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Cited by 213Sperm and Testicular FunctionReproductive Health and TechnologiesMale Reproductive Health Studies

The effect of antioxidants on male factor infertility: the Males, Antioxidants, and Infertility (MOXI) randomized clinical trial

Open access
Steiner, Anne Z., Hansen, Karl R., Barnhart, Kurt T., Cedars, Marcelle I., Legro, Richard S., Diamond, Michael P., Krawetz, Stephen A., Usadi, Rebecca +9 more·2020·Fertility and Sterility
DOI 10.1016/j.fertnstert.2019.11.008PMC PMC7219515
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Abstract

Objective To determine whether antioxidants improve male fertility, as measured by semen parameters and DNA fragmentation at 3 months and pregnancy resulting in live birth after up to 6 months of treatment, among couples with male factor infertility. Design Multicenter, double-blind, randomized, placebo-controlled trial with an internal pilot study. Setting Nine fertility centers in the United States from December 2015 to December 2018. Patient(s) Men (N = 174) with sperm concentration ≤15 million/mL, motility ≤40%, normal morphology ≤4%, or DNA fragmentation >25%, and female partners who were ovulatory, ≤40 years old, and had documented tubal patency. Intervention(s) Males randomly assigned to receive an antioxidant formulation (n = 85) containing 500 mg of vitamin C, 400 mg of vitamin E, 0.20 mg of selenium, 1,000 mg of l-carnitine, 20 mg of zinc, 1,000 μg of folic acid, 10 mg of lycopene daily, or placebo (n = 86). Treatment lasted for a minimum of 3 months and maximum of 6 months, and couples attempted to conceive naturally during the first 3 months and with clomiphene citrate with intrauterine insemination of the female partner in months 4 through 6. Main outcome measure(s) Primary outcome was live birth; secondary outcomes included pregnancy within 6 months of treatment. For the internal pilot, the primary outcomes were semen parameters and sperm DNA fragmentation index after 3 months of treatment. Result(s) In the Males, Antioxidants, and Infertility (MOXI) study, after 3 months of treatment, the change in sperm concentration differed between the antioxidant group (median -4.0 [interquartile range-12.0, 5.7] million/mL) and placebo group (+2.4 [-9.0, 15.5] million/mL). However, there were no statistically significant differences between the two groups for changes in sperm morphology, motility, or DNA fragmentation. Among the 66 oligospermic men at randomization, sperm concentration did not differ at 3 months between the antioxidant and control groups: 8.5 (4.8, 15.0) million/mL versus 15.0 (6.0, 24.0) million/mL. Of the 75 asthenospermic men, motility did not differ at 3 months: 34% ± 16.3% versus 36.4% ± 15.8%. Among the 44 men with high DNA fragmentation, DNA fragmentation did not differ at 3 months: 29.5% (21.6%, 36.5%) versus 28.0% (20.6%, 36.4%). In the entire cohort, cumulative live birth did not differ at 6 months between the antioxidant and placebo groups: 15% versus 24%. Conclusion(s) Antioxidants do not improve semen parameters or DNA integrity among men with male factor infertility. Although limited by sample size, this study suggests that antioxidant treatment of the male partner does not improve in vivo pregnancy or live-birth rates. Clinical trial registration number NCT02421887.

AI snapshot

Written from the paper’s full text.

TL;DR

In the MOXI randomized trial, a daily combination antioxidant formulation did not improve semen parameters or sperm DNA fragmentation in men with male factor infertility, and it did not increase pregnancy or live birth rates. The trial was stopped early after the internal pilot failed to show benefit.

Key findings

  • After 3 months, change in sperm concentration differed between antioxidant and placebo groups [−4.0 (−12.0, 5.7) M/ml vs +2.4 (−9.0, 15.5) M/ml; p=0.03], but there were no significant differences in change in sperm morphology, motility, or DNA fragmentation.
  • In subgroups, no significant differences were seen at 3 months: oligospermic men (n=66) sperm concentration 8.5 (4.8, 15.0) vs 15.0 (6.0, 24.0) M/ml, p=0.08; asthenospermic men (n=75) motility 34±16.3% vs 36.4±15.8%, p=0.53; men with high DNA fragmentation (n=44) 29.5 (21.6, 36.5)% vs 28.0 (20.6, 36.4)%, p=0.58.
  • Cumulative live birth at 6 months did not differ: 15% (13/85) with antioxidants vs 24% (21/86) with placebo, p=0.14. Pregnancy rates did not differ in phase 1 (9% vs 9%, p=0.98) or phase 2 (12% vs 21%, p=0.11).
  • Adherence was 88% in the antioxidant group and 82% in placebo (p=0.26); adverse events occurred in 41% vs 40% (p=0.83). Enrollment was stopped after the internal pilot failed to reject the null hypothesis for motility and DNA fragmentation.

Methods

  • Multicenter, double-blind, randomized, placebo-controlled trial with a pre-specified internal pilot, conducted at 9 U.S. fertility centers from December 2015 to December 2018.
  • Eligible couples had male factor infertility: men ≥18 years with at least one abnormal semen parameter (sperm concentration ≤15 M/ml, motility ≤40%, normal morphology ≤4%, or DNA fragmentation ≥25%); female partners were 18–40 years, ovulatory, and had documented tubal patency.
  • Men were randomized 1:1 to a daily antioxidant formulation (500 mg vitamin C, 400 mg vitamin E, 0.20 mg selenium, 1000 mg L-carnitine, 20 mg zinc, 1000 mcg folic acid, 10 mg lycopene, and 2000 IU vitamin D) or placebo for 3–6 months. Couples attempted natural conception in months 1–3 and received clomiphene citrate with intrauterine insemination in months 4–6 if not pregnant. Primary outcome was live birth; pilot outcomes were semen parameters and SCSA-measured DNA fragmentation at 3 months. Intention-to-treat analyses used chi-square/Fisher exact, Wilcoxon rank-sum, and t-tests, with p<0.05.

Limitations

  • Stated: the trial was limited by sample size for pregnancy/live birth outcomes and was not powered to determine group differences in live birth; larger trials are needed.
  • Stated: the design could not differentiate effects of individual nutrients and assumed no interactions among antioxidants in the combination formulation.
  • Stated: patients may have been selected who were unlikely to benefit, such as men without elevated reactive oxygen species; future studies could target subpopulations such as men with low vitamin levels or high seminal ROS.
  • Evident from the text: baseline imbalances existed (placebo-group men were more likely to have fathered a pregnancy previously; antioxidant-group men had a lower percentage of morphologically normal sperm), and dropout was numerically higher in the antioxidant group (21% vs 11%, p=0.055).

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.fertnstert.2019.11.008

Cites

26 of 26 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

10 of 12 cited sources checked · 6 supported · 1 flagged · accuracy not yet measured

  • Premisecitation

    Similar to the MOXI trial, the high quality trials included in the Cochrane review did not find a benefit to antioxidants on live birth.

    “Similar to the MOXI trial, the high quality trials included in the Cochrane review did not find a benefit to antioxidants on live birth. (25, 26)”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [25] Blomberg Jensen, 2018, Effects of vitamin D supplementation on semen quality, reproductive hormones, and live birth rate: a randomized clinical trial, J Clin Endocrinol Metab source

      The Secondary end points and Discussion sections (pages unavailable) report no overall live-birth benefit from vitamin D plus calcium in this trial. Our copy does not address whether high-quality trials in a Cochrane review found no live-birth benefit from antioxidants; searches for the Cochrane review, antioxidants, and the MOXI trial found no supporting passage. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
    • cites [26] Henkel, 2019, The excessive use of antioxidant therapy: a possible cause of male infertility?, Andrologia source
  • Premisecitation

    The Cochrane meta-analysis found a 12% absolute increase in motility in men treated with combination antioxidants for 3 months compared to controls.

    “However, the Cochrane meta-analysis did find a 12% absolute increase in motility in men treated with combination antioxidants for 3 months compared to controls. (7)”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [7] Smits, 2019, Antioxidants for male subfertility, Cochrane Database Syst Rev source
  • Interpretationown data

    Our negative findings contradict the overall conclusions from the Cochrane Review and meta-analysis.

    “Our negative findings contradict the overall conclusions from the Cochrane Review and meta-analysis.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [7] Smits, 2019, Antioxidants for male subfertility, Cochrane Database Syst Rev source
  • Findingown data

    Pregnancy rates in phase 2 (ovarian stimulation with clomiphene citrate and intrauterine insemination) did not differ between antioxidant and placebo groups (12% versus 21%; p=0.11).

    “or in phase 2 (12% versus 21%, p=0.11), when women received ovarian stimulation with clomiphene citrate and timed intrauterine insemination.”
    Quote in the paperSubstantial claim
  • Findingown data

    Change in sperm DNA fragmentation did not differ significantly between antioxidant and placebo groups after 3 months.

    “Change in morphology, motility, and DNA fragmentation did not differ between the two groups.”
    Quote in the paperSubstantial claim
  • May combine two claims. 16
  • Classified as probably not a substantial claim. 16

  • May combine two claims.

    Interpretationown data

    Taken together with previous findings, our results indicate that while antioxidants may reduce ROS, this does not appear to translate into reduced sperm DNA fragmentation.

    “Taken together with previous findings, our results indicate that while antioxidants may reduce ROS, this does not appear to translate into reduced sperm DNA fragmentation.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [7] Smits, 2019, Antioxidants for male subfertility, Cochrane Database Syst Rev source

      The review’s Sperm DNA fragmentation section says antioxidant use showed lower fragmentation than placebo, contrary to the claim that reduced fragmentation does not appear to follow. Its pooled estimate favoured antioxidants, although the 95% confidence interval included no effect, so the evidence for a reduction is uncertain. (LLM, conf=0.82)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    DNA fragmentation was assessed using the Sperm Chromatin Structure Analysis (SCSA) test.

    “DNA fragmentation assessment using the Sperm Chromatin Structure Analysis (SCSA) test”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [14] Evenson, 2002, Sperm chromatin structure assay: its clinical use for detecting sperm DNA fragmentation in male infertility and comparisons with other techniques, J Androl source

  • Classified as probably not a substantial claim.

    Premisecitation

    The recent Cochrane Review found that antioxidant use increased the odds of live birth by 1.8 fold.

    “The recent Cochrane Review found that antioxidant use increased the odds of pregnancy by 2.97 fold and the odd of live birth by 1.8 fold. (7)”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [7] Smits, 2019, Antioxidants for male subfertility, Cochrane Database Syst Rev source

  • Classified as probably not a substantial claim.

    Premisecitation

    The recent Cochrane Review found that antioxidant use increased the odds of pregnancy by 2.97 fold.

    “The recent Cochrane Review found that antioxidant use increased the odds of pregnancy by 2.97 fold and the odd of live birth by 1.8 fold. (7)”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [7] Smits, 2019, Antioxidants for male subfertility, Cochrane Database Syst Rev source

  • Probably not a substantial claim: may not pass S1 (asserted).

    Premisecitation

    A recent meta-analysis concluded that antioxidant supplementation taken by subfertile males may increase the chance of live birth.

    “A recent meta-analysis concluded that antioxidant supplementation taken by subfertile males may increase the chance of live birth; however, large randomized, well-designed, placebo-controlled trials were needed. (7)”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [7] Smits, 2019, Antioxidants for male subfertility, Cochrane Database Syst Rev source

  • May combine two claims.

    Premisecitation

    The Cochrane meta-analysis found that men treated with antioxidants had on average 5% lower DNA fragmentation, but the confidence interval was broad and crossed 0.

    “The recent Cochrane meta-analysis, which included 5 trials with a variety of antioxidants with a total of 254 subjects, found that men treated with antioxidants had on average 5% lower DNA fragmentation, but the confidence interval was broad and crossed 0. (7)”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [7] Smits, 2019, Antioxidants for male subfertility, Cochrane Database Syst Rev source

      The Cochrane review reports a mean difference of −5.00 in DNA fragmentation for antioxidants versus placebo or no treatment, with a 95% confidence interval of −12.61 to 2.61, which crosses zero. It reports 254 men in four RCTs (six intervention arms), not five trials. The supplied passage gives no page number. (LLM, conf=0.92)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    Approval for the study was obtained from the University of Pennsylvania, which served as the single IRB for each site with additional local site review.

    “Approval for the study was obtained from the University of Pennsylvania, which served as the single IRB for each site with additional local site review.(12)”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [12] Diamond, 2019, The efficiency of single institutional review board review in National Institute of Child Health and Human Development Cooperative Reproductive Medicine Network-initiated clinical trials, Clin Trials source

      The Methods say that the University of Pennsylvania was the single IRB of record for MOXI and FIT-PLESE at all participating primary sites, which also had to meet local institutional requirements. The Results report local protocol review at each site. The source does not establish that the citing document’s unspecified study received this approval; it says ACTorNOT was instead reviewed by IRBs at each institution. (LLM, conf=0.78)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingown data

    Change in total motile sperm count differed significantly between antioxidant and placebo groups, with an increase in placebo and a decline in antioxidant.

    “Change in sperm concentration, total sperm count, and total motile sperm count differed significantly between the two groups, with an increase in the placebo group and a decline in the antioxidant group.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Zinc levels increased after 3 months of treatment in the antioxidant group but did not change in the placebo group.

    “Selenium, vitamin E-α tocopherol, and Zinc levels increased after 3 months of treatment in the antioxidant group but did not change in the placebo group.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Selenium levels increased after 3 months of treatment in the antioxidant group but did not change in the placebo group.

    “Selenium, vitamin E-α tocopherol, and Zinc levels increased after 3 months of treatment in the antioxidant group but did not change in the placebo group.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Pregnancy and live birth rates did not differ between groups in a per protocol analysis.

    “Pregnancy and live birth rates also did not differ between groups in a per protocol analysis (Supplemental Table 5).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Change in total sperm count differed significantly between antioxidant and placebo groups, with an increase in placebo and a decline in antioxidant.

    “Change in sperm concentration, total sperm count, and total motile sperm count differed significantly between the two groups, with an increase in the placebo group and a decline in the antioxidant group.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Vitamin E-α tocopherol levels increased after 3 months of treatment in the antioxidant group but did not change in the placebo group.

    “Selenium, vitamin E-α tocopherol, and Zinc levels increased after 3 months of treatment in the antioxidant group but did not change in the placebo group.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Vitamin E-γ tocopherol levels did not change in either group.

    “Vitamin E-γ tocopherol levels did not change in either group”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Semen morphology was assessed centrally using WHO 5.0 criteria.

    “Semen smears were prepared from each sample and shipped to the University of Utah School of Medicine Andrology and IVF Laboratory for centralized assessment of sperm morphology using WHO 5.0 criteria.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Baseline characteristics were no different between the two groups, except males in the placebo group were more likely to have fathered a pregnancy in the past.

    “Baseline characteristics were no different between the two groups, except males in the placebo group were more likely to have fathered a pregnancy in the past.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Plasma vitamin levels confirm that men in the antioxidant group complied with the regimen, and men randomized to placebo did not crossover.

    “Plasma vitamin levels confirm that men in the antioxidant group complied with the regimen, and men randomized to placebo did not crossover.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Intention to treat analyses were performed to compare the two groups.

    “Intention to treat analyses were performed to compare the two groups.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The internal pilot was pre-specified.

    “A pre-specified, internal pilot was created to examine the effect of the antioxidant formulation on male semen parameters and DNA fragmentation at 3 months of treatment compared to controls.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    Baseline semen characteristics were similar in the two groups, except males in the antioxidant group had a lower percentage of morphologically normal sperm.

    “Baseline semen characteristics (Table 2) were similar in the two groups, except males in the antioxidant group had a lower percentage of morphologically normal sperm.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Written informed consent was obtained from all male and female participants.

    “Written informed consent was obtained from all male and female participants.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Antioxidants do not improve semen parameters or DNA integrity among men with male factor infertility.

    “Antioxidants do not improve semen parameters or DNA integrity among men with male factor infertility.”
    • Also stated in: § CONCLUSIONS · plain
      “Antioxidant treatment does not improve semen parameters or DNA integrity in infertile males.”
    • Also stated in: § DISCUSSION · plain
      “In this randomized controlled trial of couples with male factor infertility, the use of an antioxidant combination in the male partner did not result in a significant improvement in semen parameters after 3 months of therapy, compared to placebo.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    Randomization was generated using a computer-generated random number sequence in randomly varying blocks of 4 and 6, stratified by site and female age, with allocation 1:1 by the data coordinating center through a web-based secured randomization service.

    “The randomization scheme was generated using a computer generated random number sequence in randomly varying blocks of 4 and 6 stratified by site and female age (<35 years and ≥35 years of age) with allocation 1:1 by the data coordinating center through a web-based, secured randomization service.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    The trial was a multi-center, double-blind, randomized, placebo-controlled trial with an internal pilot.

    “Multi-center, double blind, randomized, placebo-controlled trial with an internal pilot study [Males, Antioxidants, and Infertility (MOXI)]”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The protocol was designed such that if the pilot failed to reject the null hypothesis that motility and DNA fragmentation did not differ between groups after 3 months, the MOXI trial would stop enrollment.

    “The protocol was designed such that if the pilot failed to reject the null hypothesis that motility and DNA fragmentation did not differ between the two treatment groups (antioxidant and placebo) after 3 months of treatment, the MOXI trial would stop enrollment.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Study medications were assigned in a double-blind fashion.

    “Study medications were assigned in a double-blind fashion.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Prior trials have been small and of low or very low quality.

    “Prior trials have been small and of low or very low quality. (13)”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [13] Showell, 2014, Antioxidants for male subfertility, Cochrane Database Syst Rev source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    Doses in the antioxidant formulation aligned with those in prior trials.

    “Although a theoretical concern, the antioxidant formulation used in this study did not include excessive amounts of any given antioxidant. Doses aligned with those in prior trials.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Premisenone given

    Our inclusion criteria were similar if not more selective compared to prior trials.

    “Our inclusion criteria were similar if not more selective compared to prior trials.”
    Quote in the paperNot a substantial claim
29 of 29

  • The authors state this as an assumption.

    There are no interacting effects between the different antioxidants in the formulation.

    “inherently assumes namely that there are no interacting effects between the different antioxidants in the formulation.”

  • The authors state this as an assumption.

    The effect of the intervention on live births is at least partially mediated through improvements in sperm motility and a reduction in sperm DNA fragmentation.

    “The trial stopping rule had the strong underlying hypothesis that the effect of the intervention on live births is (at least partially) mediated through improvements in sperm motility and a reduction in sperm DNA fragmentation.”

  • The paper relies on this without support.

    Conventional semen quality parameters and even sperm DNA fragmentation are, at best, modest predictors of a couple’s fertility when trying with or without medical assistance.

    “However, conventional semen quality parameters and even sperm DNA fragmentation are, at best, modest predictors of a couple’s fertility when trying with or without medical assistance.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The MOXI trial was a multicenter, randomized, double-blind, placebo-controlled trial analyzing the effect of antioxidants on semen parameters among couples with mild male factor infertility.

    “In brief, the MOXI trial was a multicenter, randomized, double-blind, placebo-controlled trial analyzing the effect of antioxidants on semen parameters among couples with mild male factor infertility.”

    From Poor reproducibility of percentage of normally shaped sperm using the World Health Organization Fifth Edition strict grading criteria (2022) · cites this paper as [22]

    The Abstract (Design) identifies MOXI as a multicenter, randomized, double-blind, placebo-controlled trial, and the Methods (Outcomes) confirm that it examined effects on semen parameters. The Methods (Study design) describe couples with male factor infertility but do not characterize all enrolled cases as mild; eligibility allowed several abnormal semen parameters, while excluding men with sperm concentration below 5 million/ml. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Completion claim conflicts with reported dropouts

    Minor

    The paper says all enrolled couples completed the study protocol, but earlier reports that only 144 of 171 randomized couples completed the study.

1 of 1

Cites

Flagged first, then by citations

2 of the 28 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Peivandi, 2010, Effects of l-carnitine on infertile men’s spermogram; a randomised clinical trial, J Reprod Infertil, 10, 245

Cited by

Sorted by citations

Related

Authors
Steiner, A. Z., Hansen, K. R., Barnhart, K. T., Cedars, M. I., Legro, R. S., Diamond, M. P., Krawetz, S. A., Usadi, R., Baker, V. L., Coward, R. M., Huang, H., Wild, R., Masson, P., Smith, J. F., Santoro, N., Eisenberg, E., & Zhang, H.
Affiliations
  • University of North Carolina at Chapel Hill (US)
  • University of Oklahoma Health Sciences Center (US)
  • University of Pennsylvania (US)
  • University of California, San Francisco (US)
  • Pennsylvania State University (US)
  • Augusta University (US)
  • Wayne State University (US)
  • Stanford University (US)
  • Yale University (US)
  • University of Colorado Denver (US)
  • National Institutes of Health (US)
Corresponding author
Steiner, Anne Z.
ORCID
Venue
Fertility and Sterility
Publisher
Elsevier BV
Published
2020-03
Volume
113
Issue
3
Pages
552-560.e3
ISSN
0015-0282 (ISSN-L)
DOI
10.1016/j.fertnstert.2019.11.008
PMC
PMC7219515
OpenAlex
W3006771562
Cited by
213
References
28
Citations by year
2026: 33 · 2025: 29 · 2024: 25 · 2023: 31 · 2022: 42 · 2021: 32 · 2020: 21
FWCI
22.74
Type
journal article
Language
en
Open access
Licence
Locations
  • Fertility and Sterility (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion)
Funders
Eunice Kennedy Shriver National Institute of Child Health and Human Development
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Sperm and Testicular Function
  • Health Sciences › Medicine › Reproductive Medicine › Reproductive Health and Technologies
  • Health Sciences › Health Professions › General Health Professions › Male Reproductive Health Studies
Keywords
male factor infertility, antioxidants, male fertility, sperm DNA fragmentation, semen parameters, sperm concentration, live birth, vitamin C, vitamin E, selenium, L-carnitine, zinc, folic acid, lycopene, intrauterine insemination, clomiphene citrate, oligozoospermia, internal pilot study
MeSH terms
Adult, Antioxidants, Double-Blind Method, Female, Humans, Infant, Newborn, Infertility, Male, Insemination, Artificial, Homologous, Male, Ovulation Induction, Pilot Projects, Pregnancy, United States, Pregnancy Rate

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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

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