Natural Treatment Trial for Astheno-Teratozoospermia

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Natural Treatment Trial for Astheno-Teratozoospermia


Males with astheno-teratozoospermia who took the natural supplement combination of vitamin E and selenium, significantly improved their sperm vitality (69.9% vs. 55.2%) and total motility (44.4% vs. 28.9%), however the percentage of sperm with normal morphology did not improve post-treatment.


In recent times, health experts have identified several possible causes of astheno-teratozoospermia (ATZ) such as varicocele, gene mutations, genetical tract infections and high levels of reactive oxygen species (ROS).

Reactive oxygen species, such as superoxide anion and hydroxyl radicals, are of particular interest because they are also essential in the proper functioning of sperm cells. They play a part in sperm production, maturation, capacitation, and even acrosome reactions during embryo fertilisation. However, experts also believe that excess ROS production can overpower the antioxidant defence mechanism, and result in oxidative stress (OS) which negatively affects various sperm parameters including sperm DNA fragmentation.

According to a few studies, it was noted that a protein known as HSPA2 is found in lower concentrations among infertile men compared to fertile men. HSPA2 helps in repairing DNA damage and nuclear sperm compaction. A study featuring men suffering from ATZ observed lower HSPA2 and higher superoxide anion levels than fertile men.

In the light of these reports, experts have proposed nutritional supplementation as one method to restore the balance between ROS and antioxidant concentrations. To date, vitamin E, one of the most important antioxidants for the body and selenium, a critical micronutrient in spermatogenesis, have both shown potential to improve sperm parameters individually, however studies on their combined use is still lacking.


To examine the effect of daily oral supplementation of selenium and vitamin E on the level of intracellular superoxide anion (O2), sperm HSPA2+, protamine deficiency and sperm parameters in males with astheno-teratozoospermia.


In this double-blind, randomized, placebo-controlled trial, patients diagnosed with ATZ, at the Royan Research and Clinical Center for Infertility (Tehran, Iran) between June 2014 and June 2016, were selected to participate.

Only patients who had a history of infertility (> 1year), normal sperm cell morphology lower than 4% and total motility below 40% were considered, while patients identified with any the following automatically excluded:

  • leukocytospermia (> 1×106 WBC/mL)
  • oligo and azoospermia
  • varicocele
  • cancer
  • endocrine disorders
  • genital tract infection
  • autoimmune disease
  • cryptorchidism
  • smoking or alcohol use
  • history of chemotherapy or radiotherapy
  • recent antioxidant intake

After careful assessment against the above criteria, 60 infertile men with ATZ were selected and then equally divided into 2 groups; a treatment group (Vitamin E + Selenium) and placebo group.

Participants in the treatment group were asked to take vitamin E (400 IU) and selenium (200µg) daily for 3 months, while the placebo group each took 2 placebo tablets daily for the same period.

Semen samples were then collected from both groups, at baseline and after treatment, for analysis of conventional sperm parameters, intracellular O2, protamine deficiency, HSPA2+ and apoptotic sperm.

Sperm parameters were analysed by a combination of computer aided measurement and laboratory technicians. Specifically, sperm concentration and total motility was initially analysed by CASA (Computer Aided Sperm Analysis) before being re-assessed manually by a technician. The same technician performed all other sperm analyses, with a second technician utilised to re-assess sperm vitality and morphology for quality control.

Assessment of intracellular O2, was carried out using dihydroethidium (DHE) and a flowcytometer, with Yo-pro-1 Iodide (YO) as a counterstain for apoptotic sperm. Similarly, the percentage of HSPA2+ was calculated by flowcytometry after preparation of semen samples according to established methods.

Finally, Chromomycin A3 (CMA3) staining was used for the measurement of protamine deficient sperm (dull green to bright yellow).


Pre-trial analysis of participant semen samples, revealed there was no statistically significant differences between the 2 groups at baseline in terms of semen parameters (P>0.13).

After 3 months of treatment, results showed that sperm concentration, percentage of sperm morphology, percentage of sperm CMA3+ and percentage of HSPA2+ remained statistically similar between the 2 groups.

However, when it came to sperm total motility (%), Vit E + Selenium may have a positive impact, as post-treatment results showed a significant difference between the 2 groups. There was a significant increase in the Vit E + Selenium group (28.9% to 44.4%) but no significant change in the placebo-controlled group (29.5% to 29.1%) over the same period.

Vitamin E + Selenium seems to affect sperm vitality as well. After 3 months, researchers noted a significant decrease in the placebo group (56.6% to 46.8%), while the treatment group experienced a significant increase (55.1% to 69.9%).

Interestingly, post-trial results revealed that semen volume in the treatment group decreased more significantly than the placebo group for unknown reasons. Sperm pH also increased significantly in the placebo group but remained similar pre and post treatment in the Vit E + Selenium group.

Finally, intracellular O2 and percentage of apoptotic sperm remained similar in the placebo group post treatment, but decreased significantly in the Vit E + Selenium group.

Vit E + SeleniumPlacebo
Sperm Parameters (Mean)Pre-treatmentPost-treatmentPre-treatmentPost-treatment
Sperm volume (ml)
Sperm (PH)
Vitality (%)55.269.956.646.8
Sperm concentration (×106/ml)40.540.743.942.2
Total motility (%)28.944.429.529.1
Normal morphology (%)
CMA3+ (%)37.136.835.737.1
HSPA2+ (%)22.322.522.622.1
DHE+ (%)35.426.635.039.0
YO+ (%)  37.128.341.044.0
Mean sperm parameters, pre-treatment and post-treatment, according to treatment.

The authors suggest from these results that vitamin E + selenium increases the removal of free radicals, leading to a reduction in ROS, which subsequently improves sperm motility, vitality and apoptosis.


  1. Small study size overall.
  2. Measurement of intracellular superoxide anion by flow cytometry has a wide margin of error.


This study was funded by Shahid Sadoughi University of Medical Sciences, Iran.


Programmed cell death.

A complete absence of sperm in ejaculated semen.

Undescended Testicles.

The probability that a result occurred by random chance.

The process by which a complex, interdependent population of germ cells produces spermatozoa (sperm).

An enlargement of the veins within the scrotum.

Similar studies

Morbat M M, et al. (2018). Effect of Selenium in Treatment of Male Infertility.

Moslemi M K, et al. (2011). Selenium–vitamin E supplementation in infertile men: effects on semen parameters and pregnancy rate.

Scott R, et al. (1998). The effect of oral selenium supplementation on human sperm motility.


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