Oxidative Stress and Male Infertility: A Critical Analysis of Current Diagnostic and Therapeutic Methods

Male infertility affects a substantial proportion of couples worldwide, with oxidative stress recognized as one of its most prevalent and potentially treatable mechanisms. This review critically analyzes current diagnostic and therapeutic approaches for oxidative stress-related male infertility, highlighting the necessity of advancing from descriptive semen analysis to mechanism-based clinical care. The biological basis of reactive oxygen species generation in spermatozoa, the dual physiological and pathological roles of redox signaling, and the contributions of leukocytes, lifestyle factors, infections, varicocele, metabolic disease, environmental exposures, and transition metals in amplifying oxidative injury are examined. Laboratory methods for assessing oxidative stress, including chemiluminescence, flow cytometry, oxidation-reduction potential, and total antioxidant capacity assays, are evaluated with respect to biological relevance, technical limitations, standardization, and clinical applicability. Evidence suggests that indiscriminate antioxidant use, without prior confirmation of oxidative stress or identification of its cause, may account for inconsistent clinical trial outcomes and could induce reductive stress. Conversely, individualized management based on comprehensive andrological evaluation, treatment of underlying conditions, and quality-controlled functional sperm testing is more rational and potentially effective. Oxidative stress should therefore be regarded as a diagnosable and monitorable clinical entity in male infertility, necessitating validated diagnostics and personalized therapeutic strategies rather than empiric supplementation alone.