The evaluation of sperm DNA integrity is recommended in the sixth edition of the 2021 World Health Organization guidelines. Oxidative stress has been identified as a crucial factor leading to genome decay, lipid peroxidation, and nucleoprotein oxidation. This double-blind, placebo-controlled clinical trial aimed to assess the effect of oral antioxidant treatment (Fertilis), which contains L-carnitine and some micronutrients, in the improvement of conventional sperm parameters, sperm DNA integrity and in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcomes. A total of 263 participants were enrolled and randomly divided into two groups: 131 participants received the antioxidant treatment, while 132 participants received a placebo. The male partners in both groups underwent the antioxidant treatment or the placebo for a duration of three months. For each participant, we performed a hormonal test, an infectious test, a spermogram, a TUNEL assay for sperm DNA fragmentation, a toluidine blue staining for sperm DNA decondensation, and an IVF/ICSI procedure. Sperm characteristics analysis (volume, count, motility, and vitality), sperm DNA fragmentation, and sperm DNA decondensation were assessed and compared to the results preceding the antioxidant treatment. The study outcome revealed a significant decrease in the DNA fragmentation index and a significant increase in sperm motility after 3 months of treatment (p = 0.01 and p = 0.02, respectively). Additionally, a significant improvement in clinical pregnancy rate (p = 0.01) and life birth rate (p = 0.031) was observed. No significant changes were observed in conventional sperm parameters (volume, count, and vitality) or sperm DNA decondensation (SDI). Antioxidant therapy has a beneficial impact on achieving pregnancy, whether through spontaneous conception or assisted reproductive procedures (ART).

Today, accumulating evidence highlights the impact of oxidative stress (OS) on semen quality. It is considered to be a key factor contributing to the decline in male fertility. OS is detected in 30–80% of men with infertility, highlighting its strong association with impaired reproductive function and with clinical outcomes following the use of assisted reproductive technologies. Spermatozoa are particularly vulnerable to oxidative damage due to their high content of polyunsaturated fatty acids (PUFAs) and limited antioxidant defense abilities. OS arises from an imbalance between the production of reactive oxygen species and the capacity to neutralize or repair their adverse effects. Evidence indicates that OS leads to lipid peroxidation, protein oxidation, mitochondrial dysfunction, and genomic instability. Micronutrient–antioxidant therapies can play a key role in infertility improvement by neutralizing free radicals and preventing cellular damage. Many different micronutrients, including L-carnitine, L-glutathione, coenzyme Q10, selenium, and zinc, as well as vitamins complexes, are proposed to improve sperm parameters and male fertility potential. This study aims to review the impact of antioxidant supplementation on semen parameters, including sperm volume, motility, concentration, morphology, genome integrity (maturity and fragmentation), and in vitro fertilization (IVF) outcomes. Antioxidant intake and a balanced lifestyle reduce oxidative stress and mitochondrial dysfunction, enhancing the spermatogenesis and spermiogenesis processes, improving sperm quality, and protecting DNA integrity.

A competent embryo and a receptive endometrium are essential for adequate embryo–maternal cross-talk and successful implantation. However, the majority of women undergoing IVF do not achieve pregnancy after the first embryo transfer, incriminating potential implantation issues. According to statistics, recurrent implantation failure (RIF), for which different definitions have been proposed, is estimated to affect about 10–25% of women undergoing in vitro fertilization (IVF). RIF is a complex condition with overlapping causes. The primary objective of this review is to explore factors such as gamete and embryo quality, chromosomal abnormalities, uterine environment, endometrial receptivity, immune cell biomarkers, and microbiota dysregulation to better understand and overcome RIF challenges. It also highlights the significance of comprehensive evaluations of novel therapies, such as activated autologous platelet-rich plasma (PRP) or peripheral blood mononuclear cell (PBMC) insemination, on pregnancy outcomes in patients with RIF.

Recent evidence suggests a global decline in semen quality, raising significant concerns about male reproductive health. Data from North Africa are limited, and the region faces unique environmental and lifestyle challenges. In addition, the COVID-19 pandemic may have caused transient or lasting effects on male fertility. This retrospective study aimed to evaluate changes in semen quality among North African men between 2019 and 2024, in comparison with data from 2013 to 2018, and to assess the potential impact of the COVID-19 pandemic on sperm parameters. A total of 21,585 semen samples from men aged 19–74 years, originating from three North African countries (Tunisia, Algeria, and Libya), were analyzed. Semen analyses were performed in a Tunisian andrology laboratory in accordance with WHO 5th and 6th edition criteria. The assessed parameters included sperm concentration, motility, morphology, vitality, and DNA integrity. Temporal and regional trends were evaluated and compared to a historical cohort from 2013 to 2018. Sperm concentration and progressive motility showed a marked decline in 2020, coinciding with the first COVID-19 wave (P < 0.001). Although a gradual recovery was noted after 2021, the 2024 values remained lower than those of 2019. Sperm morphology exhibited a continuous decline throughout the study period. Libyan men had the highest median sperm concentration, while Algerians had the lowest. Compared to the 2013–2018 cohort, there was a 27.6% decrease in concentration, a 20.5% reduction in motility, and a drop in normal morphology from 12.1 to 5%. Semen quality among North African men continued to deteriorate between 2019 and 2024, with a temporary accentuation during the COVID-19 pandemic. These findings underscore the multifactorial nature of male fertility decline in the region and highlight the need for preventive public health strategies. Lay summary: Studies show that men’s sperm quality is getting worse around the world, which can affect their ability to have children. There is not much information about this in North Africa, a region with special environmental and lifestyle factors. The COVID-19 pandemic might have also influenced men’s fertility. This study looked at sperm samples from men in three North African countries between 2019 and 2024 and compared them to samples from 2013 to 2018. The goal was to see if sperm quality changed and if COVID-19 had any effect. The results showed that in 2020, when COVID-19 first appeared, sperm numbers and how well they moved dropped a lot. After 2021, there was some improvement, but sperm quality was still lower in 2024 than before the pandemic. The shape of sperm got worse steadily over the years. Men from Libya had the best sperm counts, while men from Algeria had the lowest. In short, sperm quality in North African men got worse over the years, especially during COVID-19. This shows that many things may be causing this problem, and it is important to take steps to protect men’s reproductive health.

The different Assisted Reproductive Technology techniques are offering hope to millions of couples struggling with infertility. However, the success of IVF/ICSI is related at least partially to the optimization of embryo culture conditions, which are influenced by myriad of physiological and environmental factors. This review reports the latest advancements in embryo culture techniques, with a particular focus on the roles of oxygen tension, pH regulation, temperature stability, air quality in enhancing embryo viability, competency and implantation rates. In addition, we explored the critical importance of quality assurance (QA) factors and key performance indicators (KPIs) to keep laboratory efficiency. We highlighted also some emerging technologies, such as dynamic culture systems, metabolomics, proteomics biomarkers potential, and artificial intelligence (AI) in embryo selection and monitoring, which hold promise for further improving embryo culture techniques. By providing a comprehensive overview of the current state of embryo culture optimization, this review aims to guide future research and clinical practices in the field of assisted reproductive technology (ART).

Background: Endometriosis is a systemic chronic disease affecting seriously various aspects of fe-male health and wellbeing. It was shown to be associated with a significant increase of free circulating DNA (fcDNA) and gene methylation profile changes. The purpose of this study was to evaluate the effect of deoxyribonuclease (DNase) I therapy on these anomalies. Methods: fcDNA extraction, quantification and methylation status were performed with the use of commercial kits. DNase I was administered subcutaneously every 2 days for one month, and the pre-treatment and post-treatment fcDNA levels and methylation sta-tus, along with the degree of patients’ discomfort, were compared. Results: DNase I treatment decreased the overall level of fcDNA. Moreover, the treatment re-sulted in a significant change in methylation status (in the sense of hypermethylation or hypomethylation) in 6 out of the 9 genes targeted. Moreover, most of the patients (15/16) reported significant reduction in pain, an improvement in their ability to as-sume professional activity and less difficult sexuality. Conclusions: This is the first study reporting that DNase I treatment decreased the level of fcDNA, it did change the methylation status of some gene and, more importantly, it alleviated the clinical burden of the disease. Further research into the potential use of DNase-based medicine for endometriosis patients, including more participants, is warranted.