A Global Survey of Reproductive Specialists to Determine the Clinical Utility of Oxidative Stress Testing and Antioxidant Use in Male Infertility
Ashok Agarwal, Renata Finelli, Manesh Kumar Panner Selvam, Kristian Leisegang, Ahmad Majzoub, Nicholas N. Tadros, Edmund Ko, Neel Parekh, Ralf Henkel, Damayanthi Durairajanayagam, Giovanni M. Colpi, Chak‐Lam Cho, Hassan Sallam, Hyun Jun Park, Ramadan Saleh, S. Mičić, Rafael F. Ambar, Armand Zini, Kelton Tremellen, Juan G. Álvarez, Ayad Palani, Mohamed Arafa, Marcello Gava, Sunil Jindal, Edouard Amar, Zsolt Kopa, M. R. Moein, Gian Maria Busetto, Pallav Sengupta, Parviz K. Kavoussi, Israel Maldonado Rosas, Jamal Fikri, Edson Borges, Marlon Martínez, Djordje Bojovic, Osvaldo Rajmil, Kaan Aydos, Sıjo J. Parekattıl, Joel L. Marmar, Omar Sefrioui, A. Jungwirth, Marcelo Rodríguez Peña, E.B. Cordts, Haitham Elbardisi, Taymour Mostafa, Marjan Sabbaghian, Mohammad Ali Sadighi Gilani, Yoshiharu Morimoto, Marco G. Alves, Aleksandra Spasic, Uros Kenic, Jonathan Ramsay, E. O. Akande, Amina Oumeziane, Dmitri Dozortsev, Eric Chung, Ernestine Gwet Bell, Adolfo Allegra, Vasilios Tanos, Moïse Fiadjoe, Timur Gürgan, Michel Abou-Abdallah, Hazem Meteb Al-Rumaih, I Oborná, Hisham Arab, Sandro C. Esteves, Medhat Amer, Ateş Kadıoğlu, О. M. Yuzko, В. С. Корсак, Rupin Shah
Abstract
PURPOSE: The use of antioxidants is common practice in the management of infertile patients. However, there are no established guidelines by professional societies on antioxidant use for male infertility. MATERIALS AND METHODS: Using an online survey, this study aimed to evaluate the practice pattern of reproductive specialists to determine the clinical utility of oxidative stress (OS) testing and antioxidant prescriptions to treat male infertility. RESULTS: Responses from 1,327 participants representing 6 continents, showed the largest participant representation being from Asia (46.8%). The majority of participants were attending physicians (59.6%), with 61.3% having more than 10 years of experience in the field of male infertility. Approximately two-thirds of clinicians (65.7%) participated in this survey did not order any diagnostic tests for OS. Sperm DNA fragmentation was the most common infertility test beyond a semen analysis that was prescribed to study oxidative stress-related dysfunctions (53.4%). OS was mainly tested in the presence of lifestyle risk factors (24.6%) or sperm abnormalities (16.3%). Interestingly, antioxidants were prescribed by 85.6% of clinicians, for a duration of 3 (43.7%) or 3-6 months (38.6%). A large variety of antioxidants and dietary supplements were prescribed, and scientific evidence were mostly considered to be modest to support their clinical use. Results were not influenced by the physician's age, geographic origin, experience or training in male infertility. CONCLUSIONS: This study is the largest online survey performed to date on this topic and demonstrates 1) a worldwide understanding of the importance of this therapeutic option, and 2) a widely prevalent use of antioxidants to treat male infertility. Finally, the necessity of evidence-based clinical practice guidelines from professional societies is highlighted.