The DOI matches its Crossref record; 26 of the 28 references it cites were found in a registry or an index; 10 of the 12 sources its claims cite were checked for support.
The effect of antioxidants on male factor infertility: the Males, Antioxidants, and Infertility (MOXI) randomized clinical trial
Open accessAbstract
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.
Overview
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).
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Claims the paper makes
22 Own result · 16 Own method · 6 Supported · 3 Own interpretation · 3 No basis given · 2 Partly supported · 1 Not supported · 1 Couldn’t confirm · 1 No full text of the sources · accuracy not yet measured
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“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)”
§ The Effect of Antioxidants on Male Factor Infertility: The MOXI Randomized Clinical Trial > DISCUSSION
What the sources say
- Could not verifycites [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 sourceExperimental — accuracy not yet measured
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)
- Not checked — no full text of the sourcecites [26] Henkel, 2019, The excessive use of antioxidant therapy: a possible cause of male infertility?, Andrologia source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Could not verify
Every source the paper cites for this claim was checked and supports it.
In the paper
“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)”
§ The Effect of Antioxidants on Male Factor Infertility: The MOXI Randomized Clinical Trial > DISCUSSION
What the sources say
- Supportedcites [7] Smits, 2019, Antioxidants for male subfertility, Cochrane Database Syst Rev source
Figure 9, analysis 1.11.14, reports a mean difference of 12.43 in total sperm motility for combined antioxidants versus placebo or no treatment. Figure 9 identifies the outcome as motility at three months or less, consistent with the cited sentence’s rounded 12% increase. (LLM, conf=0.90)
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Our negative findings contradict the overall conclusions from the Cochrane Review and meta-analysis.”
§ The Effect of Antioxidants on Male Factor Infertility: The MOXI Randomized Clinical Trial > DISCUSSION
What the sources say
- Supportedcites [7] Smits, 2019, Antioxidants for male subfertility, Cochrane Database Syst Rev source
The Authors’ Conclusions (page unavailable) say antioxidant supplementation may improve live birth rates and may increase clinical pregnancy rates, although the evidence is low quality and overall inconclusive. The review’s live-birth meta-analysis reports an association with increased live birth, so negative findings would contrast with its reported direction of effect. (LLM, conf=0.86)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Supported
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“or in phase 2 (12% versus 21%, p=0.11), when women received ovarian stimulation with clomiphene citrate and timed intrauterine insemination.”
§ The Effect of Antioxidants on Male Factor Infertility: The MOXI Randomized Clinical Trial > RESULTS
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Change in morphology, motility, and DNA fragmentation did not differ between the two groups.”
§ The Effect of Antioxidants on Male Factor Infertility: The MOXI Randomized Clinical Trial > RESULTS
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Change in morphology, motility, and DNA fragmentation did not differ between the two groups.”
§ The Effect of Antioxidants on Male Factor Infertility: The MOXI Randomized Clinical Trial > RESULTS
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The percentage of males who had at least one adverse event did not differ between groups (41% in antioxidant group, 40% in placebo group, p=0.83)”
§ The Effect of Antioxidants on Male Factor Infertility: The MOXI Randomized Clinical Trial > RESULTS
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Of the 75 asthenospermic men, motility did not differ at 3 months (34±16.3% versus 36.4±15.8%; p=0.53).”
- Also stated in: § RESULTS · plain
“Among the 75 men with asthenospermia, there were no significant differences in change in sperm motility between the two treatment groups.”
§ The Effect of Antioxidants on Male Factor Infertility: The MOXI Randomized Clinical Trial > Abstract > Results
plainn = 75- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § RESULTS · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“After 3 months of treatment, change in sperm concentration differed between the antioxidant group [−4.0 (−12.0, 5.7) M/ml] and placebo group [+2.4 (−9.0, 15.5) M/ml] (p=0.03).”
§ The Effect of Antioxidants on Male Factor Infertility: The MOXI Randomized Clinical Trial > Abstract > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Similar results were observed when the male participants were stratified based on baseline sperm morphology or prior pregnancy history (Supplemental Table 3).”
§ The Effect of Antioxidants on Male Factor Infertility: The MOXI Randomized Clinical Trial > RESULTS
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- It may state two separate claims as one. 16
- Probably not a substantial claim. 16
At least one cited source doesn’t support this claim or points to a different paper, and none confirmed it — see the verdicts below.
In the paper
“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.”
§ The Effect of Antioxidants on Male Factor Infertility: The MOXI Randomized Clinical Trial > DISCUSSION
What the sources say
- Disputedcites [7] Smits, 2019, Antioxidants for male subfertility, Cochrane Database Syst Rev sourceExperimental — accuracy not yet measured
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.
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Disputed
Every source the paper cites for this claim was checked and supports it.
In the paper
“DNA fragmentation assessment using the Sperm Chromatin Structure Analysis (SCSA) test”
§ The Effect of Antioxidants on Male Factor Infertility: The MOXI Randomized Clinical Trial > METHODS > Study Treatment
What the sources say
- Supportedcites [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
The Sperm Chromatin Structure Assay section identifies SCSA as an assay of sperm DNA susceptibility to denaturation. The Data Analysis–New Terminology section states that SCSA measurements are used to calculate the level of DNA fragmentation (DFI). Page numbers are not provided in the passages. (LLM, conf=0.94)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“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)”
§ The Effect of Antioxidants on Male Factor Infertility: The MOXI Randomized Clinical Trial > DISCUSSION
What the sources say
- Supportedcites [7] Smits, 2019, Antioxidants for male subfertility, Cochrane Database Syst Rev source
The review’s meta-analysis reports a live-birth Peto odds ratio of 1.79 for antioxidants versus placebo or no treatment in subfertile men, matching the cited 1.8-fold figure. The evidence was rated low quality. (LLM, conf=0.93)
plaindirectn = 750- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“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)”
§ The Effect of Antioxidants on Male Factor Infertility: The MOXI Randomized Clinical Trial > DISCUSSION
What the sources say
- Supportedcites [7] Smits, 2019, Antioxidants for male subfertility, Cochrane Database Syst Rev source
The Clinical pregnancy section reports a Peto odds ratio of 2.97 for antioxidants versus placebo or no treatment in subfertile men. This supports the attributed pregnancy figure; the review specifies that the outcome was clinical pregnancy and rates the evidence as low quality. (LLM, conf=0.93)
plaindirectn = 750- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“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)”
§ The Effect of Antioxidants on Male Factor Infertility: The MOXI Randomized Clinical Trial > INTRODUCTION
What the sources say
- Supportedcites [7] Smits, 2019, Antioxidants for male subfertility, Cochrane Database Syst Rev source
The Authors’ Conclusions (Implications for practice) say that low-quality evidence from seven small randomized trials suggests antioxidant supplementation in subfertile males may improve couples’ live birth rates. The same section calls for further large, well-designed, randomized placebo-controlled trials, matching the citing sentence’s qualification. (LLM, conf=0.94)
hedgedconditional- Asserted: fails — The authors may not put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The authors may not put it forward as true.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“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)”
§ The Effect of Antioxidants on Male Factor Infertility: The MOXI Randomized Clinical Trial > DISCUSSION
What the sources say
- Partly supportedcites [7] Smits, 2019, Antioxidants for male subfertility, Cochrane Database Syst Rev sourceExperimental — accuracy not yet measured
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)
plaindirectn = 254- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“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)”
§ The Effect of Antioxidants on Male Factor Infertility: The MOXI Randomized Clinical Trial > METHODS > Study design
What the sources say
- Partly supportedcites [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 sourceExperimental — accuracy not yet measured
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)
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Partly supported
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The Effect of Antioxidants on Male Factor Infertility: The MOXI Randomized Clinical Trial > RESULTS
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The Effect of Antioxidants on Male Factor Infertility: The MOXI Randomized Clinical Trial > RESULTS
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The Effect of Antioxidants on Male Factor Infertility: The MOXI Randomized Clinical Trial > RESULTS
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Pregnancy and live birth rates also did not differ between groups in a per protocol analysis (Supplemental Table 5).”
§ The Effect of Antioxidants on Male Factor Infertility: The MOXI Randomized Clinical Trial > RESULTS
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The Effect of Antioxidants on Male Factor Infertility: The MOXI Randomized Clinical Trial > RESULTS
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The Effect of Antioxidants on Male Factor Infertility: The MOXI Randomized Clinical Trial > RESULTS
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Vitamin E-γ tocopherol levels did not change in either group”
§ The Effect of Antioxidants on Male Factor Infertility: The MOXI Randomized Clinical Trial > RESULTS
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The Effect of Antioxidants on Male Factor Infertility: The MOXI Randomized Clinical Trial > METHODS > Study Treatment
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The Effect of Antioxidants on Male Factor Infertility: The MOXI Randomized Clinical Trial > RESULTS
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Plasma vitamin levels confirm that men in the antioxidant group complied with the regimen, and men randomized to placebo did not crossover.”
§ The Effect of Antioxidants on Male Factor Infertility: The MOXI Randomized Clinical Trial > DISCUSSION
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Intention to treat analyses were performed to compare the two groups.”
§ The Effect of Antioxidants on Male Factor Infertility: The MOXI Randomized Clinical Trial > METHODS > Statistical analysis
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The Effect of Antioxidants on Male Factor Infertility: The MOXI Randomized Clinical Trial > METHODS > Outcomes
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The Effect of Antioxidants on Male Factor Infertility: The MOXI Randomized Clinical Trial > RESULTS
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Written informed consent was obtained from all male and female participants.”
§ The Effect of Antioxidants on Male Factor Infertility: The MOXI Randomized Clinical Trial > METHODS > Study design
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The Effect of Antioxidants on Male Factor Infertility: The MOXI Randomized Clinical Trial > Abstract > Conclusions
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- Also stated in: § CONCLUSIONS · plain
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The Effect of Antioxidants on Male Factor Infertility: The MOXI Randomized Clinical Trial > METHODS > Study Treatment
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Multi-center, double blind, randomized, placebo-controlled trial with an internal pilot study [Males, Antioxidants, and Infertility (MOXI)]”
§ The Effect of Antioxidants on Male Factor Infertility: The MOXI Randomized Clinical Trial > Abstract > Design
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ The Effect of Antioxidants on Male Factor Infertility: The MOXI Randomized Clinical Trial > METHODS > Outcomes
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Study medications were assigned in a double-blind fashion.”
§ The Effect of Antioxidants on Male Factor Infertility: The MOXI Randomized Clinical Trial > METHODS > Study Treatment
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“Prior trials have been small and of low or very low quality. (13)”
§ The Effect of Antioxidants on Male Factor Infertility: The MOXI Randomized Clinical Trial > DISCUSSION
What the sources say
- Not checked — no full text of the sourcecites [13] Showell, 2014, Antioxidants for male subfertility, Cochrane Database Syst Rev source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
§ The Effect of Antioxidants on Male Factor Infertility: The MOXI Randomized Clinical Trial > DISCUSSION
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Our inclusion criteria were similar if not more selective compared to prior trials.”
§ The Effect of Antioxidants on Male Factor Infertility: The MOXI Randomized Clinical Trial > DISCUSSION
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
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.”
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 source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
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.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ The Effect of Antioxidants on Male Factor Infertility: The MOXI Randomized Clinical Trial > RESULTS
“all enrolled couples completed the study protocol.”
§ The Effect of Antioxidants on Male Factor Infertility: The MOXI Randomized Clinical Trial > RESULTS
“171 were eligible and were randomly assigned to a treatment group (see Supplemental Figure 1); 144 of those couples completed the study.”
Citations
Cites
Generation of Reactive Oxygen Species, Lipid Peroxidation, and Human Sperm Function
Aitken, R. J., Clarkson, J. S., & Fishel, S. B. (1989) · Biology of Reproduction · doi:10.1095/biolreprod41.1.183 · Cited by 1,227 · cited 1×
“Oxidative stress can cause lipid peroxidation, thereby producing structural modifications to the sperm plasma membrane, which have been shown to interfere with sperm motility, acrosome reactions, and sperm– oocyte fusion (4).”
BackgroundEVENSON, D. P., LARSON, K. L., & JOST, L. K. (2002) · Journal of Andrology · doi:10.1002/j.1939-4640.2002.tb02599.x · Cited by 1,072 · cited 1×
“In addition, 1 mL of semen was stored at 80 C and subsequently shipped frozen to the Utah Andrology Laboratory for DNA fragmentation assessment using the sperm chromatin structure analysis (SCSA) test (14), when 10 million sperm were present.”
MethodLipid Peroxidation and Human Sperm Motility: Protective Role of Vitamin E
SULEIMAN, S. A., Ali, M., Zaki, Z. M. S., Elmalik, E. M. A., & NASR, M. A. (1996) · Journal of Andrology · doi:10.1002/j.1939-4640.1996.tb01830.x · Cited by 662 · cited 1×
“Follow-up evaluation in the natural conception trials was not systematic (22, 23).”
BackgroundAntioxidants for male subfertility
Showell, M. G., Brown, J., Yazdani, A., Stankiewicz, M. T., & Hart, R. J. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007411.pub2 · Cited by 587
Gharagozloo, P., & Aitken, R. J. (2011) · Human Reproduction · doi:10.1093/humrep/der132 · Cited by 523 · cited 1×
“Oxidative stress may also damage the nuclear and mitochondrial genome by causing single and double DNA breaks, chemical modifications of bases, DNA crosslinks, and DNA protein crosslinks (5).”
BackgroundReduction of the Incidence of Sperm DNA Fragmentation by Oral Antioxidant Treatment
Greco, E., Iacobelli, M., Rienzi, L. F., Ubaldi, F. M., Ferrero, S., & Tesařík, J. (2005) · Journal of Andrology · doi:10.2164/jandrol.04146 · Cited by 511 · cited 2×
“(11) enrolled 64 men with DNA fragmentation levelsR15%, as measured using terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay.”
BackgroundMethodSaleh, R. A., Agarwal, A. K., Sharma, R. K., Nelson, D. R., & Thomas, A. J., Jr. (2002) · Fertility and Sterility · doi:10.1016/s0015-0282(02)03294-6 · Cited by 394
Kessopoulou, E., Powers, H. J., Sharma, K. K., Pearson, M. J., Russell, J., Cooke, I. D., & Barratt, C. L. R. (1995) · Fertility and Sterility · doi:10.1016/s0015-0282(16)57861-3 · Cited by 336 · cited 3×
“A number of the included trials used antioxidants in combination with in vitro fertilization (IVF); it is certainly possible that the response to antioxidants would differ with IVF.”
BackgroundInfluentialAntioxidants for male subfertility
Showell, M. G., Mackenzie-Proctor, R., Brown, J., Yazdani, A., Stankiewicz, M. T., & Hart, R. J. (2014) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007411.pub3 · Cited by 285 · cited 6×
“In semen, antioxidants decrease oxidative stress (6), potentially improving sperm motility and reducing DNA fragmentation (7).”
BackgroundMethodInfluentialAntioxidants for male subfertility
Smits, R. M., Mackenzie-Proctor, R., Yazdani, A., Stankiewicz, M. T., Jordan, V., & Showell, M. G. (2019) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd007411.pub4 · Cited by 277
Research works printed but not linked: 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
Items 101–200 of 213
Seminal L-Carnitine In Infertile Oligoasthenoteratozoospermic Men with Varicocele
Mostafa, T., Abougabal, K. M., Mintziori, G., et al. (2022) · Journal of Reproduction & Infertility · doi:10.18502/jri.v23i1.8449 · Cited by 7
“Numerous studies showed the valuable effects of LC intake on sperm motility, and sperm DNA fragmentation concluding that combining metabolic and micro-nutritive aspects is helpful for male factor infertility treatment (18-22).”
BackgroundBoushaba, S., Helis, Y., Lebaal, R., Beldjebel, S., Benhamza, A., Ziti, C., & Belaaloui, G. (2023) · Daehan saengsik uihak hoeji/Clinical and experimental reproductive medicine · doi:10.5653/cerm.2022.05736 · Cited by 7
The dual nature of micronutrients on fertility: too much of a good thing?
Moazamian, A., Hug, E., Villeneuve, P., Bravard, S., Geurtsen, R., Hallak, J., Saez, F., Aitken, R. J., Gharagozloo, P., & Drevet, J. R. (2025) · F&S Science · doi:10.1016/j.xfss.2025.02.004 · Cited by 9
Yishentongluo decoction in treatment of idiopathic asthenozoospermia infertility
Zhang, Q., Fan, L., Li, F., et al. (2020) · Medicine · doi:10.1097/md.0000000000022662 · Cited by 7
“2 dant remains debated, since limited by sample size.([28]) In recent years, L-Carnitine (LC) has attracted extensive attention in treating male infertility.”
BackgroundMethodThe aging male: impact of aging on male reproduction
Akhigbe, R. E., Oyedokun, P. A., Adeogun, A. E., Ogunleye, O. O., Adegbola, C. A., & Akhigbe, T. M. (2025) · Biogerontology · doi:10.1007/s10522-025-10343-7 · Cited by 8
“One major point of contention is that while oxidative stress clearly damages sperm DNA and impairs fertility, clinical trials such as the large SUMMER (de Ligny et al. 2025) and MOXI (Steiner et al 2020; Knudtson et al. 2021) studies have found no consistent fertility benefits from antioxidant supplementation.”
Nguyen, H. D. K., Kuroda, S., Nguyen, N. T., et al. (2025) · Reproductive Medicine and Biology · doi:10.1002/rmb2.12693 · Cited by 6
Moyad, M. A. (2022) · Urologic Clinics of North America · doi:10.1016/j.ucl.2021.12.006 · Cited by 6
COVID-19 and Male Infertility: Is There a Role for Antioxidants?
Kalfas, T., Kaltsas, A., Symeonidis, E. N., Symeonidis, A., Zikopoulos, A., Moustakli, E., Tsiampali, C., Tsampoukas, G., Palapela, N., Zachariou, A., et al. (2023) · Antioxidants · doi:10.3390/antiox12081483 · Cited by 7
“An interval pilot study that was carried out on these patients aimed to assess the semen parameter and DFI changes three months after the supplementation initiation; no improvement was observed [157].”
BackgroundMethodSyarif, S., Saleh, R. A., Çayan, S., Birowo, P., Atmoko, W., Zainal, A. T. F., Makkaraka, M. A. G., & Agarwal, A. K. (2025) · The World Journal of Men s Health · doi:10.5534/wjmh.250159 · Cited by 8
“Therefore, increasing antioxidant levels in semen may help prevent OS and reduce sperm damage, although the effectiveness of this approach is still under debate [23].”
Male factor infertility: A contemporary overview of investigation, diagnosis and management
Krishan, A., Vukina, J., Pearce, I., & Modgil, V. (2022) · Journal of Clinical Urology · doi:10.1177/20514158221078474 · Cited by 5
“78 Although these trials were all randomised and placebo-controlled, the numbers involved are small.”
Han, B., Guo, J., Zhou, B., Li, C., Qiao, T., Hua, L., Jiang, Y., Mai, Z., Yu, S., Tian, Y., et al. (2023) · Frontiers in Endocrinology · doi:10.3389/fendo.2023.1222635 · Cited by 5
Aitken, R. J., Wilkins, A., Harrison, N., et al. (2025) · Antioxidants · doi:10.3390/antiox14010090 · Cited by 5
“…oligozoospermia (low sperm numbers), asthenozoospermia (poor sperm motility), teratozoospermia (poor sperm morphology), high levels of DNA fragmentation, varicocele, prolonged idiopathic subfertility or recurrent pregnancy loss [4–12], rather than any direct evidence of heightened oxidative stress.”
Role of Antioxidants Supplementation in the Treatment of Male Infertility
Amor, H., Shelko, N., Mohammed, M., Jankowski, P. M., & Hammadeh, M. E. (2021) · IntechOpen eBooks · doi:10.5772/intechopen.95891 · Cited by 5
“4 supplement comprising of vitamins C, E, D, selenium, L-carnitine, zinc, folic acid and lycopene from three to six months [37].”
BackgroundHigazy, A., Mohammed, W., Esmat, M. E., & Samir, M. (2025) · Arab Journal of Urology · doi:10.1080/20905998.2025.2509424 · Cited by 4
The biology and clinical aspects of female infertility
Madjunkov, M., Madjunkova, S., & Librach, C. (2026) · Systems Biology in Reproductive Medicine · doi:10.1080/19396368.2025.2593345 · Cited by 4
Antioxidants in Male and Animal Reproduction: Applications and Critical Issues
Moretti, E., & Signorini, C. (2024) · Antioxidants · doi:10.3390/antiox13111283 · Cited by 4
Seminal oxidative stress and recurrent pregnancy loss: a systematic review and meta-analysis
Câmara, F. E. A., Sobral, D. D. S., Neto, F. T. L., Esteves, S. C., & Cavalcante, M. B. (2025) · Reproductive BioMedicine Online · doi:10.1016/j.rbmo.2025.104873 · Cited by 4
Hamilton, M., Russell, S. J., Moskovtsev, S. I., Krawetz, S. A., & Librach, C. L. (2021) · F&S Reviews · doi:10.1016/j.xfnr.2021.11.005 · Cited by 5
“However, in the ‘Males, Antioxidants, and Infertility’ (MOXI) study, antioxidants failed to improve semen parameters or DNA integrity, and did not impact live birth rates among men with male factor infertility (26)(28).”
BackgroundSelf-citationSengul, M., Hekim, N., Aşçı, R., et al. (2024) · Revista da Associação Médica Brasileira · doi:10.1590/1806-9282.20240211 · Cited by 4
“…asthenozoospermic infertile men who showed the failure of antioxidant support therapy for 6 months, it was shown that there was no statistical difference in sperm count, motility, morphology, and viable pregnancy rates compared to the placebo group, and DFI rates were similar between the group 6 .”
BackgroundResultEtiology of male infertility: a review
Badar, A., Khilwani, B., Lohiya, N. K., et al. (2022) · International Journal of Reproduction Contraception Obstetrics and Gynecology · doi:10.18203/2320-1770.ijrcog20221963 · Cited by 4
Sperm DNA Fragmentation and Fertility
Marinaro, J. A., & Schlegel, P. N. (2025) · Advances in experimental medicine and biology · doi:10.1007/978-3-031-82990-1_13 · Cited by 3
Gany, S. L. S., Sahardi, N. F. N. M., Tan, J. K., & Makpol, S. (2026) · British Journal of Biomedical Science · doi:10.3389/bjbs.2026.16208 · Cited by 3
“This rising prevalence highlights the urgent need for regular screening and early intervention, particularly among high-risk groups such as older adults and individuals with comorbid conditions like cancer or chronic kidney disease [6, 7].”
Liao, T.-L., He, C.-M., Xiao, D., et al. (2025) · Asian Journal of Andrology · doi:10.4103/aja2024106 · Cited by 3
Ikuomola, E. O., Owu, D. U., Oka, V. O., et al. (2025) · F1000Research · doi:10.12688/f1000research.164618.1 · Cited by 3
Male fertility: review of the publications of January ― March 2020
Rogozin, D. S. (2020) · Urology Herald · doi:10.21886/2308-6424-2020-8-2-93-98 · Cited by 3
Male infertility-evaluation and management at a glance
Ghuman, N. K., Singh, P., & Raikar, S. (2020) · Fertility Science and Research · doi:10.4103/2394-4285.288707 · Cited by 3
Male fertility: review of the publications of July - September 2020
Rogozin, D. S. (2020) · Urology Herald · doi:10.21886/2308-6424-2020-8-4-122-128 · Cited by 3
Ma, Z., Liu, X., Lu, H., Li, H., Gao, R., Wen, R., Tang, Z.-P., Yin, H., He, Y., & Yang, H. (2022) · Evidence-based Complementary and Alternative Medicine · doi:10.1155/2022/7723358 · Cited by 3
Borovskaya, T. G., Вычужанина, А. В., Shchemerovа, Y. А., et al. (2022) · Bulletin of Experimental Biology and Medicine · doi:10.1007/s10517-022-05618-9 · Cited by 3
Advanced sperm tests and impact on clinical male factor management
Nam, C. S., & Mehta, A. (2022) · Current Opinion in Urology · doi:10.1097/mou.0000000000001049 · Cited by 3
Oxidative Stress-Induced Male Infertility: Role of Antioxidants in Cellular Defense Mechanisms
Vazquez, J. F. S., Rosas, I. M., Villar, L., Macias, L. B. L., Dominguez, L. B. R., Kesari, K. K., Martínez, E. M., León, E. B., & Roychoudhury, S. (2022) · Advances in experimental medicine and biology · doi:10.1007/978-3-031-12966-7_16 · Cited by 3
MOXI trial—is it time to stop routinely recommending antioxidant therapy to infertile men?
Kathrins, M. N. (2020) · Fertility and Sterility · doi:10.1016/j.fertnstert.2019.12.015 · Cited by 3
Should empiric therapies be used for male factor infertility?
Bühling, K. J., Chan, P. T. K., Kathrins, M. N., Showell, M. G., Vij, S. C., & Sigman, M. (2020) · Fertility and Sterility · doi:10.1016/j.fertnstert.2020.04.015 · Cited by 3
The role of sperm DNA fragmentation in reproduction: a SWOT analysis
Llácer, J., Requena, A., Checa, M. A., Bellver, J., Bosch, E., Espinós, J., Fábregues, F., Ortega, A. I., Fontes, J., & Garcia-Velasco, J. (2025) · Journal of Assisted Reproduction and Genetics · doi:10.1007/s10815-025-03645-9 · Cited by 4
“…clear evidence, as seen in the case of overtreatment of varicocele (evidence 4) [193], the indiscriminate use of antioxidants without evidence of their impact on reproductive outcomes (evidence 1b) [194], or the overuse of sperm selection methods in non-selected populations (evidence 1b) [195].”
Haznedar, N. K., Mümüşoğlu, S., Şükür, Y. E., & Bilgiç, P. (2025) · Medicine · doi:10.1097/md.0000000000044901 · Cited by 2
“[48] Although the fact that the effect of supplementation and not dietary intake was examined suggests the generalizability of our study, the randomization design of the study and the large sample size increase the reliability of the results.”
Melhem, S. J., Melhem, M., Haddad, R., Alghurabi, O., Mousa, R., Massad, E. M., Almomani, H., Alrashdan, Y., & Melhem, J. (2026) · Andrology · doi:10.1111/andr.70266 · Cited by 2
“The MOXI trial by Steiner et al. [ 64 ] is the largest placebo-controlled trial of an antioxidant formulation in men with abnormal semen parameters.”
Use of empirical medical therapies for idiopathic male infertility in Australia and New Zealand
Catford, S. R., Katz, D. J., & McLachlan, R. I. (2024) · Clinical Endocrinology · doi:10.1111/cen.15059 · Cited by 2
“32 There was also no beneficial change in any subgroups including those with high baseline sperm DNA fragmentation (SDF).”
BackgroundElnashar, A., Farag, M. A. E. F., Din, S. F. G., Salam, M. A. A. E., Elseginy, A., Mohamed, A. O. S., & Ragab, M. W. (2024) · International Urology and Nephrology · doi:10.1007/s11255-024-04187-2 · Cited by 3
“In contrast, the MOXI trial did not show any benefit from antioxidants supplementation on semen parameters or DNA integrity in infertile males [20].”
InfluentialAitken, R. J., Wilkins, A., Harrison, N., Swegen, A., & Lambourne, S. R. (2025) · Advances in Redox Research · doi:10.1016/j.arres.2025.100121 · Cited by 2
Çayan, S., Cannarella, R., Arafa, M. M., et al. (2025) · Andrologia · doi:10.1155/and/4666847 · Cited by 2
Hormonal and nonhormonal treatment of male infertility
Davies, R., Jayasena, C. N., & Minhas, S. (2023) · Elsevier eBooks · doi:10.1016/b978-0-323-89907-9.00037-5 · Cited by 2
The place of antioxidants in male infertility therapy
Gvasalia, B. R., Isaeva, A. V., & Babaev, M. U. (2023) · Andrology and Genital Surgery · doi:10.17650/2070-9781-2023-24-4-59-66 · Cited by 2
Infertilidade masculina: principais causas e terapêuticas emergentes, uma revisão
Marconato, T. C., Donne, R. D. D., Romano, R. M., & Romano, M. A. (2022) · Research Society and Development · doi:10.33448/rsd-v11i10.33139 · Cited by 1
Wen, Q., Xu, H.-Y., Zou, H., Wang, P., Xing, X., Chen, Y., Zhu, Q.-L., Chen, Y., Tan, M.-H., Zhang, M.-M., et al. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2024.1418936 · Cited by 2
From bench to babies – drug development for male subfertility
Khaw, S. C., & da Silva, S. M. (2024) · Reproduction and Fertility · doi:10.1530/raf-24-0022 · Cited by 1
Glišić, B., & Kotur‐Stevuljević, J. (2025) · Arhiv za farmaciju · doi:10.5937/arhfarm75-55898 · Cited by 1
Niu, C., Lu, X., Xie, Y., Yu, Y., Gao, Y., Shen, N., & Zheng, Y. (2025) · Reproductive Sciences · doi:10.1007/s43032-025-01958-9 · Cited by 1
Ikuomola, E. O., Owu, D. U., Oka, V. O., et al. (2025) · F1000Research · doi:10.12688/f1000research.164618.2 · Cited by 1
Oskouei, B. S., Rahimi, P., Azimzadeh, N., et al. (2026) · Clinical Nutrition Open Science · doi:10.1016/j.nutos.2026.100632 · Cited by 1
Selenium supplementation and male fertility: Mechanistic insights and therapeutic potential
Patel, N., Mishra, R., Afzal, M., et al. (2026) · Journal of Trace Elements in Medicine and Biology · doi:10.1016/j.jtemb.2026.127840 · Cited by 1
Chavarro, J. E., Salas‐Huetos, A., Mitsunami, M., Wang, S., Kitazawa, S., Souter, I. C., & Mínguez‐Alarcón, L. (2026) · Fertility and Sterility · doi:10.1016/j.fertnstert.2026.03.012 · Cited by 1
Ispossunova, G., Nikolić, D., Alchinbayev, M., et al. (2026) · Medicina · doi:10.3390/medicina62030566 · Cited by 1
Zhou, J., Hu, S., Ouyang, Y., Yang, D., Su, Z., & Liu, M. (2026) · Frontiers in Immunology · doi:10.3389/fimmu.2026.1806683 · Cited by 1
Varicocele and male infertility: Historical, anatomical and urological perspectives – a mini review
Ramachandran, K., & Krishnamoorthy, S. (2021) · Biomedicine · doi:10.51248/.v41i2.1033 · Cited by 1
Therapeutic Attempts in Idiopathic Infertility
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Antenatal antioxidants to avert autism?
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It Is Time We Rethink Our Approach to Enhancing Access to Male Infertility Care
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“As it is increasingly clear that indiscriminate use of antioxidants without oxidative testing is not beneficial for male subfertility (Schisterman et al., 2020; Steiner et al., 2020), the next step is to standardize the test for oxidative stress and identify the population which may benefit from the intervention.”
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A INFLUÊNCIA DOS ANTIOXIDANTES NA INFERTILIDADE MASCULINA
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How to minimize the dropout and crossover in an infertility trial?
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Metadata
- 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)
- 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
- bronze
- doi.org
- 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 › Medicine › Urology › 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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