The use of antioxidants in treatment of infertile men has been suggested, although the evidence base for this practice is unclear. A systematic review of randomized studies was conducted to evaluate the effects of oral antioxidants (vitamins C and E, zinc, selenium, folate, carnitine and carotenoids) on sperm quality and pregnancy rate in infertile men. MEDLINE, EMBASE, Cochrane Library and CINAHL were searched for relevant trials published from respective database inception dates to May 2009. Study selection, quality appraisal and data extraction were performed independently and in duplicate. Seventeen randomized trials, including a total of 1665 men, were identified, which differed in the populations studied and type, dosage and duration of antioxidants used. Only two-thirds of the studies (11/17) reported using allocation concealment and three studies (18%) used intention-to-treat analysis. Despite the methodological and clinical heterogeneity, 14 of the 17 (82%) trials showed an improvement in either sperm quality or pregnancy rate after antioxidant therapy. Ten trials examined pregnancy rate and six showed a significant improvement after antioxidant therapy. The use of oral antioxidants in infertile men could improve sperm quality and pregnancy rates. Adequately powered robust trials of individual and combinations of antioxidants are needed to guide clinical practice.

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Over 85% of women sustain perineal trauma to some degree during vaginal birth.1 A recent Cochrane Review concludes that antenatal perineal massage reduces the likelihood of perineal trauma and suggests women are given information on how to massage and made aware of the likely benefits.2 60 women were interviewed shortly after giving birth at St Thomas' Hospital (GSTFT) during May 2010. 60% had received information about antenatal perineal massage, 30% felt they were well informed and 27% said they were actively encouraged by their midwife. 77% were keen to practice perineal massage in future pregnancies. There is a lack of enthusiasm and commitment among some midwives in educating women about antenatal perineal massage. Women need active education and encouragement to enhance confidence and compliance. It is recommended that midwives and obstetricians at GSTFT collectively play a role in promoting antenatal perineal massage. They should all receive training with the aim of educating and following up 100% of women receiving antenatal care at GSTFT. A small investment of resources could lead to fewer repairs of perineal tears and fewer episiotomies leading to a reduction in the associated costs. A reduction in perineal trauma reduces the discomfort experienced by women, encourages comfortable mobilisation and enhances a woman's emotional and physical wellbeing and her enjoyment of the newborn. Women should be supported and motivated to prepare their bodies to the best of their abilities for pregnancy, childbirth and motherhood. Evidence shows antenatal perineal massage can play an integral role in this preparation.