Antioxidant-treated sperm enhances fertilization and early embryogenesis in intracytoplasmic sperm injection (ICSI) cycles

Background: Oxidative stress (OS) is a major factor influencing sperm quality and has been implicated in 30–80% of male factor infertility cases, often resulting in compromised fertilization capacity and diminished embryo quality in assisted reproductive technology (ART). While antioxidant supplementation has demonstrated beneficial effects on sperm parameters, particularly in European and American populations, evidence from Asian cohorts remains scarce. Moreover, the role of antioxidants in modulating early embryogenesis following Intracytoplasmic Sperm Injection (ICSI) is not yet well established. This study aimed to evaluate the association between antioxidant supplementation, specifically PROfertil®, and early embryogenesis outcomes in Malaysian couples affected by Oligoasthenoteratozoospermia (OAT). Methods: A single-center retrospective analysis was conducted on 195 female partners of OAT-affected males who underwent ART treatment between 2016 and 2021 at the Reproductive Medicine Unit, Hospital Tunku Azizah. Male partners in the treatment group received PROfertil® (two capsules daily for three months) prior to ART, while those in the control group received no supplementation. A total of 783 oocytes were retrieved from the treatment group and 796 from the control group. Statistical anaylsis were done on the early embryogenesis including fertilization, cleavage and blastocyst rates as well as embryo quality. Results: Comparative analysis using Kruskal-Wallis and Chi-Square tests revealed significant differences. Demographic analysis showed statistical differences in husband’s age and the etiology of infertility (p<0.05). The treatment group exhibited higher percentages of fertilization, cleavage on day 2, good cleavage on day 3, as well as quality embryo grading, including implantation potential on day 3 (p < 0.05). However, statistical analysis showed significant differences on day 5 in the treatment group compared to control group, with fewer good-quality blastocysts observed (p = 0.03). Conclusion: The findings suggest that antioxidant supplementation with PROfertil® improves the sperm quality and enhancing early embryogenesis outcomes in couples struggling with male factor infertility, particularly OAT-related cases. Further large-scale prospective studies are warranted to validate these results and to establish the clinical relevance of antioxidant supplementation in ART practice.