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Male Infertility
REVIEW
INTRODUCTION
There has been increasing evidence in recent years that oxidative
stress plays a vital role in the pathogenesis of idiopathic male factor
infertility. Elucidating the value of antioxidant supplementation as a
treatment option for infertility has therefore become a goal for many
researchers. Extensive research has been conducted to show that
antioxidants like vitamins E and C and carnitines help in reducing
oxidative stress by quenching free radicals.1 However, less is known
about the effectiveness of carotenoids, especially that of lycopenea
potent antioxidant and singlet oxygen quencher.2 In this review, we
will(i) explain how oxidative stress can cause infertility,(ii) synthesize
pertinent information on lycopene, (iii) discuss the possibility of
lycopene supplementation as a treatment option for idiopathic male
factor infertility and (iv) give a detailed analysis of various human
and animal studies involving lycopene that have been conducted both
invivo and invitro.
O X I D AT I V E S T R E S S A N D I T S E F F E C T S O N M A L E
REPRODUCTION
A free radical refers to a molecule that has at least one unpaired
electron,3,4 which is responsible for the molecules shortlived high
energy state that causes instability and extreme reactivity.5 These free
radicals will take part in propagative chain reactions and generate
even more free radicals until two such radicals react and the unpaired
electrons are neutralized.4 In the process, membrane lipids, amino acids
and carbohydrates in nucleic acids will be attacked by the free radicals
Center for Reproductive Medicine, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA; 2Faculty of Medicine, MARA University of
Technology, Sungai Buloh, Selangor, Malaysia.
Correspondence: Dr.A Agarwal (agarwaa@ccf.org)
Received: 12 September 2013; Revised: 04 November 2013; Accepted: 02 January 2014
1
most clearly seen when lycopene or lutein was included in the mixture.27
Besides quenching singlet molecular oxygen, lycopene is also known
to act on other free radicals like hydrogen peroxide, nitrogen dioxide
and hydroxyl radicals.19,28 Furthermore, since lycopene is lipophilic, it
tends to accumulate in cell membranes and lipoproteins, thus exerting
a more noticeable effect within such components of a cell.19
In addition to directly neutralizing ROS by acting as a singlet oxygen
quencher, hence causing the overall amount of ROS to decrease,
lycopene also indirectly decreases oxidative stress by activating other
mechanisms that increase antioxidant potential.
Nonoxidative mechanisms
Other nonoxidative mechanisms by which lycopene could exert its
effects include the following: aiding in gap junction communication,
modulating gene expression, regulating the cell cycle and enhancing
the immune system.15,17,26
It is projected that tumor cells lack gap junction communication
and therefore, continue to proliferate without inhibition. By improving
communication between cells, lycopene could possibly prevent
tumor formation and hence cancer, especially in the prostate, breast
and lung.2,15,27 Lycopene also prevents unwanted cell proliferation by
disrupting insulinlike growth factor1 signaling and preventing cell
cycle progression.17,22,27
Lycopene has been shown to have hypocholesterolemic properties
because it inhibits hydroxylmethlyglutaryl coenzyme A reductase,
an important ratelimiting enzyme responsible for cholesterol
production.19,27 A decrease in cholesterol also contributes to the
alleviation of CVD because less atherosclerotic plaque will be present.27
The aforementioned nonoxidative mechanisms of action could
possibly apply to male infertility too, but as far as the authors are aware,
no studies have been conducted in this area. Thus, more research is
still required to ascertain the exact mechanism of action by which
lycopene exerts its effects in reducing the risk of chronic diseases22
and that of male infertility.
MALE INFERTILITY AND LYCOPENE AS A POSSIBLE
TREATMENT STRATEGY
According to the World Health Organization, infertility is defined as
the inability of a sexually active couple(at least three times per month),
not using contraception, to achieve pregnancy within one year.12 About
Asian Journal of Andrology
Table1: Summary of studies measuring the effect of lycopene supplementation on oxidative stressrelated parameters
Authors(year)
Subjects
Lycopene source
Lycopene dosage(duration)
Goyal
etal.(2007)30
6 healthy human
males
Heated cream of
tomato soup
Devaraj
etal.(2008)37
82 healthy human
males
Synthetic crystalline
lycopene(alltrans)
Mangiagalli
etal.(2010)38
25 broiler breeder
males
Supplementation in
drinking water
0.5gl1 or none
(multiple samples over17weeks)
Zini
etal.(2010)13
12 healthy human
males
Purchased
0, 2 or 5mmoll1(30 min)
Aly
etal.(2012)39
Purchased
4mgkg1(7 days)
Rosato
etal.(2012)33
Preheated Sigma
L9879(purchased)
Sarkar
etal.(2012)40
Lycopene capsule
or tomato products
(soup, paste, ketchup)
Choi and
Seo(2013)35
40 healthy Mongolian
gerbil males
5% lycopene
extracted from
tomatoes(purchased)
DNA
damage
Urinary
8OHdG
Antioxidants
Immunity
Table2: Summary of studies measuring the effects of lycopene supplementation on spermrelated parameters
Authors(year)
Subjects
Lycopene source
Lycopene
dosage(duration)
Spermrelated parameters
Gupta and
Kumar(2002)29
30 infertile
human males
Unnamed
(66)
Mohanty
etal.(2001)9
50 infertile
human males
Unnamed
8mg daily
(until outcome achieved)
(60)
Zini
etal.(2010)13
12 healthy
human males
Purchased
0, 2 or 5mmoll1
(30 min)
Hekimoglu
etal.(2009)41
42 Wistar albino
rat males
Purchased
4mgkg1
daily(30 days)
Mangiagalli
etal.(2012)42
25 hybrid Martini
rabbit males
Supplementation
in drinking water
0, 0.1 or 0.5gl1
(8 weeks)
Mangiagalli MG
etal.(2010)38
25 broiler
breeder males
Supplementation
in drinking water
0.5gl1 or none(multiple
samples over17 weeks)
Aly
etal.(2012)39
24 healthy Wistar
rat males
Purchased
4mgkg (7 days)
Concentration(%)
Count(%)
(70)
Motility(%)
Morphology(%)
(53)
(46)
(54)
(38)
Viability
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