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 Tadros, Edmund Ko, Neel Parekh, Ralf Henkel, Damayanthi Durairajanayagam, Giovanni M. Colpi, Chak Lam Cho, Hassan N. Sallam, Hyun Jun Park, Ramadan Saleh, Sava Micic, Rafael F. Ambar, Armand Zini, Kelton Tremellen, Juan G. AlvarezAyad Palani, Mohamed Arafa, Marcello M. Gava, Sunil Jindal, Edouard Amar, Zsolt Kopa, Mohammad Reza Moein, Gian Maria Busetto, Pallav Sengupta, Parviz Kavoussi, Israel Maldonado, Jamal Fikri, Edson Borges, Marlon Martinez, Djordje Bojovic, Osvaldo Rajmil, Kaan Aydos, Sijo Parekattil, Joel L. Marmar, Omar Sefrioui, Andreas Jungwirth, Marcelo Gabriel Rodriguez Peña, Emerson B. Cordts, Haitham Elbardisi, Taymour Mostafa, Marjan Sabbaghian, Mohammad Ali Sadighi Gilani, Yoshiharu Morimoto, Marco G. Alves, Aleksandra Spasic, Uros Kenic, Jonathan Ramsay, Ebenezer Oluwole Akande, Amina Oumeziane, Dmitri Dozortsev, Eric Chung, Ernestine Gwet Bell, Adolfo Allegra, Vasilios Tanos, Moïse Fiadjoe, Timur Gurgan, Michel Abou-Abdallah, Hazem Al-Rumaih, Ivana Oborna, Hesham Arab, Sandro Esteves, Medhat Amer, Ates Kadioglu, Oleksandr Yuzko, Vladislav Korsak, Rupin Shah

Research output: Contribution to journalArticlepeer-review

19 Citations (Scopus)
43 Downloads (Pure)


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.

Original languageEnglish
Pages (from-to)470-488
Number of pages19
JournalWorld Journal of Men's Health
Issue number3
Publication statusPublished - Jul 2021


  • Antioxidants
  • Male infertility
  • Oxidative stress
  • Reproduction, physicians
  • Survey


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