Therapeutic Roles and Safety Profiles of Non-Vitamin Antioxidant Supplements in Female Infertility:  A Narrative Review

Effat  Davoudi-Monfared; Seyedeh Mahdieh  Fotouk Kiaie; Mahbod  Ebrahimi

doi:10.18502/jfrh.v20i1.22015

Effat Davoudi-Monfared Department of Clinical Pharmacy, Yas Hospital Complex, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
Seyedeh Mahdieh Fotouk Kiaie Yas Hospital Complex, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Mahbod Ebrahimi Vali-E-Asr Reproductive Health Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/jfrh.v20i1.22015

Keywords: Antioxidant; Female Infertility; Oxidative damage; Drug safety

Abstract

Objective: Treatment of female infertility consists different strategies including metabolic, hormonal and surgical therapeutic modalities. Non-vitamin supplements with antioxidant activity as carnitines, Inositols, Poly Unsaturated Fatty Acids (PUFAs), coenzyme Q10 and melatonin are among those with most popularity, but their prescription may confer some warnings.

Materials and methods: This review narrates the antioxidant mechanism of these supplements, beside their effect on outcomes of infertility treatment while considering side effects, warnings and ranges of doses.

Results: Carnitines are used for energy production and fat metabolism, while they have anti-aging and antioxidant effects. Supplementation with carnitines improve obesity outcomes, especially in Poly Cystic Ovarian Disease (PCOS) patients. Rare cases have shown increasing risk of seizure with levocarnitine. Coenzyme Q10 (Ubiquinone) has shown benefit in patients with PCOS or poor ovarian responders. It significantly increased live birth rate and the side effects are minimal even in higher doses. Poly Unsaturated Fatty Acids (PUFAs) have shown impact on follicular development and embryo quality. The hazard is increasing lipid low density lipoprotein (LDL) in high doses. Use of inositols in female infertility treatment is due to its metabolic effect and insulin resistance in PCOS patients resulting in decreasing use of gonadotropins. They have produced acceptable results about count of follicles and oocyte quality. Hypoglycemic effects of inositols have been reported as side effect, especially in combination with other hypoglycemic agents. Melatonin can increase the clinical pregnancy rate, and improve the outcomes about oocyte and quality of embryo via receptor- and non-receptor- action. Dizziness, drowsiness, and headache are reported in higher doses of melatonin.

Conclusion: The attitude that all supplement can be prescribed without restriction endangers susceptible patients. Hence, increasing our knowledge about efficacy and safety profile can help individualize prescription of supplements for female infertility.