The global evaluation of the effects of antioxidants on seminal outcomes in infertile men: a systematic review and meta-analysis
Clinical Snapshot
PICO Framework
| P — Population | Infertile men (n=11,889 across 101 studies) |
| I — Intervention | Antioxidant supplementation (various types and dosages) |
| C — Comparator | Control groups (placebo or no treatment) |
| O — Outcomes | Sperm concentration, normal sperm morphology, progressive sperm motility, and total sperm motility |
Bottom Line
This comprehensive meta-analysis of 101 studies involving nearly 12,000 infertile men suggests antioxidant supplementation may improve key sperm parameters, particularly concentration and motility. The standardised mean differences were substantial (2.33 for concentration, 1.62 for motility), with longer treatment durations (>6 months) showing superior efficacy. However, the authors appropriately conclude that evidence remains insufficient for definitive clinical recommendations. While the large sample size and global scope strengthen the findings, the lack of detailed methodology reporting, unclear quality assessment, and absence of heterogeneity data limit confidence in the results. For Australian practitioners, these findings support cautious consideration of antioxidant therapy in male infertility management, particularly for motivated patients willing to commit to extended treatment periods, while awaiting more definitive evidence from high-quality randomised controlled trials.
Key Findings
P Value: Not reported in abstract
Effect Size: SMD 2.33 for sperm concentration; SMD 1.62 for total motility
Primary Outcome: Sperm concentration and total motility significantly improved with antioxidant treatment
Nnt Or Sensitivity: Treatment duration >6 months more effective than <3 months
Confidence Interval: 95% CI: 1.73-2.94 (concentration); 95% CI: 1.20-2.04 (motility)
Clinical Application
Generally feasible as oral supplementation, though optimal formulations and dosing unclear Relevant to Australian fertility clinics; antioxidant supplements available but not PBS-subsidised; aligns with RACGP guidelines on evidence-based fertility management Men with diagnosed infertility seeking fertility treatment
Abstract
The aim of the current review is to summarise information from publications on the impact of antioxidants on seminal outcomes in infertile men. A systematic search was performed in the five valid databases (Scopus, PubMed, Medline, Embase, and Web of Science) utilizing two sets of keywords up to September 2025, according to the PRISMA approach. Of the 11749 papers identified, 101 papers were included in this review, for a total of 11889 infertile men. Sperm concentration, normal sperm morphology, progressive sperm motility, and total sperm motility, were considerably higher in experimental groups compared with control groups. Both sperm concentration (106 mL-1) and total motility (%) were higher in experimental groups compared to control groups with an overall pooled standardised mean difference (SMD) of 2.33 (95% CI: 1.73, 2.94) for sperm concentration and SMD of 1.62 (95% CI: 1.20, 2.04) for total motility (%). Subgroup analysis demonstrated that duration of treatments of more than 6 months were more effective than those of less than 3 months. Based on the findings of this review, no definitive recommendation can be made regarding the use of antioxidants as a therapy for male infertility, and further research is necessary.
References
- 1.Xu, Q., Wan, Z., Xiong, Z., Zhu, X., Han, Q., Wang, Y., Zhao, J., & Yu, F. (2026). The global evaluation of the effects of antioxidants on seminal outcomes in infertile men: a systematic review and meta-analysis. Human Fertility, Article 2650222. https://doi.org/10.1080/14647273.2026.2650222
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