The Benefit of Nutraceutical Food Supplementation and Antioxidants for the Treatment of the Infertile Couple and in Assisted Reproduction

Varicocele, male accessory gland infection, immunological infertility, and idiopathic oligozoospermia are the main causes of male infertility. Disturbances of ovulation, pelvic inflammatory disease, and endometriosis are common causes of female reproductive failure. The mechanisms by which these causes interfere with male and female reproduction are inflammation through prostaglandins and cytokines, and oxidative overload damaging the cell membrane, inducing mutagenesis of the DNA, and impairing mitochondrial energy production. A unique nutraceutical food supplement (NFS) has been created that aims at correcting these mechanisms and at reducing the influence of detrimental environmental factors. The efficiency of adding this NFS to causal therapy, or in assisted reproduction is expressed as numbers of couples needed to treat (NNT) to obtain one additional pregnancy. When the NFS is added to the treatment of varicocele the NNT is 3. Treating both partners with the NFS resulted in one additional ongoing pregnancy for every 4 IVF treatments. *Corresponding author: Frank H Comhaire, Professor emeritus, Ghent University, Brakelmeersstraat, 18, B 9830 Sint Martens-Latem, Belgium, E-mail: [email protected] Received November 21, 2011; Accepted March 20, 2012; Published March 24, 2012 Citation: Comhaire FH, Decleer W (2012) The Benefit of Nutraceutical Food Supplementation and Antioxidants for the Treatment of the Infertile Couple and in Assisted Reproduction. Reproductive Sys Sexual Disord S1:004. doi:10.4172/2161038X.S1-004 Copyright: © 2012 Comhaire FH, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Introduction Since the introduction of in vitro fertilisation (IVF) in 1978, and subsequently of intracytoplasmic sperm injection (ICSI) in 1990 [1], there has been little progress in techniques that aim at achieving pregnancy using deficient gametes. The implementation of advanced genetic tests, that assess the whole genome of the embryos, may improve the success rate of these techniques, but it does not address the core of the problem, namely, why gametes are deficient and which are the mechanisms affecting the gametes. The recent understanding of these two basic aspects of couple infertility has resulted in the development of rational treatment strategies that have been proven both effective and efficient. The present paper aims at reviewing the definitions, the physiology and pathology of male and female infertility with emphasis on the mechanisms that are involved, and at highlighting the role of nutraceutical food supplementation (NFS) for the clinical management of infertility. Emphasis is placed on the therapeutic outcome in terms of numbers needed to treat (NNT) which are calculated on the basis of controlled trials. The NNT expresses an epidemiological measure of the effectiveness of particular health care interventions in either preventing or treating a particular disease using a particular mode of treatment. The NNT is the average number of persons who need to be treated to either prevent one additional bad outcome or to obtain one additional good outcome [2]. The NNT takes into account the absolute difference in frequency of successful outcome, rather than the relative change. For instance, doubling of the success rate (relative risk, RR) thanks to a particular treatment will result in a completely different NNT in case the doubling is from 1% to 2% (RR: 2.00, NNT = 100) than if the doubling is from 20% to 40% (RR: 2.00, NNT = 5). Knowing the NNT of different treatments is particularly useful for the clinical management of couple infertility, and it can be employed for the calculation of the cost/benefit ratio of different treatments. Definition, Testicular Physiology and Laboratory Investigation Definition: The infertile couple According to the definition of the World Health Organization [3] a couple is considered infertile if no spontaneous pregnancy has been achieved in spite of “exposure to the risk of pregnancy” during at least 12 months. A male factor is detected in nearly half of the infertile couples, in 65% a problem is present in the female partner, and in approximately 10% no obvious abnormalities are found. Hence, in one out of every 4 couples both the male and the female partner simultaneously present fertility-impairing pathology. Testicular Function and regulation Spermatogenesis takes place in the protected environment of the seminiferous tubules, where the haploid gametes are isolated from the rest of the body by the blood-testis barrier, created mostly by the cells of Sertoli. The optimal functioning of these cells depends on the adequate stimulation by follicle stimulating hormone (FSH) secreted by the pituitary, which is controlled through feedback by Inhibin B. The hormone secretion by the interstitial cells of Leydig submerges the seminiferous tubules in an extremely high concentration of testosterone and of its 5-alfa-reduced metabolite: 5-α-dihydrotestosterone. The Leydig cells are stimulated by the gonadotropin luteinising hormone (LH), the secretion of which depends on pulsatile stimulation by the hypothalamic neuro-secrete: Luteinising Hormone Releasing Hormone (LHRH). Feedback of LHRH secretion by testosterone requires the latter to be aromatised to estradiol-17-β by the hypothalamic cells [4]. The role of semen analysis Semen analysis is of pivotal importance for the systematic investigation of every infertile couple. Computer aided semen analysis (CASA) can be performed by means of fully computerized equipments such as the IVOS HamiltonThorne®, SCA®, or of a semiautomatic system [5] (Autosperm®). These permit the reproducible and precise measurement of sperm concentration, motility characteristics Citation: Comhaire FH, Decleer W (2012) The Benefit of Nutraceutical Food Supplementation and Antioxidants for the Treatment of the Infertile Couple and in Assisted Reproduction. Reproductive Sys Sexual Disord S1:004. doi:10.4172/2161-038X.S1-004