Global Andrology Forum Clinical Guidelines on Antioxidant Use in the Treatment of Male Infertility
Recommended Citation
Agarwal A, Mostafa T, Al Hashimi M, Çayan S, Pescatori E, Singh K, Şahin B, Zini A, Chung E, Arafa M, Ko E, Pinggera GM, Saleh R, Atmoko W, Rambhatla A, Cannarella R, Palani A, Ozer C, Abdulgabbar Noman M, Dimitriadis F, Toprak T, Ceyhan E, Corral Molina JM, Nguyen MT, Le TV, Putra R, Boeri L, Gül M, Alhathal N, Kandil H, Thomas C, Rashed A, Binsaleh S, Falcone M, Yogiswara N, Japari A, Oriazowan Julius A, Çeker G, Güngör ND, Giulioni C, Abdelrahman IFS, Nguyen Q, Calik G, Hegde AV, Motawi AT, Dipankar SP, Manfredi C, Tsujimura A, Konstantinidis C, Ashour S, Nada EA, Al-Marhoon M, Abu El-Hamd M, Alghobary M, Mogharabian N, Almusafer M, El-Sakka A, Khalifa AAE, Sarikaya S, Phuoc NHV, Alfatlawy NK, Benjamin LTY, Smith RP, Park HJ, Russo GI, Ördek E, Lin H, Kadihasanoglu M, Kumar N, Deger MD, Khalafalla KM, Altay B, Mak SK, Görür S, Shamohammadi I, Dursun M, Pening D, Narimani N, Bolat MS, Rajmil O, Alkawaz UM, Aydos K, Kaya C, Maya WDC, Zachariou A, Duran MB, Shatylko T, Balercia G, De La Rosette J, El Meliegy A, Saylam B, Bahçeci T, Efesoy O, Eugeni E, Zilaitiene B, Gherabi N, Kahraman O, Crafa A, Vazquez JFS, Bahar F, Taha EA, Selim OM, Hasan MSM, Tadros NN, Ho CCK, Sogutdelen E, Busetto GM, Micic S, Gokalp F, Mohammad EJ, Asci R, Hasirci E, Musa MU, Joshi PB, Reda A, Yazbeck C, Adriansjah R, Kinzikeeva E, Salvio G, Turunc T, Kim D, Vishwakarma RB, Makarounis K, Ruzaev M, Alipour H, and Shah R. Global Andrology Forum Clinical Guidelines on Antioxidant Use in the Treatment of Male Infertility. World J Mens Health 2026.
Document Type
Article
Publication Date
1-1-2026
Publication Title
World J Mens Health
Keywords
Antioxidants; Delphi technique; GRADE approach; Guideline; Male infertility; Surveys and questionnaires
Abstract
PURPOSE: Antioxidant (AOX) therapy has long been investigated for the management of male infertility. It has potential benefits, but persistent controversy affects its broad acceptance and clinical utility. This study aimed to develop standardized, evidence-based guidelines for AOX use by synthesizing the best available evidence and achieving global expert consensus.
MATERIALS AND METHODS: A comprehensive literature review was conducted by senior experts of the Global Andrology Forum (GAF). Additionally, data on the real-life use of oxidative stress (OS) testing and AOX use obtained from the largest global survey of practicing physicians conducted by GAF, which served as a reference point for this study. In phase one, 151 international specialists (>5 years' experience) participated in a modified Delphi process to evaluate AOX therapy in male infertility. Experts reviewed draft statements and rated agreement on a 10-point Likert scale. Statements achieving >80% consensus (with score >7/10) were accepted. The original eight statements were expanded to 19 and finalized into 18. In phase two, 84 senior physicians (>10 years' experience) graded the Delphi-approved statements using the GRADE approach.
RESULTS: Four out of the 18 statements failed to reach consensus and were excluded. Of the final 14 statements, seven (50%) were graded as "Strong" and seven (50%) as "Weak." Current evidence indicates that AOX therapy can reduce OS, improve sperm quality, and potentially enhance reproductive outcomes. However, benefits vary by agent, regimen, and patient population. The guidelines emphasize the need to document OS and to consider underlying factors before initiating AOX therapy, and caution against indiscriminate or prolonged use.
CONCLUSIONS: Developed through a dual-validation process and endorsed by a globally diverse expert panel, these GAF guidelines represent the first standardized, evidence-based guidelines for AOX use in male infertility. By addressing heterogeneity in research and practice, they provide clinicians with practical, safe, and patient-centered recommendations for rational AOX therapy worldwide.
PubMed ID
41508382
ePublication
ePub ahead of print
