probiotics outperform antioxidants in improving semen parameters of men with idiopathic oligoasthenoteratozoospermia: a randomized controlled trial

Background: idiopathic oligoasthenoteratozoospermia (ioat) treatment still poses significant challenges. this study aims to compare the therapeutic efficacy of probiotics on sperm parameters of ioat patients with placebo and antioxidants.methods: in this triple-blind, randomized controlled trial, 110 men with ioat were assigned to receive either a probiotic (familact®), an antioxidant (sperigen®), or a placebo daily for 3 months, in two academic centers in iran (isfahan and yazd). the study was conducted from july 2021 to april 2022. sperm parameters were analyzed using computer-assisted semen analysis. the main measured outcomes included semen volume and sperm features, including motility, morphology, and concentration. changes in semen parameters were assessed using linear mixed-effects models with fixed effects for time, group, and their interaction. estimated marginal means were compared across groups using bonferroni-adjusted pairwise tests.results: overall, 110 men (mean age of 34.3±4.5 years) were included in the final analysis. significant time×group interactions were found for sperm concentration (p=0.003), motility (p<0.001), and morphology (p<0.001), but not for semen volume (p=0.71). after 3 months, the probiotic group showed significantly greater improvements in sperm concentration (10.42±1.11×106/ml, p=0.007), motility (46.65±3.73%, p=0.001), and morphology (4.31±0.21%, p<0.001) compared to the placebo group. additionally, probiotics outperformed antioxidants in morphology (p<0.001) and motility (p=0.009).  conclusion: this study is the first to directly compare probiotics and antioxidants in treating ioat. probiotics showed superior performance in sperm motility and morphology compared to antioxidants, although drawing a strong conclusion requires further robust studies.