulative clinical pregnancy rate per couple1/77 (1%)29/77 (38%)
Cumulative live-birth rate per couple0/77 (0%)23/77 (30%)
Clinical outcomes, at baseline (T0), and after 90 days (T90) of antioxidant supplementation. #, 3 ongoing pregnancies at time of publication.

Perinatal characteristics of newborns with available data (22/23) confirmed that they were of appropriate weight and there was no preterms, stillbirths or malformations.  

No side effects from the oral intake of Gametogen was reported by participants.

SUMMARY: DO ANTIOXIDANT SUPPLEMENTS INCREASE SPERM COUNT

In this ICSI study, 3 months of antioxidant supplementation, significantly improved male fertility with increased sperm count (63.5 vs. 58.3 ×106) and progressive motility (34.6 vs. 27.6 %), decreased sperm DNA fragmentation (16.3 vs. 28.3 %) and increased (cumulative) clinical pregnancy rates.

Limitations

  1. Small study size.
  2. Observed results could be either from a single component or a specific mixture of antioxidants.
  3. Effect of treatment on semen oxidative status was not analysed.

Funding

This study was funded by the manufacturer of Gametogen (Laborest).

Glossary

Asthenospermia
Reduced sperm motility.

Azoospermia
A complete absence of sperm in ejaculated semen.

Blastocyst
A fertilised embryo that has developed an inner cell mass and outer layer (trophoblast) some time from day 4 onwards.

Cumulative
An increasing total after successive additions.

Longitudinal
Long term study of outcomes.

n
Sample size.

Neonate
Newborn child.

Oligospermia
Low sperm count.

Oocyte
Unfertilised immature / mature egg.

P-value
The probability that a result occurred by random chance.

Perinatal
Period of time from birth of baby up to 1 years of age.

Vitrification
Rapid freezing an embryo to avoid formation of ice crystals.

Similar studies

Gambera L, et al. (2019). Effects of antioxidant treatment on seminal parameters in patients undergoing in vitro fertilization. https://doi.org/10.4081/aiua.2019.3.187

Canepa P, et al. (2018). Combined treatment with myo-inositol, alpha-lipoic acid, folic acid and vitamins significantly improves sperm parameters of sub-fertile men: A multi-centric study. https://doi.org/10.26355/eurrev_201810_16180

Korosi T, et al. (2017). Physiological Intra-Cytoplasmic Sperm Injection (PICSI) outcomes after oral pretreatment and semen incubation with myo-inositol in oligoasthenoteratozoospermic men: results from a prospective, randomized controlled trial. https://pubmed.ncbi.nlm.nih.gov/28724183/

Rago R, et al. (2017). Controlled, prospective, observational study on the efficiency and tolerability of a combination of potential Nrf2-inducing antioxidants and micronutrients as pre-treatment for ICSI in dyspermic patients with previous failure. https://pubmed.ncbi.nlm.nih.gov/28429340/

Geva E, et al. (1996). The effect of antioxidant treatment on human spermatozoa and fertilization rate in an in vitro fertilization program. https://doi.org/10.1016/s0015-0282(16)58514-8


fertilPEDIA

Treating Asthenozoospermia

Treating Asthenozoospermia

Asthenozoospermia, is defined as reduced or absent sperm motility (< 32%) in fresh ejaculate. It is one of the main causes of infertility in... Read more

Low Sperm Count Overview

Low Sperm Count Overview

Low sperm count, also known as oligospermia or oligozoospermia, happens when a man has 15 million or less sperm per millilitre (mL) of…. Read more

Questions or comments?