This review summarizes the role of free radicals and oxidative stress in the pathophysiology of human reproduction.
An extensive review of the literature on the role of oxidative stress in influencing assisted reproduction and its outcome is described in this article. Free radicals or reactive oxygen species mediate their action through many of the proinflammatory cytokines and this mechanism has been proposed as a common underlying factor for endometriosis, ovarian cancer, polycystic ovary disease, and various other pathologies affecting the female reproductive process, as highlighted in this review. Oxidative stress, sperm DNA damage, and apoptosis have been implicated in male infertility. Elevated reactive oxygen species levels correlate with the poor fertility outcomes seen in the assisted reproductive technology setting.
Oxidative stress has been implicated in male and female infertility, including fetal dysmorphogenesis, abortions, and intrauterine growth restriction. Accurate evaluation of seminal oxidative stress by standardized assays may help in the diagnosis and management of male infertility. There is evidence in the literature on the beneficial effects of oral antioxidant supplementation in male infertility. Current ongoing trials will provide answers on the safety and effectiveness of antioxidants in improving maternal and fetal outcomes. Further studies need to be conducted to determine if antioxidant supplementation will prevent fetal developmental defects in high-risk pregnancy with diabetes.
aCenter for Advanced Research in Human Reproduction, Infertility and Sexual Function, Glickman Urological Institute and the Department of Obstetrics–Gynecology, Cleveland Clinic, Cleveland, Ohio, USA
bTulane University Health Sciences Center, New Orleans, Louisiana, USA
Correspondence to: Dr Ashok Agarwal, Professor, Lerner College of Medicine, Case Western Reserve University, and Director, Center for Advanced Research in Human Reproduction, Infertility and Sexual Function, Glickman Urological Institute and Department of Obstetrics and Gynecology, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk A19.1, CL, Ohio 44195, USA. Tel: +1 216 444 9485; fax: +1 216 445 6049; E-mail: Agarwaa@ccf.org