Mathieu d'Argent Emmanuelle, Ravel Celia, Rousseau Alexandra, Morcel Karine, Massin Nathalie, Sussfeld Julie, Simon Tabassome, Antoine Jean-Marie, Mandelbaume Jacqueline, Daraï Emile, Kolanska Kamila
Service de Gynécologie Obstétrique et Médecine de la Reproduction, AP-HP Sorbonne Université site Tenon, 4 rue de la Chine, 75020 Paris, France.
CHU Rennes, Laboratoire de Biologie de la Reproduction-CECOS, Inserm, EHESP, Irset (Institut de Recherche en Santé, Environnement et Travail)-UMR_S 1085, Université de Rennes, 35000 Rennes, France.
J Clin Med. 2021 Apr 26;10(9):1876. doi: 10.3390/jcm10091876.
Dietary supplementation is commonly used in men with male infertility but its exact role is poorly understood. The aim of this multicenter, randomized, double-blind, placebo-controlled trial was to evaluate the impact of high-dose folic acid supplementation on IVF-ICSI outcomes. 162 couples with male infertility and an indication for IVF-ICSI were included for one IVF-ICSI cycle. Male partners of couples wishing to conceive, aged 18-60 years old, with at least one abnormal spermatic criterion were randomized in a 1:1 ratio to receive daily supplements containing 15 mg of folic acid or a placebo for 3 months from Day 0 until semen collection for IVF-ICSI. Sperm parameters and DNA fragmentation before and after the treatment and the biochemical and clinical pregnancy rates after the fresh embryo transfer were analyzed. We observed an increase in the biochemical pregnancy rate and a trend for a higher clinical pregnancy rate in the folic acid group compared to placebo (44.1% versus 22.4%, = 0.01 and 35.6% versus 20.4%, = 0.082, respectively). Even if no changes in sperm characteristics were observed, a decrease in DNA fragmentation in the folic acid group was noted (8.5 ± 4.5 vs. 6.4 ± 4.6, < 0.0001). High-dose folic acid supplementation in men requiring IVF-ICSI for male infertility improves IVF-ICSI outcomes.
膳食补充剂常用于男性不育症患者，但人们对其确切作用了解甚少。这项多中心、随机、双盲、安慰剂对照试验的目的是评估高剂量叶酸补充剂对体外受精-卵胞浆内单精子注射（IVF-ICSI）结局的影响。162对有男性不育症且有IVF-ICSI指征的夫妇被纳入进行一个IVF-ICSI周期。希望受孕的夫妇中，年龄在18至60岁之间、至少有一项精子标准异常的男性伴侣按1:1的比例随机分组，从第0天开始每天接受含15毫克叶酸的补充剂或安慰剂，持续3个月，直至采集精液用于IVF-ICSI。分析了治疗前后的精子参数和DNA碎片率，以及新鲜胚胎移植后的生化妊娠率和临床妊娠率。我们观察到，与安慰剂组相比，叶酸组的生化妊娠率有所提高，临床妊娠率有升高趋势（分别为44.1%对22.4%，P = 0.01；35.6%对20.4%，P = 0.082）。即使未观察到精子特征的变化，但叶酸组的DNA碎片率有所下降（8.5±4.5对6.4±4.6，P<0.0001）。对于因男性不育症需要进行IVF-ICSI的男性，补充高剂量叶酸可改善IVF-ICSI结局。
