World J Mens Health.  2021 Jul;39(3):470-488. 10.5534/wjmh.210025.

A Global Survey of Reproductive Specialists to Determine the Clinical Utility of Oxidative Stress Testing and Antioxidant Use in Male Infertility

  • 1American Center for Reproductive Medicine, Cleveland Clinic, Ohio, USA
  • 2Department of Urology, Tulane University Health Sciences Center, New Orleans, LA, USA
  • 3chool of Natural Medicine, University of the Western Cape, South Africa
  • 4Department of Urology, Hamad Medical Corporation, Doha, Qatar
  • 5Weill Cornell Medicine-Qatar, Doha, Qatar
  • 6Division of Urology, Southern Illinois University School of Medicine, Springfield, IL, USA
  • 7Department of Urology, Loma Linda University Health, Loma Linda, CA, USA
  • 8Department of Urology, Cleveland Clinic, Cleveland, OH, USA
  • 9Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
  • 10Department of Medical Bioscience, University of the Western Cape, Bellville, South Africa
  • 11Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor, Malaysia
  • 12Andrology and IVF Unit, Procrea Institute, Lugano, Switzerland
  • 13S. H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong
  • 14Alexandria University Faculty of Medicine, Alexandria, Egypt
  • 15Department of Urology, Pusan National University School of Medicine, Busan, Korea
  • 16Medical Research Institute of Pusan National University Hospital, Busan, Korea
  • 17Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Sohag University, Sohag, Egypt
  • 18Uromedica Polyclinic, Andrology Department, Belgrade, Serbia
  • 19Sexual and Reproductive Medicine, Department of Urology, Faculdade de Medicina do ABC, Santo André, Brazil
  • 20Andrology Group at Ideia Fertil Institute of Human Reproduction, Santo Andre, Brazil
  • 21Department of Surgery, McGill University, St. Mary’s Hospital, Montreal, QC, Canada
  • 22Department of Obstetrics Gynaecology and Reproductive Medicine, Flinders University, Bedford Park, South Australia
  • 23Centro ANDROGEN, La Coruro, Spain
  • 24Department of Biochemistry, College of Medicine, University of Garmian, Kalar, Iraq
  • 25Hamad Medical Corporation, Doha, Qatar
  • 26Department of Andrology, Sexology & STIs, Faculty of Medicine, Cairo University, Cairo, Egypt
  • 27Department of Andrology and Reproductive Medicine, Jindal Hospital, Meerut, India
  • 28Cabinet D’Andrologie Victor Hugo, American Hospital of Paris Reproductive Center, Paris, France
  • 29Andrology Centre, Department of Urology, Semmelweis University, Budapest, Hungary
  • 30azd Research and Clinical Center for Infertility, Yazd, Iran
  • 31Department of Urology and Renal Transplantation, University of Foggia Policlinico Riuniti of Foggia,Foggia, Italy
  • 32Department of Physiology, Faculty of Medicine, Bioscience and Nursing, MAHSA University, Kuala Lumpur, Malaysia
  • 33Austin Fertility & Reproductive Medicine/Westlake IVF, Austin, TX, USA
  • 34Citmer Reproductive Medicine, IVF LAB, Mexico City, Mexico
  • 35IVF Unit, Al Boustane Clinic, Rabat, Morocco
  • 36Fertility Medical Group, Sapientiae Institute, São Paulo, Brazil
  • 37Department of Urology, University of Santo Tomas Hospital, Manila, Philippines
  • 38GAO Bojović, Belgrade, Serbia
  • 39Deparment of Andrology, Fundacio Puigvert, Barcelona, Spain
  • 40Department of Urology, University of Ankara, Ankara, Turkey
  • 41Avant Concierge Urology & University of Central Florida, Winter Garden, FL, USA
  • 42Honorary Staff of Cooper University Hospital, Camden, NJ, USA
  • 43Anfa Fertility Center, Casablanca, Morocco
  • 44St. Barbara Clinic, Bad Vigaun, Austria
  • 45Andrology Unit, Instituto De Ginecologia y Fertilidad (IFER), Buenos Aires, Argentina
  • 46Instituto Ideia Fertil-Human Reproduction Centre-Faculdade de Medicina do ABC, Sao Paulo, Brazil
  • 47Department of Andrology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
  • 48IVF Japan Group, HORAC Grand Front Osaka Clinic, Osaka, Japan
  • 49Department of Anatomy and Unit for Multidisciplinary Research in Biomedicine (UMIB), Institute of Biomedical Sciences Abel Salazar (ICBAS), University of Porto, Porto, Portugal
  • 50Department of Urology, Military Medical Academy, Belgrade, Serbia
  • 51Urology VUK Center, Belgrade, Serbia
  • 52Department of Andrology, Hammersmith Hospital, London, UK
  • 53Department of Obstetrics & Gynaecology, University College Hospital, Ibadan, Nigeria
  • 54Tiziri IVF Center, Algeriers, Algeria
  • 55American College of Embryology, Houston, TX, USA
  • 56Department of Urology, University of Queensland, Brisbane, Australia
  • 57Odyssèe Clinic for Assisted Reproduction, Douala, Cameroun
  • 58ANDROS Day Surgery Clinic, Reproductive Medicine Unit, Palermo, Italy
  • 59Department of Obstetrics and Gynecology, University of Nicosia Medical School, Nicosia, Cyprus
  • 60Biasa Fertility Clinic, Lomè, Togo
  • 61Department of Obstetrics and Gynecology, Bahcesehir University, Istanbul, Turkey
  • 62Middle East Fertility Society, Canadian Foundation for Reproductive Medicine, Lebanon
  • 63Reproductive Medicine Unit, New Jahra Hospital, Ministry of Health, Al Jahra, Kuwait
  • 64Fertimed Ltd., Olomouc, Czech Republic
  • 65RMU Dr. Arab Medical Center, Jeddah, Saudi Arabia
  • 66ANDROFERT, Andrology & Human Reproduction Clinic, Campinas, Brazil
  • 67Division of Urology, Department of Surgery, University of Campinas (UNICAMP), Campinas, Brazil
  • 68Section of Andrology, Istanbul Faculty of Medicine, Istanbul, Turkey
  • 69Department of Obstetrics and Gynecology, Bukovinian State Medical University, Chernivtsi, Ukraine
  • 70International Centre for Reproductive Medicine, Saint-Petersburg, Russia
  • 71Department of Urology, Lilavati Hospital and Research Centre, Mumbai, India


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.
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.
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.


Antioxidants; Male infertility; Oxidative stress; Reproduction; physicians; Survey
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