***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: PURPOSE We investigated the effects of the administration of ubiquinol ( a reduced form of coenzyme Q(10 ) ) on semen parameters and seminal plasma antioxidant capacity in infertile men with idiopathic oligoasthenoteratozoospermia . MATERIAL S AND METHODS A total of 228 men with unexplained infertility were r and omly assigned 1:1 into 2 groups . Group 1 ( 114 ) received 200 mg ubiquinol daily by mouth for 26 weeks and group 2 ( 114 ) received a similar regimen of placebo . After completion of the 26-week treatment phase , all participants were followed for another 12-week off-drug period . Primary outcomes were improvement in sperm density , sperm motility and sperm strict morphology . RESULTS At the end of the 26-week treatment period mean ± SD sperm density in the ubiquinol and placebo groups was 28.7 ± 4.6 × 10(6)/ml and 16.8 ± 4.4 × 10(6)/ml ( p = 0.005 ) , sperm motility was 35.8 % ± 2.7 % and 25.4 % ± 2.1 % ( p = 0.008 ) , and sperm strict morphology was 17.6 % ± 4.4 % and 14.8 % ± 4.1 % ( p = 0.01 ) of normal sperm , respectively . During the treatment period serum follicle-stimulating hormone levels decreased significantly ( p = 0.02 ) and serum inhibin B concentrations increased significantly ( p = 0.01 ) . During the off-drug period semen parameters gradually returned to baseline values but the differences were still significant for sperm density ( p = 0.03 ) and sperm motility ( p = 0.03 ) . The correlation coefficients analysis revealed a positive association between the duration of treatment with ubiquinol and sperm density ( r = 0.74 , p = 0.017 ) , sperm motility ( r = 0.66 , p = 0.024 ) and sperm morphology ( r = 0.57 , p = 0.027 ) . CONCLUSIONS Ubiquinol was significantly effective in men with unexplained oligoasthenoteratozoospermia for improving sperm density , sperm motility and sperm morphology OBJECTIVE To determine the effectiveness of the in vivo administration of vitamin E as treatment for reactive oxygen species-associated male infertility .  SETTING University-based center for reproductive medicine . DESIGN Double-blind r and omized placebo cross-over controlled trial . PATIENTS , PARTICIPANTS Thirty healthy men with high levels of reactive oxygen species generation in semen and a normal female partner . INTERVENTIONS Patients were allocated to two groups according to the blinded r and omization . Each patient received either 600 mg/d of vitamin E ( Ephynal , 300 mg tablets ; F. Hoffman-La Roche Ltd. , Basle , Switzerl and ) ( order A ) or identical placebo tablets ( order B ) for 3 months . Then after a 1-month wash-out period the patients were crossed-over to the other treatment . MAIN OUTCOME MEASURES Improvement in the in vitro function of the spermatozoa measured by conventional semen analysis , computerized motility assessment , determination of reactive oxygen species generation , binding to the zona pellucida of the unfertilized human oocyte in a competitive zona binding assay , development of hyperactivated motility ( both spontaneous and in the presence of 20 % of the natural agonist , human follicular fluid ) and pregnancy . RESULTS Rise in the blood serum vitamin E levels after treatment accompanied by improvement in one of the sperm function tests : the zona binding assay . The zona binding ratio for order A improved from 0.2 ( range 0 to 0.5 ) before treatment to 0.5 ( range 0.1 to 1.0 ) after treatment , the corresponding values for order B were 0.2 ( range 0 to 1.0 ) before treatment and 0.3 ( range 0.1 to 0.7 ) after treatment . CONCLUSION Oral administration of vitamin E significantly improves the in vitro function of human spermatozoa as assessed by the zona binding test OBJECTIVE To determine the effect of ascorbic acid supplementation on the sperm quality of heavy smokers . DESIGN Microscopic examination of semen for 1 month during supplementation with placebo or ascorbic acid at dose levels of 200 or 1,000 mg/d . SETTING Department of Obstetrics and Gynecology , The University of Texas Medical Branch . PARTICIPANTS Seventy-five men ( 20 to 35 years old ) r and omly divided into one of three supplementation groups : placebo , 200 mg and 1,000 mg of ascorbic acid . MAIN OUTCOME Improvement in sperm quality as compared with presupplementation levels and between the three treatment groups . RESULTS The placebo group showed no improvement in sperm quality . The groups receiving ascorbic acid showed improvement in sperm quality with most improvement in the 1,000-mg group . Pearson 's correlation showed statistically significant relationships between the weekly group means of serum and seminal plasma ascorbic acid levels and sperm qualities . CONCLUSIONS Ascorbic acid supplementation of heavy smokers in excess of 200 mg/d results in improved sperm quality We recently introduced reduced glutathione into the therapeutic protocol s in some selected cases of dyspermia .  This therapy improved semen quality both in a pilot follow-up study and in a double-blind cross-over trial . This improvement was seen in patients with varicocele and germ-free genital tract inflammation , two pathologies in which production of reactive oxygen species or other toxic compounds could have a pathogenic role . Polyunsaturated fatty acids of phospholipids play a major role in membrane constitution and function and are one of the main targets of the lipoperoxidative process . Therefore , to underst and the therapeutic action of reduced glutathione , we selected infertile patients and studied the modifications produced by the therapy in seminal parameters , biochemical sperm membrane parameters , and the pattern of fatty acids of phospholipids from blood serum and red blood cell membranes ( a model widely accepted as representative of general cell membrane status ) . The results showed an improvement in both sperm parameters and cell membrane characteristics . This study suggests that biochemical modifications in membrane constitution could explain the seminal results of glutathione therapy . On the other h and , it seems likely that only subjects with systemic membrane disturbances associated with and rological pathologies express this membrane damage in spermatozoa , result ing in dyspermia . This sperm alteration can be partially reversed by glutathione therapy if the structural cell membrane damage is not too severe AIM OF THE STUDY To evaluate with an open-label study the efficacy and safety of a complex of nutritional supplements with antioxidant activity ( L-carnitine , acetyl-L-carnitine , fructose , citric acid , selenium , coenzyme Q10 , zinc , ascorbic acid , cyanocobalamin , folic acid ) in primary infertile patients with idiopathic astenoteratozoospermia . METHODS The study was conducted in a population of 114 infertile men ( 96 completed the study ) diagnosed with idiopathic astenoteratozoospermia since at least 18 months . Patients orally received a formulation ( Proxeed - Sigma-Tau ) containing L-carnitine 145 mg , acetyl-L-carnitine 64 mg , fructose 250 mg , citric acid 50 mg , selenium 50 mcg , coenzyme Q10 20 mg , zinc 10 mg , ascorbic acid 90 mg , cyanocobalamin 1.5 mcg , folic acid 200 mcg in combination once a day for 4 months . RESULTS At the end of study , the mean sperm progressive motility showed a statistically significant increase from 18.3 + /- 3.8 to 42.1 + /- 5.5 . Sixteen patients achieved pregnancy during the study . No significant improvement were observed for sperm density and rate of morphologically normal forms . The treatment was well tolerated . CONCLUSIONS Carnitines in association with others functional substances can improve the most important parameters of sperm quality Purpose Surgical repair of varicocele has long been a procedure to correct spermatogenesis . However , the outcome has been reported to be inadequate . We combined varicocelectomy with supplement therapy to evaluate the concurrent effect of these procedures . Methods A prospect i ve r and omized controlled study was undertaken to investigate the effects of zinc sulfate , folic acid and zinc sulfate/folic acid on sperm quality , protamine content and acrosomal integrity following surgical repair of varicocele . Male subjects with palpable varicocele were included in the study and r and omized into four groups . Subjects received Zinc sulfate , Follic acid , Zinc sulfate/Follic acid or placebo for 6 months . A semen sample was obtained before surgery and 3 and 6 months after surgical repair . Semen sample s were evaluated for sperm parameters as well as chromatin content and acrosomal integrity . Results Most of the evaluated parameters showed a mild improvement after varicocelectomy in the placebo group . Interestingly , co-administration of Zinc sulfate and folic acid improved most factors significantly . Folic acid administration but not zinc sulfate could increase sperm number . Hence , Zinc sulfate was better than folic acid when change in morphology was assessed , and none of them was significantly effective in sperm motility . In Zinc sulfate and Follic acid groups , protamine content and halo formation rate significantly improved . Conclusions We may conclude that co-administration of zinc and folic acid significantly improved sperm parameters and increased varicocelectomy outcomes . So , medical treatment with compatible drugs after surgery might be advantageous for obtaining acceptable results The objective of this study was to detect a therapy for idiopathic and varicocele-associated oligoasthenospermia ( OAT ) . Idiopathic and varicocele OAT patients were r and omized into 3 groups . Each group was composed of varying degrees of left varicoceles ( grade d into 5 grade s with echo-color Doppler ) and of idiopathic OATs . Group 1 used a placebo , group 2 used oral L-carnitine ( 2 g/d ) + acetyl-L-carnitine ( 1 g/d ) , group 3 used L-carnitine/acetyl-L-carnitine + 1 x 30-mg cinnoxicam suppository every 4 days . Drugs were administered for 6 months . The groups were composed as follows : group 1 , 71 varicoceles and 47 idiopathic OATs ; group 2 , 62 varicoceles and 39 idiopathic OATs ; group 3 , 62 varicoceles and 44 idiopathic OATs .  Sperm concentration , motility , and morphology before during and after treatments were assessed . Pregnancy rates and side effects were recorded . Group 1 did not have modified sperm patterns during treatment . Group 2 had significantly increased sperm patterns at 3 and 6 months into therapy in idiopathic patients and in patients with grade s I , II , and III varicocele , but not in grade s IV and V. Group 3 had significantly increased sperm parameters in all patients , with the exception of grade V varicocele . Group 3 sperm patterns proved significantly higher during therapy than group 2 . All sperm patterns fell to baseline after therapy suspension . Minor side effects occurred . Pregnancy rates were 1.7 % ( group 1 ) , 21.8 % ( group 2 ) , and 38.0 % ( group 3 ) ( P < .01 ) . L-carnitine/acetyl-L-carnitine + cinnoxicam suppositories proved a reliable treatment for low- grade varicoceles and idiopathic OATs Sperm DNA fragmentation is known to compromise male fertility . Previous findings have suggested the implication of oxidative stress in the etiology of this pathological condition . The present study was conducted to find out if the pathologically increased incidence of DNA fragmentation in ejaculated spermatozoa can be reduced by oral treatment with two antioxidants , vitamins C and E.  Sixty-four men with unexplained infertility and an elevated ( > or = 15 % ) percentage of DNA-fragmented spermatozoa in the ejaculate were r and omized between an antioxidant treatment  ( 1 g vitamin C and 1 g  vitamin E daily for 2 months ) group and a  placebo group . Sperm DNA fragmentation was evaluated by terminal deoxyribonucleotidyl transferase-mediated dUTP nick-end labeling assay before and after treatment . No differences in basic sperm parameters were found between the antioxidant treatment and the placebo group before or after treatment . However , the percentage of DNA-fragmented spermatozoa was markedly reduced ( P < .001 ) in the antioxidant treatment group after the treatment ( 9.1 + /- 7.2 ) as compared with the pretreatment values ( 22.1 + /- 7.7 ) . No difference in the pretreatment and posttreatment incidence of sperm DNA fragmentation was observed in the placebo group . These data show that sperm DNA damage can be efficiently treated with oral antioxidants administered during a relatively short time period Peroxidative damage induced by reactive oxygen species ( ROS ) has been proposed as one of the major causes of defective 
    Output:
    
Although there is a wide variability in selected population , dose regimen and final outcomes , nutritional supplements both alone and in combination seems to be able to improve semen parameters ( sperm count , sperm motility and morphology ) and pregnancy rate in infertile men .
CONCLUSIONS There are rising evidence s from published r and omized trials and systematic review suggesting that nutritional supplementation may improve semen parameters and the likelihood of pregnancy in men affected by OAT .
This improvement , however , is not consistent and there is a wide variation in the treatment regimens used .