{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T11:25:50Z","timestamp":1788348350231,"version":"build-2803163510"},"reference-count":64,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2023,10,31]],"date-time":"2023-10-31T00:00:00Z","timestamp":1698710400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"MEDIS laboratories"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Antioxidants"],"abstract":"<jats:p>The evaluation of sperm DNA integrity is recommended in the sixth edition of the 2021 World Health Organization guidelines. Oxidative stress has been identified as a crucial factor leading to genome decay, lipid peroxidation, and nucleoprotein oxidation. This double-blind, placebo-controlled clinical trial aimed to assess the effect of oral antioxidant treatment (Fertilis), which contains L-carnitine and some micronutrients, in the improvement of conventional sperm parameters, sperm DNA integrity and in vitro fertilization\/intracytoplasmic sperm injection (IVF\/ICSI) outcomes. A total of 263 participants were enrolled and randomly divided into two groups: 131 participants received the antioxidant treatment, while 132 participants received a placebo. The male partners in both groups underwent the antioxidant treatment or the placebo for a duration of three months. For each participant, we performed a hormonal test, an infectious test, a spermogram, a TUNEL assay for sperm DNA fragmentation, a toluidine blue staining for sperm DNA decondensation, and an IVF\/ICSI procedure. Sperm characteristics analysis (volume, count, motility, and vitality), sperm DNA fragmentation, and sperm DNA decondensation were assessed and compared to the results preceding the antioxidant treatment. The study outcome revealed a significant decrease in the DNA fragmentation index and a significant increase in sperm motility after 3 months of treatment (p = 0.01 and p = 0.02, respectively). Additionally, a significant improvement in clinical pregnancy rate (p = 0.01) and life birth rate (p = 0.031) was observed. No significant changes were observed in conventional sperm parameters (volume, count, and vitality) or sperm DNA decondensation (SDI). Antioxidant therapy has a beneficial impact on achieving pregnancy, whether through spontaneous conception or assisted reproductive procedures (ART).<\/jats:p>","DOI":"10.3390\/antiox12111937","type":"journal-article","created":{"date-parts":[[2023,10,31]],"date-time":"2023-10-31T12:44:03Z","timestamp":1698756243000},"page":"1937","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Effect of Micronutrients and L-Carnitine as Antioxidant on Sperm Parameters, Genome Integrity, and ICSI Outcomes: Randomized, Double-Blind, and Placebo-Controlled Clinical Trial"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-9685-7633","authenticated-orcid":false,"given":"Marwa","family":"Lahimer","sequence":"first","affiliation":[{"name":"Service of Reproductive Biology, University Hospital Farhat Hached, Sousse, University of Sousse, Sousse 4000, Tunisia"},{"name":"Exercise Physiology and Physiopathology: From Integrated to Molecular \u201cBiology, Medicine and Health\u201d (Code: LR19ES09), Sousse 4002, Tunisia"},{"name":"PERITOX-(UMR-I 01), UPJV\/INERIS, UPJV, CURS, Chemin du Thil, 80025 Amiens, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oumaima","family":"Gherissi","sequence":"additional","affiliation":[{"name":"Service of Reproductive Biology, University Hospital Farhat Hached, Sousse, University of Sousse, Sousse 4000, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nesrine","family":"Ben Salem","sequence":"additional","affiliation":[{"name":"Service of Reproductive Biology, University Hospital Farhat Hached, Sousse, University of Sousse, Sousse 4000, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henda","family":"Ben Mustapha","sequence":"additional","affiliation":[{"name":"Service of Reproductive Biology, University Hospital Farhat Hached, Sousse, University of Sousse, Sousse 4000, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V\u00e9ronique","family":"Bach","sequence":"additional","affiliation":[{"name":"PERITOX-(UMR-I 01), UPJV\/INERIS, UPJV, CURS, Chemin du Thil, 80025 Amiens, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hafida","family":"Khorsi-Cauet","sequence":"additional","affiliation":[{"name":"PERITOX-(UMR-I 01), UPJV\/INERIS, UPJV, CURS, Chemin du Thil, 80025 Amiens, France"},{"name":"ART and Reproductive Biology Laboratory, University Hospital and School of Medicine, Picardie University Jules Verne, CHU Sud, 80025 Amiens, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hedi","family":"Khairi","sequence":"additional","affiliation":[{"name":"Faculty of Medicine Ibn Eljazzar of Sousse, Department of Obstetrics & Gynecology Sousse University, Sousse 4000, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Habib","family":"Ben Ali","sequence":"additional","affiliation":[{"name":"Laboratory Histology Embryologiy, Faculty of Medicine Sousse, University of Sousse, Sousse 4000, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moncef","family":"BenKhalifa","sequence":"additional","affiliation":[{"name":"PERITOX-(UMR-I 01), UPJV\/INERIS, UPJV, CURS, Chemin du Thil, 80025 Amiens, France"},{"name":"ART and Reproductive Biology Laboratory, University Hospital and School of Medicine, Picardie University Jules Verne, CHU Sud, 80025 Amiens, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mounir","family":"Ajina","sequence":"additional","affiliation":[{"name":"Service of Reproductive Biology, University Hospital Farhat Hached, Sousse, University of Sousse, Sousse 4000, Tunisia"},{"name":"Exercise Physiology and Physiopathology: From Integrated to Molecular \u201cBiology, Medicine and Health\u201d (Code: LR19ES09), Sousse 4002, Tunisia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,10,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Boitrelle, F., Shah, R., Saleh, R., Henkel, R., Kandil, H., Chung, E., Vogiatzi, P., Zini, A., Arafa, M., and Agarwal, A. (2021). The Sixth Edition of the WHO Manual for Human Semen Analysis: A Critical Review and SWOT Analysis. Life, 11.","DOI":"10.3390\/life11121368"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"296","DOI":"10.5534\/wjmh.190055","article-title":"Male Oxidative Stress Infertility (MOSI): Proposed Terminology and Clinical Practice Guidelines for Management of Idiopathic Male Infertility","volume":"37","author":"Agarwal","year":"2019","journal-title":"World J. Mens. Health"},{"key":"ref_3","unstructured":"Leslie, S.W., Soon-Sutton, T.L., and Khan, M.A. (2023, August 05). Male Infertility, StatPearls, Available online: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK562258\/."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/s12958-015-0032-1","article-title":"A unique view on male infertility around the globe","volume":"13","author":"Agarwal","year":"2015","journal-title":"Reprod. Biol. Endocrinol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Montjean, D., Godin Pag\u00e9, M.-H., B\u00e9langer, M.-C., Benkhalifa, M., and Miron, P. (2023). An Overview of E-Cigarette Impact on Reproductive Health. Life, 13.","DOI":"10.3390\/life13030827"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Montjean, D., Neyroud, A.-S., Yefimova, M.G., Benkhalifa, M., Cabry, R., and Ravel, C. (2022). Impact of Endocrine Disruptors upon Non-Genetic Inheritance. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23063350"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1250","DOI":"10.1111\/andr.13228","article-title":"The environmental and occupational influence of pesticides on male fertility: A systematic review of human studies","volume":"10","author":"Giulioni","year":"2022","journal-title":"Andrology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"902","DOI":"10.3906\/sag-1605-47","article-title":"Routine assessment of occupational exposure and its relation to semen quality in infertile men: A cross-sectional study","volume":"47","author":"Daoud","year":"2017","journal-title":"Turk. J. Med. Sci."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1861","DOI":"10.1093\/humrep\/dead157","article-title":"Male reproductive ageing: A radical road to ruin","volume":"38","author":"Aitken","year":"2023","journal-title":"Human. Reprod."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1093\/humupd\/dmac033","article-title":"Age-associated epigenetic changes in mammalian sperm: Implications for offspring health and development","volume":"29","author":"Ashapkin","year":"2023","journal-title":"Hum. Reprod. Update"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"77560","DOI":"10.1007\/s11356-023-27695-7","article-title":"Effect of pesticide exposure on human sperm characteristics, genome integrity, and methylation profile analysis","volume":"30","author":"Lahimer","year":"2023","journal-title":"Environ. Sci. Pollut. Res."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Lahimer, M., Montjean, D., Cabry, R., Capelle, S., Lefranc, E., Bach, V., Ajina, M., Ben Ali, H., Khorsi-Cauet, H., and Benkhalifa, M. (2023). Paternal Age Matters: Association with Sperm Criteria\u2019s- Spermatozoa DNA Integrity and Methylation Profile. J. Clin. Med., 12.","DOI":"10.3390\/jcm12154928"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1016\/S0015-0282(16)43999-3","article-title":"Peroxidative breakdown of phospholipids in human spermatozoa, spermicidal properties of fatty acid peroxides, and protective action of seminal plasma","volume":"31","author":"Jones","year":"1979","journal-title":"Fertil. Steril."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1093\/molehr\/gap059","article-title":"On the possible origins of DNA damage in human spermatozoa","volume":"16","author":"Aitken","year":"2010","journal-title":"Mol. Human. Reprod."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1070692","DOI":"10.3389\/fendo.2023.1070692","article-title":"Unraveling the harmful effect of oxidative stress on male fertility: A mechanistic insight","volume":"14","author":"Hussain","year":"2023","journal-title":"Front. Endocrinol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"799294","DOI":"10.3389\/fmolb.2021.799294","article-title":"The Impact of Oxidative Stress in Male Infertility","volume":"8","author":"Mannucci","year":"2022","journal-title":"Front. Mol. Biosci."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5534\/wjmh.2014.32.1.1","article-title":"Effect of Oxidative Stress on Male Reproduction","volume":"32","author":"Agarwal","year":"2014","journal-title":"World J. Mens. Health"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1002\/mrd.22871","article-title":"Reactive oxygen species as mediators of sperm capacitation and pathological damage","volume":"84","author":"Aitken","year":"2017","journal-title":"Mol. Reprod. Dev."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"729","DOI":"10.29252\/ijrm.14.12.729","article-title":"Antioxidant supplements and semen parameters: An evidence based review","volume":"14","author":"Ahmadi","year":"2016","journal-title":"Int. J. Reprod. Biomed."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1111\/andr.12547","article-title":"Impact of antioxidant treatment on DNA fragmentation index: A double-blind placebo-controlled randomized trial","volume":"6","author":"Stenqvist","year":"2018","journal-title":"Andrology"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"233","DOI":"10.5534\/wjmh.200196","article-title":"Utility of Antioxidants in the Treatment of Male Infertility: Clinical Guidelines Based on a Systematic Review and Analysis of Evidence","volume":"39","author":"Agarwal","year":"2021","journal-title":"World J. Mens. Health"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3390\/oxygen2010001","article-title":"Beneficial Effects of Antioxidants in Male Infertility Management: A Narrative Review","volume":"2","author":"Cilio","year":"2022","journal-title":"Oxygen"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"810242","DOI":"10.3389\/fendo.2022.810242","article-title":"The Effect of Antioxidants on Sperm Quality Parameters and Pregnancy Rates for Idiopathic Male Infertility: A Network Meta-Analysis of Randomized Controlled Trials","volume":"13","author":"Li","year":"2022","journal-title":"Front. Endocrinol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Dimitriadis, F., Borgmann, H., Struck, J.P., Salem, J., and Kuru, T.H. (2023). Antioxidant Supplementation on Male Fertility\u2014A Systematic Review. Antioxidants, 12.","DOI":"10.3390\/antiox12040836"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Osman, R., Lee, S., Almubarak, A., Han, J.-I., Yu, I.-J., and Jeon, Y. (2023). Antioxidant Effects of Myo-Inositol Improve the Function and Fertility of Cryopreserved Boar Semen. Antioxidants, 12.","DOI":"10.3390\/antiox12091673"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"824078","DOI":"10.3389\/fendo.2021.824078","article-title":"Systematic Review and Critical Analysis on Dietary Supplements for Male Infertility: From a Blend of Ingredients to a Rationale Strategy","volume":"12","author":"Garolla","year":"2022","journal-title":"Front. Endocrinol."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Scaruffi, P., Licata, E., Maccarini, E., Massarotti, C., Bovis, F., Sozzi, F., Stigliani, S., Dal Lago, A., Casciano, I., and Rago, R. (2021). Oral Antioxidant Treatment of Men Significantly Improves the Reproductive Outcome of IVF Cycles. J. Clin. Med., 10.","DOI":"10.3390\/jcm10153254"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1038\/aja.2012.23","article-title":"Reduction in sperm aneuploidy levels in severe oligoasthenoteratospermic patients after medical therapy: A preliminary report","volume":"14","author":"Cavallini","year":"2012","journal-title":"Asian J. Androl."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"hoad020","DOI":"10.1093\/hropen\/hoad020","article-title":"The lack of evidence behind over-the-counter antioxidant supplements for male fertility patients: A scoping review","volume":"2023","author":"Fleischer","year":"2023","journal-title":"Hum. Reprod. Open."},{"key":"ref_30","first-page":"61","article-title":"Review on the role of glutathione on oxidative stress and infertility","volume":"22","author":"Adeoye","year":"2018","journal-title":"JBRA Assist. Reprod."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1611","DOI":"10.1017\/S1751731117003147","article-title":"Dietary l-arginine supplementation improves semen quality and libido of boars under high ambient temperature","volume":"12","author":"Chen","year":"2018","journal-title":"Animal"},{"key":"ref_32","first-page":"33","article-title":"L-carnitine combined with coenzyme Q10 for idiopathic oligoasthenozoospermia: A double-blind randomized controlled trial","volume":"24","author":"Cheng","year":"2018","journal-title":"Zhonghua Nan Ke Xue"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/j.freeradbiomed.2023.01.024","article-title":"Both selenium deficiency and excess impair male reproductive system via inducing oxidative stress-activated PI3K\/AKT-mediated apoptosis and cell proliferation signaling in testis of mice","volume":"197","author":"Xu","year":"2023","journal-title":"Free. Radic. Biol. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e18224","DOI":"10.1016\/j.heliyon.2023.e18224","article-title":"Effects of folic acid and folic acid plus zinc supplements on the sperm characteristics and pregnancy outcomes of infertile men: A systematic review and meta-analysis","volume":"9","author":"Li","year":"2023","journal-title":"Heliyon"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1001\/jama.2019.18714","article-title":"Effect of Folic Acid and Zinc Supplementation in Men on Semen Quality and Live Birth Among Couples Undergoing Infertility Treatment","volume":"323","author":"Schisterman","year":"2020","journal-title":"JAMA"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"7637","DOI":"10.1128\/MCB.25.17.7637-7644.2005","article-title":"The Nuclear Form of Phospholipid Hydroperoxide Glutathione Peroxidase Is a Protein Thiol Peroxidase Contributing to Sperm Chromatin Stability","volume":"25","author":"Conrad","year":"2005","journal-title":"Mol. Cell. Biol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"47","DOI":"10.4236\/arsci.2014.23006","article-title":"Beneficial Effect of an Oral Antioxidant Supplementation (Fertimax2) on IVF-ICSI Outcomes: A Preliminary Clinical Study","volume":"2","author":"Kacem","year":"2014","journal-title":"Adv. Reprod. Sci."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.1093\/humrep\/der037","article-title":"Alpha Scientists in Reproductive Medicine and ESHRE Special Interest Group of Embryology The Istanbul consensus workshop on embryo assessment: Proceedings of an expert meeting","volume":"26","author":"Balaban","year":"2011","journal-title":"Hum. Reprod."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.1016\/S0015-0282(00)00518-5","article-title":"Blastocyst score affects implantation and pregnancy outcome: Towards a single blastocyst transfer","volume":"73","author":"Gardner","year":"2000","journal-title":"Fertil. Steril."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"27","DOI":"10.11604\/pamj.2022.42.27.31539","article-title":"Effect of intrauterine administration of human chorionic gonadotropin one day before fresh blastocyst transfer on clinical outcomes: A quasi-experimental study","volume":"42","author":"Mustapha","year":"2022","journal-title":"Pan Afr. Med. J."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"277","DOI":"10.5653\/cerm.2022.05463","article-title":"Coenzyme Q10 improves sperm motility and antioxidant status in infertile men with idiopathic oligoasthenospermia","volume":"49","author":"Alahmar","year":"2022","journal-title":"Clin. Exp. Reprod. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"15579883211036790","DOI":"10.1177\/15579883211036790","article-title":"Comparison of 3- and 6-Month Outcomes of Combined Oral L-Carnitine Fumarate and Acetyl-L-Carnitine Therapy, Included in an Antioxidant Formulation, in Patients with Idiopathic Infertility","volume":"15","author":"Wandtke","year":"2021","journal-title":"Am. J. Mens. Health"},{"key":"ref_43","first-page":"61","article-title":"L-Carnitine and Pentoxifylline Supplementation Improves Sperm Viability and Motility at Low Temperature","volume":"17","author":"Nateghian","year":"2023","journal-title":"Int. J. Fertil. Steril."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e13267","DOI":"10.1111\/and.13267","article-title":"Double-blind, randomised, placebo-controlled trial on the effect of L-carnitine and L-acetylcarnitine on sperm parameters in men with idiopathic oligoasthenozoospermia","volume":"51","author":"Micic","year":"2019","journal-title":"Andrologia"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/s12958-019-0468-9","article-title":"Effects of N-acetyl-cysteine supplementation on sperm quality, chromatin integrity and level of oxidative stress in infertile men","volume":"17","author":"Jannatifar","year":"2019","journal-title":"Reprod. Biol. Endocrinol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e14612","DOI":"10.1111\/and.14612","article-title":"N-acetyl-l-cysteine and alpha lipoic acid are protective supplement on human sperm parameters in cryopreservation of asthenoteratozoospermia patients","volume":"54","author":"Jannatifar","year":"2022","journal-title":"Andrologia"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1016\/S1472-6483(10)60024-7","article-title":"Improvement in sperm DNA quality using an oral antioxidant therapy","volume":"18","author":"Tunc","year":"2009","journal-title":"Reprod. BioMedicine Online"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1111\/j.1479-828X.2007.00723.x","article-title":"A randomised control trial examining the effect of an antioxidant (Menevit) on pregnancy outcome during IVF-ICSI treatment","volume":"47","author":"Tremellen","year":"2007","journal-title":"Aust. N. Zeal. J. Obstet. Gynaecol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1177\/03915603211049888","article-title":"The effects of two different antioxidant combinations on sperm parameters","volume":"89","author":"Yaris","year":"2022","journal-title":"Urologia"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1007\/s10815-013-0047-5","article-title":"Coenzyme Q10 and male infertility: A meta-analysis","volume":"30","author":"Lafuente","year":"2013","journal-title":"J. Assist. Reprod. Genet."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"e1434546","DOI":"10.1155\/2021\/1434546","article-title":"Molecular Profiling of Spermatozoa Reveals Correlations between Morphology and Gene Expression: A Novel Biomarker Panel for Male Infertility","volume":"2021","author":"Cassuto","year":"2021","journal-title":"BioMed Res. Int."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"945351","DOI":"10.3389\/frph.2022.945351","article-title":"The relevance of sperm morphology in male infertility","volume":"4","author":"Moretti","year":"2022","journal-title":"Front. Reprod. Health"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1186\/s40659-022-00409-y","article-title":"Sperm DNA integrity does play a crucial role for embryo development after ICSI, notably when good-quality oocytes from young donors are used","volume":"55","author":"Novo","year":"2022","journal-title":"Biol. Res."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1093\/humupd\/dmp048","article-title":"World Health Organization reference values for human semen characteristics","volume":"16","author":"Cooper","year":"2010","journal-title":"Human. Reprod. Update"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1186\/1477-7827-3-28","article-title":"Role of oxidative stress in female reproduction","volume":"3","author":"Agarwal","year":"2005","journal-title":"Reprod. Biol. Endocrinol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/S0140-6736(20)32667-2","article-title":"Male infertility","volume":"397","author":"Agarwal","year":"2021","journal-title":"Lancet"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"S553","DOI":"10.21037\/tau.2017.03.11","article-title":"Evaluation of sperm DNA structure, fragmentation and decondensation: An essential tool in the assessment of male infertility","volume":"6","author":"Menezo","year":"2017","journal-title":"Transl. Androl. Urol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"89","DOI":"10.23736\/S0391-1977.20.03188-0","article-title":"Positive effect of nutraceuticals on sperm DNA damage in selected infertile patients with idiopathic high sperm DNA fragmentation","volume":"45","author":"Delbarba","year":"2020","journal-title":"Minerva Endocrinol."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Marinaro, J.A., and Schlegel, P.N. (2023). Sperm DNA Damage and Its Relevance in Fertility Treatment: A Review of Recent Literature and Current Practice Guidelines. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms24021446"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"2908","DOI":"10.1093\/humrep\/des261","article-title":"The effect of sperm DNA fragmentation on miscarriage rates: A systematic review and meta-analysis","volume":"27","author":"Robinson","year":"2012","journal-title":"Human. Reprod."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1095\/biolreprod.111.095778","article-title":"Rethinking In Vitro Embryo Culture: New Developments in Culture Platforms and Potential to Improve Assisted Reproductive Technologies","volume":"86","author":"Smith","year":"2012","journal-title":"Biol. Reprod."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1017\/S0967199420000660","article-title":"Effect of antioxidants on preimplantation embryo development in vitro: A review","volume":"29","author":"Zarbakhsh","year":"2021","journal-title":"Zygote"},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"\u0141akoma, K., Kukharuk, O., and \u015ali\u017c, D. (2023). The Influence of Metabolic Factors and Diet on Fertility. Nutrients, 15.","DOI":"10.3390\/nu15051180"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1186\/s13072-018-0224-y","article-title":"Oxidative stress in sperm affects the epigenetic reprogramming in early embryonic development","volume":"11","author":"Wyck","year":"2018","journal-title":"Epigenetics Chromatin"}],"container-title":["Antioxidants"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3921\/12\/11\/1937\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:14:35Z","timestamp":1760130875000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3921\/12\/11\/1937"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,31]]},"references-count":64,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2023,11]]}},"alternative-id":["antiox12111937"],"URL":"https:\/\/doi.org\/10.3390\/antiox12111937","relation":{},"ISSN":["2076-3921"],"issn-type":[{"value":"2076-3921","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,31]]}}}