The reactive oxygen species—total antioxidant capacity score is a new measure of oxidative stress to predict male infertility*

Abstract

The imbalance between reactive oxygen species (ROS) production and total antioxidant capacity (TAC) in seminal fluid indicates oxidative stress and is correlated with male infertility. A composite ROS-TAC score may be more strongly correlated with infertility than ROS or TAC alone. We measured ROS, TAC, and ROS-TAC scores in semen from 127 patients and 24 healthy controls. Of the patients, 56 had varicocele, eight had varicocele with prostatitis, 35 had vasectomy reversals, and 28 had idiopathic infertility. ROS levels were higher among infertile men, especially those with varicocele with prostatitis (mean +/- SE, 3.25 +/- 0.89) and vasectomy reversals (2.65 +/- 1.01). All infertile groups had significantly lower ROS-TAC scores than control. ROS-TAC score identified 80% of patients and was significantly better than ROS at identifying varicocele and idiopathic infertility. The 13 patients whose partners later achieved pregnancies had a mean ROS-TAC score of 47.7 +/- 13.2, similar to controls but significantly higher than the 39 patients who remained infertile (35.8 +/- 15.0; P < 0.01). ROS-TAC score is a novel measure of oxidative stress and is superior to ROS or TAC alone in discriminating between fertile and infertile men. Infertile men with male factor or idiopathic diagnoses had significantly lower ROS-TAC scores than controls, and men with male factor diagnoses that eventually were able to initiate a successful pregnancy had significantly higher ROS-TAC scores than those who failed.

Role of reactive oxygen species in the pathophysiology of human reproduction

“…Across all clinical diagnoses, the ROS-TAC score was a superior discriminator between fertile and infertile men than either ROS or TAC alone (Table 3) (95). The average ROS-TAC score for the fertile vasectomy-reversal men was nearly identical to that of normal fertile donors (98).…”

“…Infertile men with varicoceles were also found to have high levels of ROS, low levels of TAC (27), and low ROS-TAC scores (95). Varicocelectomy was associated with a significant increase in pregnancy and live birth rates for couples who underwent IUI, although standard semen parameters were not improved in all patients (101).…”

“…Extensive research in the field of male infertility has been conducted to develop adequate indices of OS that would help determine, with accuracy, whether OS is a significant contributor in male infertility (95). Levels of OS vary greatly in infertile men (96).…”

“…The fact that neither ROS alone nor TAC alone can adequately quantify seminal OS led to the logical conclusion that combining these two variables may be a better index for the diagnosis of the overall OS affecting spermatozoa (95). This conclusion led to the introduction of the ROS-TAC score as a new method for assessment of OS status in infertile men (95).…”

“…This conclusion led to the introduction of the ROS-TAC score as a new method for assessment of OS status in infertile men (95). The new ROS-TAC score is a statistical formula derived from levels of ROS in washed sperm suspensions and TAC in seminal plasma using principal component analysis.…”