Probiotics Outperform Antioxidants in Improving Semen Parameters of Men with Idiopathic Oligoasthenoteratozoospermia: A Randomized Controlled Trial

Abstract

Background: Idiopathic oligoasthenoteratozoospermia (iOAT) treatment still poses significant challenges. This study aims to compare the therapeutic efficacy of probiotics on sperm parameters of iOAT patients with placebo and antioxidants. Methods: In this triple-blind, randomized controlled trial, 110 men with iOAT were assigned to receive either a probiotic (Familact (R)), an antioxidant (Sperigen (R)), or a placebo daily for 3 months, in two academic centers in Iran (Isfahan and Yazd). The study was conducted from July 2021 to April 2022. Sperm parameters were analyzed using computer-assisted semen analysis. The main measured outcomes included semen volume and sperm features, including motility, morphology, and concentration. Changes in semen parameters were assessed using linear mixed-effects models with fixed effects for time, group, and their interaction. Estimated marginal means were compared across groups using Bonferroni-adjusted pairwise tests. Results: Overall, 110 men (mean age of 34.3 +/- 4.5 years) were included in the final analysis. Significant TimexGroup interactions were found for sperm concentration (P=0.003), motility (P<0.001), and morphology (P<0.001), but not for semen volume (P=0.71). After 3 months, the probiotic group showed significantly greater improvements in sperm concentration (10.42 +/- 1.11x10(6)/mL, P=0.007), motility (46.65 +/- 3.73, P=0.001), and morphology (4.31 +/- 0.21, P<0.001) compared to the placebo group. Additionally, probiotics outperformed antioxidants in morphology (P<0.001) and motility (P=0.009). Conclusion: This study is the first to directly compare probiotics and antioxidants in treating iOAT. Probiotics showed superior performance in sperm motility and morphology compared to antioxidants, although drawing a strong conclusion requires further robust studies. Trial Registration Number: IRCT20150420021869N5.