抗氧化劑與激素療法對特發性男性不孕症之療效：系統性文獻回顧

楊富程

國立台灣大學醫學院附設醫院 教學部

The Efficacy of Combined Antioxidant and Hormonal Therapy in Men with Idiopathic Infertility: A Systematic Literature Review

Fu-Cheng Yang

 Department of Medical Education, National Taiwan University Hospital, Taiwan

Purpose: Idiopathic male infertility (IMI) accounts for 30% to 58% of male factor cases and is frequently driven by oxidative stress and endocrine disruption. While monotherapies are common, their efficacy is often inconsistent. This systematic literature review aims to qualitatively synthesize available clinical evidence regarding the synergistic efficacy of combining antioxidant therapy (e.g., Coenzyme Q10) with hormonal modulation (e.g., Letrozole or SERMs) in improving semen quality and hormonal profiles in men with IMI.

Materials and Methods: This systematic review followed the PRISMA guidelines. A comprehensive search was performed across PubMed, Embase, and the Cochrane Library to identify clinical trials involving combined therapeutic regimens for IMI. Study quality and risk of bias were assessed using the Cochrane Risk of Bias (RoB 2.0). Data were extracted focusing on sperm concentration, motility, morphology, and the testosterone-to-estradiol (T/E2) ratio.

Results: The review of identified studies indicates that combined therapy consistently outperforms monotherapy in optimizing the male reproductive environment. Specifically, the combination of Letrozole and Coenzyme Q10 was shown to significantly improve the T/E2 ratio compared to Letrozole alone, suggesting a protective effect on Leydig cells and enhanced HPG axis stimulation. Qualitative synthesis also highlighted that combined regimens involving Clomiphene Citrate and various antioxidants significantly increased sperm concentration and motility across multiple trials. Furthermore, individual studies suggest that these combinations are particularly effective for patients with identified male oxidative stress infertility (MOSI). No serious adverse events were reported.

Conclusions: The study demonstrates that combined antioxidant and hormonal therapy provides a superior strategy for managing idiopathic male infertility. This approach effectively addresses both the oxidative damage and the underlying hormonal imbalances that impair spermatogenesis. While the clinical evidence is promising, the literature highlights a need for standardized dosing and larger-scale trials to further validate long-term reproductive outcomes.