We have covered the topic of Oxidative Stress and its impact on sperm DNA in an earlier blog. Oxidative Stress arises when there is an imbalance between reactive oxygen species (ROS) and antioxidants (AOX), causing abnormalities in semen and sperm (SDF). Certain levels of ROS in cells and tissues are required for sperm maturity and function.
While research on causes of male infertility is advancing at a tremendous pace, there are still some conditions, such as idiopathic (no identifiable cause) male infertility, which are difficult to diagnose. Undeniably, oxidative stress plays a major role in male infertility. Studies have shown that 30% to 80% of infertile men have elevated seminal ROS levels.
When oxidative stress occurs, it can lead to changes in the DNA cells (by acting as mutagens) which can affect semen parameters, quality, spermatogenesis, fertilisation and pregnancy.
That is one of the reasons why tests for oxidative stress are included in the evaluation of male infertility. The term MOSI (Male Oxidative Stress Infertility) was proposed to describe infertile men with OS and abnormal semen features. ORP (oxidation reduction potential) is used as a biomarker, since it classifies levels of both oxidants and antioxidants or reductants.
Since oxidative stress is caused by increased ROS with less antioxidants to balance, the treatment of OS has been to introduce antioxidants, to lower the OS and maintain the required balance. Common methods of antioxidant usage are through vitamins A, C and E, L-carnitines, -3 fatty acids and Coenzyme-Q10. L-carnitines are known to increase sperm morphology and motility, -3 fatty acids for sperm concentration and Coenzyme-Q10 for sperm density and motility. Since zinc, folic acid and selenium are antioxidant co-factors, these are included. Natural antioxidants available in food items are recommended and it has been found that oral antioxidant therapy may improve semen parameters.
Antioxidants are easily available and the cost is much less than ART (assisted reproduction therapy), so the initial treatment is usually based on introducing antioxidant supplements. However, these protocols are not evidence-based. Outcomes of clinical trials using antioxidants have not been consistent, with some ranging from a definite benefit to others with no effect at all and some with detrimental effects also. These could be due to incorrect dosage of antioxidants, prolonged usage or poor studies.
Hence, before embarking on antioxidant therapy, men with idiopathic infertility should undergo a MOSI test, which can be done efficiently and inexpensively, such as the MiOXSYS. If positive for MOSI, then additional screenings should be done to find treatable causes followed by action to be taken to reduce the OS, including lifestyle factors such as smoking, obesity, alcohol, radiation etc. ORP testing should be repeated after 3 months of taking these steps to alleviate the OS. If the other causes have been eliminated and positivity for MOSI remains, then antioxidant treatment can be started. Infertile men without MOSI are usually advised against taking antioxidants.
Further studies and research are required and more clarification on the causes of this diagnosis of MOSI will assist in identifying and separating those males who will benefit from antioxidant therapy and those who may be at risk with effects of overdosage of antioxidants.
At Andrology Center, we assist in initial diagnosis of infertility by carrying out the basic semen analysis test as well as the more detailed DFI (sperm DNA fragmentation) test. We use the SCSA (sperm chromatin structure assay) method and are pleased to be the only authorised laboratory in India to carry out this genuine test. With our ultra-modern equipment and advanced technology, accurate results are guaranteed and our standardised reports help both the fertility specialist and the couple to decide on the most effective treatment.
