Combination of vitamin E and clomiphene citrate in treating patients with idiopathic oligoasthenozoospermia: A prospective, randomized trial

Abstract

SUMMARYThe most common cause of male infertility is idiopathic oligoasthenozoospermia. Empirical medical treatment for idiopathic male infertility is still a controversial issue. The aim of this study was to evaluate any possible effects of combining vitamin E as antioxidant and clomiphene citrate as antiestrogen on spermatozoa concentration and motility in comparison to give either of medications alone in patients with idiopathic oligoasthenozoospermia. This is a comparative prospective randomized study. Ninety patients with idiopathic oligoasthenozoospermia were randomized into equally three groups: Group A: received vitamin E (400 mg/day) for 6 months. Group B: received clomiphene citrate (25 mg daily) for 6 months. Group C: received combination of both drugs in the same doses for 6 months. All patients were subjected to the following: history taking, general and genital examination, semen analysis, serum FSH, total testosterone, and scrotal duplex. Semen examination was performed according to the guidelines of (WHO, 2010), at the start of treatment and was repeated after 3 months and after 6 months of treatment. Regarding vitamin E group, there was insignificant increase in mean sperm concentration after 6 months of treatment in comparison to baseline. On the other hand, there was a significant improvement of mean sperm concentration in the other two groups after 6 months of treatment, with more significance in combination therapy group (p = 0.001). The mean total sperm motility has improved in all patients groups, in comparison to baseline, with more significance in combination therapy group. In vitamin E group, it was 28.07 AE 9.65% (p = 0.000). For those in clomiphene citrate group, was 33.33 AE 14.10% (p = 0.003) and 40.50 AE 17.54% (p = 0.000) in combination therapy group. Combining antioxidant and antiestrogen therapy is a valid option for the treatment of a selected group of men with unexplained isolated oligoasthenozoospermia.

Efficacy of Antioxidant Supplementation on Conventional and Advanced Sperm Function Tests in Patients with Idiopathic Male Infertility

“…In this context, antioxidant supplementation has been recommended as one of the treatment choices for men with idiopathic infertility [4,13]. Though several studies have reported beneficial effects of antioxidant supplementation in idiopathic infertile men [18][19][20]35,36], some reported the negative impacts of antioxidant therapy on male infertility [24][25][26]. Hence, there is not yet consensus on the clinical effectiveness of antioxidant therapy in male infertility.…”

“…With an increasing acknowledgment of the role of oxidative stress in the pathophysiology of male infertility, antioxidant supplementation is recommended as one of the treatment choices for idiopathic infertile men [4,13]. Oral supplementation of a single antioxidant or combination of antioxidants such as l-carnitine, l-acetyl carnitine, N-acetyl-cysteine, Coenzyme Q10, selenium, vitamin C, vitamin E, and lycopene has been reported to improve semen parameters and sperm DNA integrity in idiopathic infertile men [14][15][16][17][18][19][20]. Furthermore, multi-antioxidant supplementation is considered more effective for male fertility parameters owing to the synergetic effects of antioxidants [16,21,22].…”

Asthenozoospermia: Cellular and molecular contributing factors and treatment strategies

“…The mean total sperm motility has improved in all patients groups ElSheikh et al (2015) iOAT individuals (N = 30) Lycopene 2,000 mcg, twice a day/3 months Significant increase in sperm motility Gupta and Kumar (2002) iAT individuals (N = 114) L-Carnitine 145 mg, acetyl-L-carnitine 64 mg, fructose 250 mg, citric acid 50 mg, Se 50 µg, CoQ10 20 mg, Zn 10 mg, ascorbic acid 90 mg, cyanocobalamin 1.5 µg, and folic acid 200 mcg once a day/4 months Progressive motility improved significantly Busetto et al (2012) iAT ( …”

“…The mean total sperm motility has improved in all patients groups ElSheikh et al (2015) iOAT individuals (N = 30) Lycopene 2,000 mcg, twice a day/3 months Significant increase in sperm motility Gupta and Kumar (2002) iAT individuals (N = 114) L-Carnitine 145 mg, acetyl-L-carnitine 64 mg, fructose 250 mg, citric acid 50 mg, Se 50 µg, CoQ10 20 mg, Zn 10 mg, ascorbic acid 90 mg, cyanocobalamin 1.5 µg, and folic acid 200 mcg once a day/4 months Progressive motility improved significantly Busetto et al (2012) iAT (N = 525) Se 200 µg + vitamin E 400 units/ min 100 days Improvement in sperm motility Moslemi and Tavanbakhsh (2011) iOAT individuals (N = 130) Placebo (N = 130) Saffron 60 mg/day/26 weeks No statistically significant improvements in all semen parameters Safarinejad et al (2012) Infertile men with oligo-and/or astheno-and/or teratozoospermia (N = 104) 6 months of supplementation with l-carnitine, acetyl-l-carnitine Both progressive and total motility were higher in supplemented patients (p = .0088 and p = .0120, respectively)…”

The effect of vitamin E & vitamin B on sperm function in rat varicocele model

“…The lower motility of co-administration of Vit E with sesame oil to when sesame oil alone was used can be related to reductive effect of over supplementation with antioxidant but not at the membrane level, since Bodipy dye as a membrane lipid peroxidation marker was not lower than the control-sham group. In this regard, several studies showed that similar to Vitamin C that its excessive doses can prone sperm DNA to damage via oxidation of purine and pyrimidine bases (ElSheikh et al, 2015;Ménézo et al, 2007;Piomboni et al, 2008), excessive doses of Vit E can also lead to "reductive stress." The reductive stress observed in this study was at sperm motility level and not DNA fragmentation or lipid peroxidation.…”