Review Articles
Oxidative Puzzle of Female Infertility: A Systematic Narrative Review
Authors
Keywords:
- Oxidative stress; Reactive oxygen species; Female infertility; Antioxidant supplementation
Abstract
Oxidative stress, characterized by an imbalance between the production of the reactive oxygen species (ROS) and the ability of the antioxidant defense systems. It is crucial to the pathophysiology of infertile women, deleterious impacts through the oocyte maturation, ovulatory functions, associated with reproductive disorders as polycystic ovary syndrome (PCOS) and endometriosis. Mitochondria of oocytes and granulosa cells are the leading sources of ROS whose generation is further worsened by ageing, obesity, as well as environmental assaults. Although physiological levels of ROS are necessary to normal follicular growth and ovulation, excessive levels of ROS cause oocyte DNA breakage, meiotic spindle deregulation, and embryonic in survival. The inherent antioxidant enzymes which as superoxide dismutase (SOD) and glutathione, give the cellular systems partial protection against oxidative damage, however significant and the exogenous antioxidant supplementation such as vitamins C and E, coenzyme Q10, N-acetyl cysteine as well as Melatonin have shown an encouraging result in randomized controlled trials (RCTs) and meta-analyses. Clinical evidence shows that there are better ovarian responsiveness and better oocyte yield and better pregnancy rates in assisted reproductive technologies (ART) especially in women with advanced ovarian age or PCOS. A Cochrane systematic review found a moderate relationship between antioxidant use and increased rates of live births, but the evidence quality was overall low because of the study heterogeneity. Notably, antioxidant interventions were generally well-tolerated and portable with minimal side effects. Future studies ought to focus on more rigorously constructed, high quality, RCTs that are targeted at clinically meaningful end point outcomes like live birth rates as well as consider adjunct parameters of sperm DNA fragmentation, which modifies female reproductive outcomes indirectly. Combination of personalized antioxidant treatment and specific lifestyle changes has a significant therapeutic potential for the female reproductive health and optimizing fertility.
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References
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