Evidence map›Paper›PMID 33474843›Full record

ReviewThe world journal of men's health2021

Utility of Antioxidants in the Treatment of Male Infertility: Clinical Guidelines Based on a Systematic Review and Analysis of Evidence.

Ashok Agarwal, Kristian Leisegang, Ahmad Majzoub, Ralf Henkel, Renata Finelli, Manesh Kumar Panner Selvam, Nicholas Tadros, Neel Parekh, Edmund Y Ko, Chak Lam Cho and 5 more

Open access · diamondAbstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in The world journal of men's health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 60 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
60citing papers in PubMed, 2 pooled it
15.0field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

60 citing papers in PubMed, 2 syntheses or guidelines pooled it, 95 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Trial
  4. Article
  5. Review
  6. Review
  7. Review
  8. Article
  9. Article
  10. Review
  11. Article
  12. Recent Trends in the Management of Varicocele.Journal of clinical medicine · 2025
    Review
  13. Review
  14. Review
  15. Article
  16. Review
  17. Article
  18. Review
  19. Effects ofThe world journal of men's health · 2024
    Article
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors at 9 institutions in 9 countries.

Ashok AgarwalAmerican Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA. agarwaa@ccf.org.ORCID https://orcid.org/0000-0003-0585-1026
Kristian LeisegangSchool of Natural Medicine, Faculty of Community and Health Sciences, University of the Western Cape, Bellville, South Africa.ORCID https://orcid.org/0000-0002-3003-8048
Ahmad MajzoubAmerican Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.ORCID https://orcid.org/0000-0001-7423-6241
Ralf HenkelAmerican Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.ORCID https://orcid.org/0000-0003-1128-2982
Renata FinelliAmerican Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.ORCID https://orcid.org/0000-0002-5926-6407
Manesh Kumar Panner SelvamAmerican Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.ORCID https://orcid.org/0000-0002-9120-2278
Nicholas TadrosDivision of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA.ORCID https://orcid.org/0000-0002-2272-235X
Neel ParekhDepartment of Urology, Cleveland Clinic, Cleveland, OH, USA.ORCID https://orcid.org/0000-0002-6218-9254
Edmund Y KoDepartment of Urology, Loma Linda University, Loma Linda, CA, USA.ORCID https://orcid.org/0000-0002-7465-3616
Chak Lam ChoDepartment of Surgery, Union Hospital, Hong Kong.ORCID https://orcid.org/0000-0003-2520-6833
Mohamed ArafaAmerican Center for Reproductive Medicine, Cleveland Clinic, Cleveland, OH, USA.ORCID https://orcid.org/0000-0003-0107-8857
Marco G AlvesDepartment of Anatomy & Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal.ORCID https://orcid.org/0000-0001-7635-783X
Pedro Fontes OliveiraQOPNA & LAQV, Department of Chemistry, University of Aveiro, Aveiro, Portugal.ORCID https://orcid.org/0000-0002-4989-5699
Juan G AlvarezCentro Androgen, La Coruña, Spain and Harvard Medical School, Boston, MA, USA.ORCID https://orcid.org/0000-0002-4851-9579
Rupin ShahDepartment of Urology, Lilavati Hospital and Research Centre, Mumbai, India.ORCID https://orcid.org/0000-0002-7868-5949
Cleveland Clinic · USHarvard University · USLilavati Hospital & Research Centre · INLoma Linda University · USSouthern Illinois University School of Medicine · USUnion Hospital · CNUniversidade do Porto · PTUniversity of Aveiro · PTUniversity of the Western Cape · ZA

Funding

American Center for Reproductive Medicine 500000105879
6 · The paper itself

Abstract

It is widely accepted that oxidative stress plays an important role in the pathophysiology of male infertility and that antioxidants could have a significant role in the treatment of male infertility. The main objectives of this study are: 1) to systematically review the current evidence for the utility of antioxidants in the treatment of male infertility; and 2) propose evidence-based clinical guidelines for the use of antioxidants in the treatment of male infertility. A systematic review of the available clinical evidence was performed, with articles published on Scopus being manually screened. Data extracted included the type of antioxidant used, the clinical conditions under investigation, the evaluation of semen parameters and reproductive outcomes. The adherence to the Cambridge Quality Checklist, Cochrane Risk of Bias for randomized controlled trials (RCTs), CONSORT guidelines and JADAD score were analyzed for each included study. Further, we provided a Strength Weakness Opportunity Threat (SWOT) analysis to analyze the current and future value of antioxidants in male infertility. Of the 1,978 articles identified, 97 articles were included in the study. Of these, 52 (53.6%) were uncontrolled (open label), 12 (12.4%) unblinded RCTs, and 33 (34.0%) blinded RCTs, whereas 44 (45.4%) articles tested individual antioxidants, 31 (32.0%) a combination of several products in variable dosages, and 22 (22.6%) registered antioxidant products. Based on the published evidence, we 1) critically examined the necessity of additional double-blind, randomized, placebo-controlled trials, and 2) proposed updated evidence-based clinical guidelines for antioxidant therapy in male infertility. The current systematic review on antioxidants and male infertility clearly shows that antioxidant supplementation improves semen parameters. In addition, it provides the indications for antioxidant treatment in specific clinical conditions, including varicocele, unexplained and idiopathic male infertility, as well as in cases of altered semen quality.

Indexed as

AntioxidantsOxidative stressPractice guidelineSemen analysisSperm maturation

Identifiers

PMID33474843
PMCPMC7994666
OpenAlexW3125938833

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.