The Role of Oxidative Stress and Antioxidants in Assisted Reproduction

Aim: Oxidative stress contributes to the high rate of failure seen in assisted reproductive techniques in achieving fertilization and pregnancy. Many studies have been done to elucidate the sources of oxidative stress in the setting of assisted reproductive technology (ART) and interventions to overcome its negative influence on the outcome of IVF and ICSI. This article explores the utility of metabolomics as a novel, non-invasive method of accurately and efficiently quantifying oxidative stress. The aim of this study was to review the current literature on the effects of various interventions, including the use of antioxidants supplementation of IVF culture media and patients to improve fertilization and pregnancy rates in subfertile patients undergoing ART. Methods: Review of recent publications through Pubmed and the Cochrane data base. Results: Oxidative stress is correlated with negatives ART outcomes. Both exogenous and endogenous sources of reactive oxygen species during IVF/ICSI are well established in the literature. Compared to IVF, ICSI is known to minimize the exposure of gametes to endogenous sources of oxidative stress. Strategies to control exogenous sources of oxidative stress within the ART setting include reducing visible/near UV light exposure, the addition of metal chelators to culture media, maintenance of low oxygen tension in the environment and the use of antioxidant therapy. Antioxidant supplementation of culture media with vitamin C, vitamin E, and melatonin has been investigated and yielded conflicting results. Whereas oral antioxidant supplementation of male patients has been accepted and is currently practiced, there is a lack of consensus regarding the effectiveness of supplementation of vitamin C, vitamin E and melatonin in females undergoing ART. Conclusion: There is a need for further investigation with randomized controlled studies to confirm the efficacy and safety of antioxidant supplementation of culture media and patients as well as the need to determine the dosage required to improve fertilization rates and pregnancy outcome with IVF/ICSI.