The role of antioxidants in idiopathic male factor infertility

Purpose of review Idiopathic male factor infertility remains a major reproductive health concern, presenting with abnormal semen parameters despite no identifiable anatomical, hormonal, genetic, infectious, or endocrine cause. Oxidative stress is recognized as a central mechanism, as excessive reactive oxygen species can impair sperm concentration, motility, morphology, mitochondrial function, and DNA integrity. This review evaluates antioxidant therapy, mainly, in idiopathic male factor infertility. Recent findings Current evidence suggests that selected antioxidants may improve several semen parameters. However, improvements in semen quality do not consistently translate into higher pregnancy or live birth rates. Evidence remains limited by small sample sizes, heterogeneous formulations, variable dosing, inconsistent outcome reporting, and inadequate oxidative stress testing. Summary Antioxidants may be useful as targeted adjunctive therapy for selected men with idiopathic abnormal semen parameters, suspected oxidative stress, or elevated sperm DNA fragmentation. However, routine empirical use in all infertile men is not supported by evidence given the heterogeneity of formulations and limited comparative evidence. Treatment should be individualized, time-limited, and guided by oxidative stress assessment when available. Importantly, supplementation should not delay surgical intervention or assisted reproductive technologies when indicated. Future studies should prioritize standardized protocols and live birth outcomes.