Evidence map›Paper›PMID 36102104›Full record

ArticleThe world journal of men's health2023

Impact of Antioxidant Therapy on Natural Pregnancy Outcomes and Semen Parameters in Infertile Men: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Ashok Agarwal, Rossella Cannarella, Ramadan Saleh, Ahmed M Harraz, Hussein Kandil, Gianmaria Salvio, Florence Boitrelle, Shinnosuke Kuroda, Ala'a Farkouh, Amarnath Rambhatla and 21 more

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PubMed Full text at PMC Publisher
In one paragraph

Article in The world journal of men's health, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers, 3 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
33citing papers in PubMed, 3 pooled it
6.8field-weighted citation impact, top 2% 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

33 citing papers in PubMed, 3 syntheses or guidelines pooled it, 42 citations in OpenAlex.

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  12. Advances in immunological research on male infertility.Frontiers in reproductive health · 2026
    Review
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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

31 authors at 20 institutions in 15 countries.

Ashok AgarwalAmerican Center for Reproductive Medicine, Global Andrology Forum, Moreland Hills, OH, USA. agarwaa32099@outlook.com.ORCID https://orcid.org/0000-0003-0585-1026
Rossella CannarellaDepartment of Clinical and Experimental Medicine, University of Catania, Catania, Italy.ORCID https://orcid.org/0000-0003-4599-8487
Ramadan SalehDepartment of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt.ORCID https://orcid.org/0000-0003-0503-3533
Ahmed M HarrazDepartment of Urology, Mansoura University Urology and Nephrology Center, Mansoura, Egypt.ORCID https://orcid.org/0000-0002-8902-517X
Hussein KandilFakih IVF Fertility Center, Abu Dhabi, UAE.ORCID https://orcid.org/0000-0002-5549-3274
Gianmaria SalvioDepartment of Endocrinology, Polytechnic University of Marche, Ancona, Italy.ORCID https://orcid.org/0000-0001-9290-5699
Florence BoitrelleReproductive Biology, Fertility Preservation, Andrology, CECOS, Poissy Hospital, Poissy, France.ORCID https://orcid.org/0000-0002-5322-0141
Shinnosuke KurodaGlickman Urological & Kidney Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.ORCID https://orcid.org/0000-0001-8890-0297
Ala'a FarkouhAmerican Center for Reproductive Medicine, Global Andrology Forum, Moreland Hills, OH, USA.ORCID https://orcid.org/0000-0002-0362-9109
Amarnath RambhatlaDepartment of Urology, Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.ORCID https://orcid.org/0000-0002-1383-6670
Armand ZiniDivision of Urology, Department of Surgery, McGill University, Montreal, QC, Canada.ORCID https://orcid.org/0000-0002-2194-5578
Giovanni ColpiNext Fertility Procrea, Lugano, Switzerland.ORCID https://orcid.org/0000-0003-1431-1777
Murat GülDepartment of Urology, Selcuk University School of Medicine, Konya, Turkey.ORCID https://orcid.org/0000-0002-6657-6227
Parviz KavoussiAustin Fertility & Reproductive Medicine/Westlake IVF, Austin, TX, USA.ORCID https://orcid.org/0000-0001-7390-5837
Taha Abo-Almagd Abdel-Meguid HamodaDepartment of Urology, King Abdulaziz University, Jeddah, Saudi Arabia.ORCID https://orcid.org/0000-0002-8070-4088
Edmund KoDepartment of Urology, Loma Linda University Health, Loma Linda, CA, USA.ORCID https://orcid.org/0000-0002-7465-3616
Gokhan CalikDepartment of Urology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkey.ORCID https://orcid.org/0000-0002-9976-9666
Tuncay ToprakDepartment of Urology, Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, Istanbul, Turkey.ORCID https://orcid.org/0000-0003-1348-5273
Germar-Michael PinggeraDepartment of Urology, Medical University Innsbruck, Innsbruck, Austria.ORCID https://orcid.org/0000-0001-6463-2494
Hyun Jun ParkDepartment of Urology, Pusan National University School of Medicine, Busan, Korea.ORCID https://orcid.org/0000-0003-0566-9574
Ramy Abou GhaydaUrology Institute, University Hospitals, Case Western Reserve University, Cleveland, OH, USA.ORCID https://orcid.org/0000-0002-5170-3983
Suks MinhasDivision of Surgery, Department of Surgery and Cancer, Imperial College, London, UK.ORCID https://orcid.org/0000-0001-6516-619X
Gian Maria BusettoDepartment of Urology and Organ Transplantation, University of Foggia, Ospedali Riuniti of Foggia, Foggia, Italy.
Mustafa Emre BakırcıoğluSENSART Clinic, Istanbul, Turkey.ORCID https://orcid.org/0000-0003-2411-9703
Ates KadiogluSection of Andrology, Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.ORCID https://orcid.org/0000-0002-4239-7638
Eric ChungDepartment of Urology, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia.ORCID https://orcid.org/0000-0003-3373-3668
Giorgio Ivan RussoUrology Section, University of Catania, Catania, Italy.ORCID https://orcid.org/0000-0003-4687-7353
Aldo E CalogeroDepartment of Clinical and Experimental Medicine, University of Catania, Catania, Italy.ORCID https://orcid.org/0000-0001-6950-335X
Rafael F AmbarDepartment of Urology, Centro Universitario em Saude do ABC, Santo André, Brazil.ORCID https://orcid.org/0000-0002-3496-2895
Channa N JayasenaDepartment of Reproductive Endocrinology and Andrology, Imperial College London, London, UK.ORCID https://orcid.org/0000-0002-2578-8223
Rupin ShahDivision of Andrology, Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India.ORCID https://orcid.org/0000-0002-7868-5949
Cleveland Clinic · USUniversity of Catania · ITHammersmith Hospital · GBHenry Ford Health System · USImperial College London · GBInnsbruck Medical University · ATInstitute for Human Reproduction · USIstanbul Medipol University · TRIstanbul University · TRIVI Middle East Fertility Clinic · AEKing Abdulaziz University · SALilavati Hospital & Research Centre · INLoma Linda University · USMansoura University · EGMarche Polytechnic University · ITMcGill University · CAPusan National University Hospital · KRSağlık Bilimleri Üniversitesi · TRSelçuk University · TRSohag University · EG

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeSeminal oxidative stress (OS) is a recognized factor potentially associated with male infertility, but the efficacy of antioxidant (AOX) therapy is controversial and there is no consensus on its utility. Primary outcomes of this study were to investigate the effect of AOX on spontaneous clinical pregnancy, live birth and miscarriage rates in male infertile patients. Secondary outcomes were conventional semen parameters, sperm DNA fragmentation (SDF) and seminal OS. MATERIALS AND

methodsLiterature search was performed using Scopus, PubMed, Ovid, Embase, and Cochrane databases. Only randomized controlled trials (RCTs) were included and the meta-analysis was conducted according to PRISMA guidelines.

resultsWe assessed for eligibility 1,307 abstracts, and 45 RCTs were finally included, for a total of 4,332 infertile patients. We found a significantly higher pregnancy rate in patients treated with AOX compared to placebo-treated or untreated controls, without significant inter-study heterogeneity. No effects on live-birth or miscarriage rates were observed in four studies. A significantly higher sperm concentration, sperm progressive motility, sperm total motility, and normal sperm morphology was found in patients compared to controls. We found no effect on SDF in analysis of three eligible studies. Seminal levels of total antioxidant capacity were significantly higher, while seminal malondialdehyde acid was significantly lower in patients than controls. These results did not change after exclusion of studies performed following varicocele repair.

conclusionsThe present analysis upgrades the level of evidence favoring a recommendation for using AOX in male infertility to improve the spontaneous pregnancy rate and the conventional sperm parameters. The failure to demonstrate an increase in live-birth rate, despite an increase in pregnancy rates, is due to the very few RCTs specifically assessing the impact of AOX on live-birth rate. Therefore, further RCTs assessing the impact of AOX on live-birth rate and miscarriage rate, and SDF will be helpful.

Indexed as

AntioxidantsMale infertilityMeta-analysisPregnancySemen parametersSperm DNA fragmentation

Identifiers

PMID36102104
PMCPMC9826914
OpenAlexW4295549162

What OpenQuestion holds

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Registered trials

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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.