Utility of Antioxidants in the Treatment of Male Infertility: Clinical Guidelines Based on a Systematic Review and Analysis of Evidence.
Utility of Antioxidants in the Treatment of Male Infertility: Clinical Guidelines Based on a Systematic Review and Analysis of Evidence.
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DOI：
10.5534/wjmh.200196
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发表时间：
2021-04
期刊：
影响因子：
--
通讯作者：
Shah R
中科院分区：
文献类型：
--
作者：
Agarwal A;Leisegang K;Majzoub A;Henkel R;Finelli R;Panner Selvam MK;Tadros N;Parekh N;Ko EY;Cho CL;Arafa M;Alves MG;Oliveira PF;Alvarez JG;Shah R
人们普遍认为，氧化应激在男性不育的病理生理学中起着重要作用，而抗氧化剂在男性不育的治疗中可能发挥重要作用。本研究的主要目的是：1）系统回顾抗氧化剂在治疗男性不育症中的效用的现有证据； 2) 提出使用抗氧化剂治疗男性不育症的循证临床指南。对现有临床证据进行了系统审查，并手动筛选了在 Scopus 上发表的文章。提取的数据包括所使用的抗氧化剂的类型、所调查的临床状况、精液参数的评估和生殖结果。分析了每项纳入研究对剑桥质量检查表、随机对照试验 (RCT) 的 Cochrane 偏倚风险、CONSORT 指南和 JADAD 评分的遵守情况。此外，我们还提供了优势劣势机会威胁（SWOT）分析来分析抗氧化剂在男性不育症中当前和未来的价值。在确定的 1,978 篇文章中，有 97 篇文章被纳入该研究。其中，52 篇（53.6%）为非对照（开放标签）、12 篇（12.4%）非盲 RCT 和 33 篇（34.0%）盲 RCT，而 44 篇（45.4%）文章测试了单独的抗氧化剂，31 篇（32.0%）文章测试了不同剂量的几种产品的组合，以及 22 篇（22.6%）注册的抗氧化剂产品。根据已发表的证据，我们 1) 严格审查了额外双盲、随机、安慰剂对照试验的必要性，2) 提出了更新的男性不育抗氧化治疗循证临床指南。目前对抗氧化剂和男性不育症的系统评价清楚地表明，补充抗氧化剂可以改善精液参数。此外，它还为特定临床病症（包括精索静脉曲张、不明原因和特发性男性不育症以及精液质量改变的情况）提供抗氧化治疗的适应症。
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.
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