{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T23:17:19Z","timestamp":1788391039655,"version":"build-2803163510"},"reference-count":61,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2022,10,28]],"date-time":"2022-10-28T00:00:00Z","timestamp":1666915200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The inability to become pregnant for at least 1 year despite regular unprotected intercourse may indicate infertility of one or both partners. This problem affects approximately 10\u201320% of couples worldwide, regardless of race, with male infertility reported to account for 25\u201360% of cases. Among the most common pathological causes of male infertility is the presence of varicocele and chronic infections of the male reproductive system. This study was performed using data collected at the Genesis Infertility Treatment Clinic, Bydgoszcz, Poland, between 1 January 2015 and 30 June 2017. A total of 163 men meeting the inclusion criteria were selected and divided into the idiopathic infertility group (78 men) and varicocele-related infertility group (85 men). All patients received treatment with a male fertility supplement containing a combination of 1725 mg of L-carnitine fumarate, 500 mg of acetyl-L-carnitine, 90 mg of vitamin C, 20 mg of coenzyme Q10, 10 mg of zinc, 200 \u00b5g of folic acid, 50 \u00b5g of selenium, and 1.5 \u00b5g of vitamin B12 (Proxeed\u00ae Plus, Sigma-Tau, Italy) twice a day for a period of 6 months from the time of the diagnosis of infertility. The treatment resulted in significant improvements in general semen parameters, particularly sperm count, sperm concentration, total motility, and progressive motility. This antioxidant therapy produced a particularly marked therapeutic benefit in patients with Grade III varicocele, with a greater improvement in progressive motility than in men with less severe or no varicocele. The use of the antioxidant preparation examined here seems reasonable in men with idiopathic infertility and as an adjuvant in those with varicocele-related infertility in whom surgical treatment has resulted in no improvement. Its use should be considered particularly in patients with Grade III varicocele who do not wish to undergo surgical treatment or in whom such a treatment is not possible for various reasons.<\/jats:p>","DOI":"10.3390\/jcm11216391","type":"journal-article","created":{"date-parts":[[2022,10,30]],"date-time":"2022-10-30T07:26:50Z","timestamp":1667114810000},"page":"6391","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["The Role and Place of Antioxidants in the Treatment of Male Infertility Caused by Varicocele"],"prefix":"10.3390","volume":"11","author":[{"given":"Marek","family":"Szyma\u0144ski","sequence":"first","affiliation":[{"name":"Department of Women\u2019s Health and Reproductive Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toru\u0144, 85-067 Bydgoszcz, Poland"},{"name":"NZOZ Medical Center, Clinic of Infertility Treatment \u201cGenesis\u201d, 85-435 Bydgoszcz, Poland"},{"name":"Clinic of Gynaecology and Oncological Gynecology, 10th Military Research Hospital and Polyclinic, IPHC, 85-681 Bydgoszcz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2745-530X","authenticated-orcid":false,"given":"Piotr","family":"Domaracki","sequence":"additional","affiliation":[{"name":"Department of Women\u2019s Health and Reproductive Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toru\u0144, 85-067 Bydgoszcz, Poland"},{"name":"Clinic of Gynaecology and Oncological Gynecology, 10th Military Research Hospital and Polyclinic, IPHC, 85-681 Bydgoszcz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelika","family":"Szyma\u0144ska","sequence":"additional","affiliation":[{"name":"NZOZ Medical Center, Clinic of Infertility Treatment \u201cGenesis\u201d, 85-435 Bydgoszcz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomasz","family":"Wandtke","sequence":"additional","affiliation":[{"name":"NZOZ Medical Center, Clinic of Infertility Treatment \u201cGenesis\u201d, 85-435 Bydgoszcz, Poland"},{"name":"Department of Lung Diseases, Neoplasms and Tuberculosis, Faculty of Medicine, Nicolaus Copernicus University in Toru\u0144, 85-094 Bydgoszcz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Szyca","sequence":"additional","affiliation":[{"name":"Clinic of Surgery and Oncological Surgery, 10th Military Research Hospital and Polyclinic, IPHC, 85-681 Bydgoszcz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u0141ukasz","family":"Brycht","sequence":"additional","affiliation":[{"name":"Department of Women\u2019s Health and Reproductive Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toru\u0144, 85-067 Bydgoszcz, Poland"},{"name":"Clinic of Surgery and Oncological Surgery, 10th Military Research Hospital and Polyclinic, IPHC, 85-681 Bydgoszcz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karolina","family":"Wasilow","sequence":"additional","affiliation":[{"name":"Department of Women\u2019s Health and Reproductive Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toru\u0144, 85-067 Bydgoszcz, Poland"},{"name":"NZOZ Medical Center, Clinic of Infertility Treatment \u201cGenesis\u201d, 85-435 Bydgoszcz, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wojciech Jan","family":"Skorupski","sequence":"additional","affiliation":[{"name":"1st Department of Cardiology, Poznan University of Medical Sciences, 61-848 Poznan, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1007\/978-0-387-09597-4_9","article-title":"Antioxidant systems and oxidative stress in the testes","volume":"636","author":"Aitken","year":"2009","journal-title":"Mol. Mech. Spermatogenes"},{"key":"ref_2","unstructured":"World Health Organization (2010). WHO Laboratory Manual for the Examination and Processing of Human Semen, World Health Organization. [5th ed.]."},{"key":"ref_3","first-page":"18","article-title":"Causes of male infertility: A 9-year prospective monocentre study on 1737 patients with reduced total sperm counts","volume":"32","author":"Punab","year":"2017","journal-title":"Hum. Reprod."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.aju.2017.11.001","article-title":"Role of reactive oxygen species in male infertility: An updated review of literature","volume":"16","author":"Wagner","year":"2018","journal-title":"Arab. J. Urol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1973","DOI":"10.3892\/etm.2016.3569","article-title":"DNA methylation in spermatogenesis and male infertility","volume":"12","author":"Cui","year":"2016","journal-title":"Exp. Ther. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1111\/bju.13539","article-title":"Analysis of the functional aspects and seminal plasma proteomic profile of sperm from smokers","volume":"118","author":"Antoniassi","year":"2016","journal-title":"BJU Int."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.aju.2017.12.004","article-title":"Lifestyle causes of male infertility","volume":"16","author":"Durairajanayagam","year":"2018","journal-title":"Arab. J. Urol."},{"key":"ref_8","first-page":"60","article-title":"The role of oxidative stress and antioxidants in male fertility","volume":"66","author":"Wolski","year":"2013","journal-title":"Cent. Eur. J. Urol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1080\/2090598X.2019.1599624","article-title":"Oxidative stress and sperm function: A systematic review on evaluation and management","volume":"17","author":"Dutta","year":"2019","journal-title":"Arab. J. Urol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"630","DOI":"10.1016\/S1472-6483(10)61190-X","article-title":"Relationship between oxidative stress, varicocele and infertility: A meta-analysis","volume":"12","author":"Agarwal","year":"2006","journal-title":"Reprod. Biomed. Online"},{"key":"ref_11","first-page":"728","article-title":"Attenuation of oxidative stress & DNA damage in varicocelectomy: Implications in infertility management","volume":"132","author":"Dada","year":"2010","journal-title":"Indian J. Med. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"45","DOI":"10.5005\/jp-journals-10016-1147","article-title":"Effect of vitamin C, vitamin E, zinc, selenium, and coenzyme Q10 in infertile men with idiopathic oligoasthenozoospermia","volume":"8","author":"Alahmar","year":"2017","journal-title":"Int. J. Infertil. Fetal. Med."},{"key":"ref_13","first-page":"IE01","article-title":"The impact of oxidative stress on testicular function and the role of antioxidants in improving it: A review","volume":"11","author":"Asadi","year":"2017","journal-title":"J. Clin. Diagn. Res. JCDR"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"222","DOI":"10.4103\/1008-682X.171657","article-title":"An update on the role of medical treatment including antioxidant therapy in varicocele","volume":"18","author":"Garg","year":"2016","journal-title":"Asian J. Androl."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1007\/s40618-017-0713-z","article-title":"Varicocele and semen quality: A retrospective case\u2013control study of 4230 patients from a single centre","volume":"41","author":"Pallotti","year":"2017","journal-title":"J. Endocrinol. Investig."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"12685","DOI":"10.1111\/and.12685","article-title":"Inflammatory and anti-inflammatory cytokines in the seminal plasma of infertile men suffering from varicocele","volume":"49","author":"Zeinali","year":"2016","journal-title":"Andrologia"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3542","DOI":"10.3389\/fimmu.2021.729539","article-title":"Varicocele-Mediated Male Infertility: From the Perspective of Testicular Immunity and Inflammation","volume":"12","author":"Fang","year":"2021","journal-title":"Front. Immunol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"225","DOI":"10.3109\/14647273.2015.1050462","article-title":"Oral antioxidant treatment partly improves integrity of human sperm DNA in infertile grade I varicocele patients","volume":"18","author":"Abad","year":"2015","journal-title":"Hum. Fertil."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"13179","DOI":"10.1111\/and.13179","article-title":"Berberine ameliorates experimental varicocele-induced damages at testis and sperm levels; evidences for oxidative stress and inflammation","volume":"51","author":"Najaran","year":"2019","journal-title":"Andrologia"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"994","DOI":"10.1016\/j.fertnstert.2010.10.031","article-title":"Adolescent varicocele: Improved sperm function after varicocelectomy","volume":"95","author":"Lacerda","year":"2011","journal-title":"Fertil. Steril."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"6806","DOI":"10.1002\/fsn3.2632","article-title":"Lycopene protects sperm from oxidative stress in the experimental varicocele model","volume":"9","author":"Babaei","year":"2021","journal-title":"Food Sci. Nutr."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1111\/j.1439-0272.2008.00900.x","article-title":"Seminal reactive oxygen species-antioxidant relationship in fertile males with and without varicocele","volume":"41","author":"Mostafa","year":"2009","journal-title":"Andrologia"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1038\/nrurol.2012.198","article-title":"Insight into oxidative stress in varicocele-associated male infertility: Part 2","volume":"10","author":"Hamada","year":"2013","journal-title":"Nat. Rev. Urol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1111\/and.12313","article-title":"Seminal plasma leptin and spermatozoon apoptosis in patients with varicocele and leucocytospermia","volume":"47","author":"Wang","year":"2015","journal-title":"Andrologia"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"794","DOI":"10.1016\/j.urology.2009.01.078","article-title":"Retrospective Assessment of Potential Negative Synergistic Effects of Varicocele and Tobacco Use on Ultrastructural Sperm Morphology","volume":"74","author":"Collodel","year":"2009","journal-title":"Urology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/j.ucl.2013.08.001","article-title":"The Varicocele","volume":"41","author":"Masson","year":"2014","journal-title":"Urol. Clin."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1038\/nrurol.2012.197","article-title":"Insight into oxidative stress in varicocele-associated male infertility: Part 1","volume":"9","author":"Agarwal","year":"2012","journal-title":"Nat. Rev. Urol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"270","DOI":"10.3109\/19396368.2013.794253","article-title":"Silymarin protects from varicocele-induced damages in testis and improves sperm quality: Evidence for E2f1 involvement","volume":"59","author":"Moshtaghion","year":"2013","journal-title":"Syst. Biol. Reprod. Med."},{"key":"ref_29","first-page":"120","article-title":"A preliminary study: N-acetyl-L-cysteine improves semen quality following varicocelectomy","volume":"10","author":"Barekat","year":"2016","journal-title":"Int. J. Fertil. Steril."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1016\/j.urology.2014.07.006","article-title":"Does L-carnitine therapy add any extra benefit to standard inguinal varicocelectomy in terms of deoxyribonucleic acid damage or sperm quality factor indices: A randomized study","volume":"84","author":"Pourmand","year":"2014","journal-title":"Urology"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Martin-Hidalgo, D., Bragado, M.J., Batista, A.R., Oliveira, P.F., and Alves, M.G. (2019). Antioxidants and Male Fertility: From Molecular Studies to Clinical Evidence. Antioxidants, 8.","DOI":"10.3390\/antiox8040089"},{"key":"ref_32","first-page":"141","article-title":"Origin and role of DNA damage in varicocele","volume":"6","author":"Tavalaee","year":"2012","journal-title":"Int. J. Fertil. Steril."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/S0015-0282(16)57306-3","article-title":"Controlled trial of high spermatic vein ligation for varicocele in infertile men","volume":"63","author":"Madgar","year":"1995","journal-title":"Fertil. Steril."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1808","DOI":"10.1016\/S0022-5347(17)37035-0","article-title":"Microsurgical Inguinal Varicocelectomy With Delivery of the Testis: An Artery and Lymphatic Sparing Technique","volume":"148","author":"Goldstein","year":"1992","journal-title":"J. Urol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1016\/0090-4295(93)90268-F","article-title":"Varicocele: A progressive or static lesion?","volume":"42","author":"Witt","year":"1993","journal-title":"Urology"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1530\/REP-19-0452","article-title":"Impact of oxidative stress on male and female germ cells: Implications for fertility","volume":"159","author":"Aitken","year":"2020","journal-title":"Reproduction"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"3","DOI":"10.4081\/aiua.2020.3.263","article-title":"L-carnitine as primary or adjuvant treatment in infertile patients with varicocele. A systematic review","volume":"92","author":"Tsampoukas","year":"2020","journal-title":"Arch. Ital. Urol. Androl."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1111\/and.12067","article-title":"Effect of folic acid and zinc sulphate on endocrine parameters and seminal antioxidant level after varicocelectomy","volume":"46","author":"Azizollahi","year":"2014","journal-title":"Andrologia"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1016\/j.repbio.2017.10.003","article-title":"Nitric oxide, malondialdheyde and non-enzymatic antioxidants assessed in viable spermatozoa from selected infertile men","volume":"17","author":"Moretti","year":"2017","journal-title":"Reprod. Biol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1016\/S0015-0282(16)42979-1","article-title":"Levels of L-carnitine and LO-acetylcarnitine in normal and infertile human semen: A lower level of LO-acetylcarnitine in infertile semen","volume":"28","author":"Kohengkul","year":"1977","journal-title":"Fertil. Steril."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1420","DOI":"10.1152\/physrev.1983.63.4.1420","article-title":"Carnitine--metabolism and functions","volume":"63","author":"Bremer","year":"1983","journal-title":"Physiol. Rev."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1007\/s12011-011-8957-5","article-title":"Selenium, Copper and Zinc in Seminal Plasma of Men with Varicocele, Relationship with Seminal Parameters","volume":"143","author":"Camejo","year":"2011","journal-title":"Biol. Trace Elem. Res."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"323","DOI":"10.2174\/1389450033491082","article-title":"Zinc homeostasis-regulating proteins: New drug targets for triggering cell fate","volume":"4","author":"Chimienti","year":"2003","journal-title":"Curr. Drug Targets"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/S0891-5849(01)00583-4","article-title":"The antioxidant properties of zinc: Interactions with iron and antioxidants","volume":"31","author":"Zago","year":"2001","journal-title":"Free Radic. Biol. Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1093\/humupd\/dml054","article-title":"The importance of folate, zinc and antioxidants in the pathogenesis and prevention of subfertility","volume":"13","author":"Ebisch","year":"2007","journal-title":"Hum. Reprod. Update"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1007\/s12033-007-0052-y","article-title":"Bioenergetic and antioxidant properties of coenzyme Q10: Recent developments","volume":"37","author":"Littarru","year":"2007","journal-title":"Mol. Biotechnol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1002\/biof.164","article-title":"Coenzyme Q10 in male infertility: Physiopathology and therapy","volume":"37","author":"Mancini","year":"2011","journal-title":"Biofactors"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1785","DOI":"10.1016\/j.fertnstert.2008.02.119","article-title":"Coenzyme Q10 treatment in infertile men with idiopathic asthenozoospermia: A placebo-controlled, double-blind randomized trial","volume":"91","author":"Balercia","year":"2009","journal-title":"Fertil. Steril."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1111\/and.12152","article-title":"Coenzyme Q10 supplementation in infertile men with low-grade varicocele: An open, uncontrolled pilot study","volume":"46","author":"Festa","year":"2014","journal-title":"Andrologia"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1111\/j.1365-2605.2006.00700.x","article-title":"Relationship between seminal ascorbic acid and sperm DNA integrity in infertile men","volume":"29","author":"Song","year":"2006","journal-title":"Int. J. Androl."},{"key":"ref_51","first-page":"27","article-title":"The prevalence of Y chromosome microdeletions in Iranian infertile men with azoospermia and severe oligospermia","volume":"19","author":"Asadi","year":"2017","journal-title":"Cell J."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"111086","DOI":"10.1016\/j.biopha.2020.111086","article-title":"Proxeed plus salvage rat testis from ischemia- reperfused injury by enhancing antioxidant\u2019s activities and inhibition of iNOS expression","volume":"133","author":"Sangodele","year":"2021","journal-title":"Biomed Pharmacother."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"4","DOI":"10.4081\/aiua.2020.4.362","article-title":"Antioxidant treatment of increased sperm DNA fragmentation: Complex combinations are not more successful","volume":"92","author":"Ozer","year":"2020","journal-title":"Arch. Ital. Urol. Androl."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"13267","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_55","doi-asserted-by":"crossref","first-page":"12927","DOI":"10.1111\/and.12927","article-title":"Effect of metabolic and antioxidant supplementation on sperm parameters in oligo-astheno-teratozoospermia, with and without varicocele: A double-blind placebo-controlled study","volume":"50","author":"Busetto","year":"2018","journal-title":"Andrologia"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/j.aju.2017.11.013","article-title":"Systematic review of antioxidant types and doses in male infertility: Benefits on semen parameters, advanced sperm function, assisted reproduction and live-birth rate","volume":"16","author":"Majzoub","year":"2018","journal-title":"Arab. J. Urol."},{"key":"ref_57","doi-asserted-by":"crossref","unstructured":"Gambera, L., Stendardi, A., Ghelardi, C., Fineschi, B., and Aini, R. (2019). Effects of antioxidant treatment on seminal parameters in patients undergoing in vitro fertilization. Arch. Ital. Urol. Androl., 91.","DOI":"10.4081\/aiua.2019.3.187"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"97","DOI":"10.5653\/cerm.2020.04175","article-title":"Coenzyme Q10, oxidative stress, and male infertility: A review","volume":"48","author":"Alahmar","year":"2021","journal-title":"Clin. Exp. Reprod. Med."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"1628","DOI":"10.1093\/humrep\/der132","article-title":"The role of sperm oxidative stress in male infertility and the significance of oral antioxidant therapy","volume":"26","author":"Gharagozloo","year":"2011","journal-title":"Hum. Reprod."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1016\/j.fertnstert.2019.11.008","article-title":"The effect of antioxidants on male factor infertility: The Males, Antioxidants, and Infertility (MOXI) randomized clinical trial","volume":"113","author":"Steiner","year":"2020","journal-title":"Fertil. Steril."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1016\/j.eururo.2016.04.010","article-title":"Cigarette Smoking and Semen Quality: A New Meta-analysis Examining the Effect of the 2010 World Health Organization Laboratory Methods for the Examination of Human Semen","volume":"70","author":"Sharma","year":"2016","journal-title":"Eur. Urol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/21\/6391\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:05:20Z","timestamp":1760144720000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/21\/6391"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,28]]},"references-count":61,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2022,11]]}},"alternative-id":["jcm11216391"],"URL":"https:\/\/doi.org\/10.3390\/jcm11216391","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,28]]}}}