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DOI 10.5534/wjmh.250290

Медицинская библиотека · The world journal of men's health · 2026

Global Andrology Forum Clinical Guidelines on Antioxidant Use in the Treatment of Male Infertility.

Agarwal Ashok, Mostafa Taymour, Al Hashimi Manaf, Çayan Selahittin, Pescatori Edoardo, Singh Keerti, Şahin Bahadır, Zini Armand, Chung Eric, Arafa Mohamed, Ko Edmund, Pinggera Germar-M, Saleh Ramadan, Atmoko Widi, Rambhatla Amarnath, Cannarella Rossella, Palani Ayad, Ozer Cevahir, Abdulgabbar Noman Mohammed, Dimitriadis Fotios, Toprak Tuncay, Ceyhan Erman, Corral Molina Juan Manuel, Nguyen Manh Truong, Le Tan V, Putra Rosadi, Boeri Luca, Gül Murat, Alhathal Naif, Kandil Hussein, Thomas Charalampos, Rashed Ayman, Binsaleh Saleh, Falcone Marco, Yogiswara Niwanda, Japari Andrian, Oriazowan Julius Akhaine, Çeker Gökhan, Güngör Nur Dokuzeylül, Giulioni Carlo, Abdelrahman Islam Fathy Soliman, Nguyen Quang, Calik Gokhan, Hegde Abheesh Varma, Motawi Ahmad Tarek, Dipankar Satish Pundlik, Manfredi Celeste, Tsujimura Akira, Konstantinidis Charalampos, Ashour Shedeed, Nada Essam Aa, Al-Marhoon Mohamed, Abu El-Hamd Mohammed, Alghobary Moheiddin, Mogharabian Nasser, Almusafer Murtadha, El-Sakka Ahmed, Khalifa Ahmed Abd Elmoaty, Sarikaya Selcuk, Phuoc Nguyen Ho Vinh, Alfatlawy Noor Kareem, Benjamin Lim Tze Ying, Smith Ryan Patrick, Park Hyun Jun, Russo Giorgio Ivan, Ördek Eser, Lin Haocheng, Kadihasanoglu Mustafa, Kumar Naveen, Deger Muslim Dogan, Khalafalla Kareim Mohamed, Altay Baris, Mak Siu King, Görür Sadik, Shamohammadi Iman, Dursun Murat, Pening David, Narimani Nima, Bolat Mustafa Suat, Rajmil Osvaldo, Alkawaz Ula Mohmmed, Aydos Kaan, Kaya Coşkun, Maya Walter D Cardona, Zachariou Athanasios, Duran Mesut Berkan, Shatylko Taras, Balercia Giancarlo, De La Rosette Jean, El Meliegy Amr, Saylam Barış, Bahçeci Tuncer, Efesoy Ozan, Eugeni Elena, Zilaitiene Birute, Gherabi Nazim, Kahraman Oğuzhan, Crafa Andrea, Vazquez Jesus Fernando Solorzano, Bahar Fahmi, Taha Emad Abdelraheem, Selim Osama M, Hasan Mohamed Saeed Mohamed, Tadros Nicholas N, Ho Christopher Chee Kong, Sogutdelen Emrullah, Busetto Gian Maria, Micic Sava, Gokalp Fatih, Mohammad Ehab Jasim, Asci Ramazan, Hasirci Eray, Musa Muhammad Ujudud, Joshi Praveen Bhimasen, Reda Ahmed, Yazbeck Chadi, Adriansjah Ricky, Kinzikeeva Ella, Salvio Gianmaria, Turunc Tahsin, Kim Dongsuk, Vishwakarma Ranjit Babulal, Makarounis Konstantinos, Ruzaev Mikhail, Alipour Hiva, Shah Rupin

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Аннотация

PURPOSE: Antioxidant (AOX) therapy has long been investigated for the management of male infertility. It has potential benefits, but persistent controversy affects its broad acceptance and clinical utility. This study aimed to develop standardized, evidence-based guidelines for AOX use by synthesizing the best available evidence and achieving global expert consensus.

MATERIALS AND

METHODS

A comprehensive literature review was conducted by senior experts of the Global Andrology Forum (GAF). Additionally, data on the real-life use of oxidative stress (OS) testing and AOX use obtained from the largest global survey of practicing physicians conducted by GAF, which served as a reference point for this study. In phase one, 151 international specialists (>5 years' experience) participated in a modified Delphi process to evaluate AOX therapy in male infertility. Experts reviewed draft statements and rated agreement on a 10-point Likert scale. Statements achieving >80% consensus (with score >7/10) were accepted. The original eight statements were expanded to 19 and finalized into 18. In phase two, 84 senior physicians (>10 years' experience) graded the Delphi-approved statements using the GRADE approach.

RESULTS

Four out of the 18 statements failed to reach consensus and were excluded. Of the final 14 statements, seven (50%) were graded as "Strong" and seven (50%) as "Weak." Current evidence indicates that AOX therapy can reduce OS, improve sperm quality, and potentially enhance reproductive outcomes. However, benefits vary by agent, regimen, and patient population. The guidelines emphasize the need to document OS and to consider underlying factors before initiating AOX therapy, and caution against indiscriminate or prolonged use.

CONCLUSIONS

Developed through a dual-validation process and endorsed by a globally diverse expert panel, these GAF guidelines represent the first standardized, evidence-based guidelines for AOX use in male infertility. By addressing heterogeneity in research and practice, they provide clinicians with practical, safe, and patient-centered recommendations for rational AOX therapy worldwide.

Для цитирования: Agarwal Ashok, Mostafa Taymour, Al Hashimi Manaf, Çayan Selahittin, Pescatori Edoardo, Singh Keerti, Şahin Bahadır, Zini Armand, Chung Eric, Arafa Mohamed, Ko Edmund, Pinggera Germar-M, Saleh Ramadan, Atmoko Widi, Rambhatla Amarnath, Cannarella Rossella, Palani Ayad, Ozer Cevahir, Abdulgabbar Noman Mohammed, Dimitriadis Fotios, Toprak Tuncay, Ceyhan Erman, Corral Molina Juan Manuel, Nguyen Manh Truong, Le Tan V, Putra Rosadi, Boeri Luca, Gül Murat, Alhathal Naif, Kandil Hussein, Thomas Charalampos, Rashed Ayman, Binsaleh Saleh, Falcone Marco, Yogiswara Niwanda, Japari Andrian, Oriazowan Julius Akhaine, Çeker Gökhan, Güngör Nur Dokuzeylül, Giulioni Carlo, Abdelrahman Islam Fathy Soliman, Nguyen Quang, Calik Gokhan, Hegde Abheesh Varma, Motawi Ahmad Tarek, Dipankar Satish Pundlik, Manfredi Celeste, Tsujimura Akira, Konstantinidis Charalampos, Ashour Shedeed, Nada Essam Aa, Al-Marhoon Mohamed, Abu El-Hamd Mohammed, Alghobary Moheiddin, Mogharabian Nasser, Almusafer Murtadha, El-Sakka Ahmed, Khalifa Ahmed Abd Elmoaty, Sarikaya Selcuk, Phuoc Nguyen Ho Vinh, Alfatlawy Noor Kareem, Benjamin Lim Tze Ying, Smith Ryan Patrick, Park Hyun Jun, Russo Giorgio Ivan, Ördek Eser, Lin Haocheng, Kadihasanoglu Mustafa, Kumar Naveen, Deger Muslim Dogan, Khalafalla Kareim Mohamed, Altay Baris, Mak Siu King, Görür Sadik, Shamohammadi Iman, Dursun Murat, Pening David, Narimani Nima, Bolat Mustafa Suat, Rajmil Osvaldo, Alkawaz Ula Mohmmed, Aydos Kaan, Kaya Coşkun, Maya Walter D Cardona, Zachariou Athanasios, Duran Mesut Berkan, Shatylko Taras, Balercia Giancarlo, De La Rosette Jean, El Meliegy Amr, Saylam Barış, Bahçeci Tuncer, Efesoy Ozan, Eugeni Elena, Zilaitiene Birute, Gherabi Nazim, Kahraman Oğuzhan, Crafa Andrea, Vazquez Jesus Fernando Solorzano, Bahar Fahmi, Taha Emad Abdelraheem, Selim Osama M, Hasan Mohamed Saeed Mohamed, Tadros Nicholas N, Ho Christopher Chee Kong, Sogutdelen Emrullah, Busetto Gian Maria, Micic Sava, Gokalp Fatih, Mohammad Ehab Jasim, Asci Ramazan, Hasirci Eray, Musa Muhammad Ujudud, Joshi Praveen Bhimasen, Reda Ahmed, Yazbeck Chadi, Adriansjah Ricky, Kinzikeeva Ella, Salvio Gianmaria, Turunc Tahsin, Kim Dongsuk, Vishwakarma Ranjit Babulal, Makarounis Konstantinos, Ruzaev Mikhail, Alipour Hiva, Shah Rupin. Global Andrology Forum Clinical Guidelines on Antioxidant Use in the Treatment of Male Infertility.. The world journal of men's health. 2026. DOI: 10.5534/wjmh.250290.
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