Key Points

• Oxidative stress is a common pathology, effecting up to 80% of infertile men.

• Common lifestyle causes of sperm oxidative stress include obesity, smoking and alcohol abuse.

• Occupational exposure to metal fumes such as occurs with welding, soldering, manufacturing of lead acid batteries and foundry work all can cause oxidative stress.

• Systemic diseases characterised by a general state of oxidative stress such as diabetes, thyroid dysfunction, chronic viral infections (Hepatitis and HIV), hae-moglobinopathies (thalassaemia, sickle cell disease), haemochromatosis and depression are all likely to negatively impact on sperm function.

• Features in the routine semen analysis suggestive of the presence of oxidative stress include abnormal sperm morphology with "cytoplasmic droplets", poor sperm motility, low HOST results, large numbers of round cells or leukocytes and altered semen viscosity or raised pH.

• First line therapy for the management of sperm oxidative stress is to remove any lifestyle or environmental triggers (decrease weight, stop smoking, removal of environmental toxins), followed by the amelioration of any systemic disease processes linked with oxidative stress.

• The Cochrane Collaboration review on oral antioxidant therapy for male infertility concludes that antioxidants are effective in improving both natural and IVF assisted pregnancy rates.

• No universally accepted antioxidant formulation has been agreed upon for the management of male infertility. However, based on the available data a combinational formulation containing vitamins C, vitamin E, zinc, selenium, and antioxi-dant phytochemicals such as lycopene, garlic, astaxanthin or resveratrol would make a reasonable choice. As the sperm production cycle is 70 days, maximal effect of antioxidant therapy is likely to take 2-3 months.

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