Conclusions

A very fine balance between a physiological oxidative stress and the antioxidative capacity of the ejaculate is of critical importance for the physiology as well as the pathophysiology of the male germ cells [15, 187]. Thus, a derailment of this balance has an impact on both male fertility and andrological diagnostics. Owing to these complex interactions between oxidation and antioxidative protection, it is indisputably not sufficient to determine a male's fertility status by simply relying on a standard semen analysis with some additional testing of sperm functions. The determination of the seminal redox status is the way forward to improve andrological diagnostic. However, this would then have to include the determination of ROS levels as well as the antioxidant capacity present in the ejaculate in terms of a ROS-TAC score [ 168, 177] . This concept of oxidative stress also explains the discrepancies in the literature about the impact and importance of ROS on sperm functions as well as that of leukocytes.

With regard to the determination of this balance, one would have to test for both, ROS and TAC, in order to determine the true oxidative status in the semen of patients. Unfortunately, a ROS-TAC score as suggested by Sharma et al. [185] has not been clinically evaluated yet. This is regrettable, not only since it is a necessary completion of andrological diagnostic but also because many patients look for treatment with antioxidants. However, it is simply not sufficient to treat patient with antioxidants without knowing the redox status of the semen. Since too much of antioxidant treatment might also cause harm [ 188 [ . the redox status should be detected before the prescription of an antioxidative treatment.

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