男性補充葉酸和鋅無益於治療不育症
作者：
小柯機器人發布時間：2020/1/13 14:11:50
補充葉酸和鋅對不孕不育夫婦精液質量和嬰兒活產的影響，這一成果由尤尼斯·甘迺迪·施賴弗國家兒童健康和人類發展研究所Sunni L. Mumford研究團隊取得。研究論文於2020年1月7日發表在《美國醫學會雜誌》上。
市面上為提高男性生育力的膳食補充劑通常含有葉酸和鋅，據說可提高精液質量。然而，還沒有大規模試驗來檢驗這種療法對改善精液質量或嬰兒活產的療效。
為了探討補充葉酸和鋅對精液質量和嬰兒活產的影響，2013年6月至2017年12月，研究組在美國4個生殖內分泌和不孕症治療研究中心進行了一項多中心、隨機、臨床試驗，共招募了2370對計劃進行不孕症治療的成年夫婦。研究組將男性按1：1隨機分組，其中1185例每天服用5mg葉酸和30mg元素鋅，1185例服用安慰劑，為期6個月。
2370名男性的平均年齡為33歲，其中有1773名（75%）接受了最終6個月的隨訪，1629名（69%）男性在治療結束後提供了精液。葉酸+鋅組的嬰兒活產率為34%，安慰劑組為35%，差異不顯著。
治療6個月後，兩組間的精子濃度、活力、形態、體積和活躍精子總數均無顯著差異，但葉酸+鋅組的精子DNA片段百分比為29.7%，顯著高於安慰劑組（27.2%）。葉酸+鋅組更容易發生胃腸道不良反應，其中腹部不適或疼痛的發生率為6%，噁心為4%，嘔吐為3%；安慰劑組則分別為3%、2%和1%。
綜上，對於不孕不育夫婦，與安慰劑相比，男性補充葉酸和鋅並未顯著改善精液質量或提高嬰兒活產率。該發現不支持男性補充葉酸和鋅來治療不育症。
附：英文原文
Title: Effect of Folic Acid and Zinc Supplementation in Men on Semen Quality and Live Birth Among Couples Undergoing Infertility Treatment: A Randomized Clinical Trial
Author: Enrique F. Schisterman, Lindsey A. Sjaarda, Traci Clemons, Douglas T. Carrell, Neil J. Perkins, Erica Johnstone, Denise Lamb, Kayla Chaney, Bradley J. Van Voorhis, Ginny Ryan, Karen Summers, Jim Hotaling, Jared Robins, James L. Mills, Pauline Mendola, Zhen Chen, Elizabeth A. DeVilbiss, C. Matthew Peterson, Sunni L. Mumford
Issue&Volume: 2020/01/07
Abstract:
Importance Dietary supplements marketed for male fertility commonly contain folic acid and zinc based on limited prior evidence for improving semen quality. However, no large-scale trial has examined the efficacy of this therapy for improving semen quality or live birth.
Objective To determine the effect of daily folic acid and zinc supplementation on semen quality and live birth.
Design, Setting, and Participants The Folic Acid and Zinc Supplementation Trial was a multicenter randomized clinical trial. Couples (n = 2370; men aged ≥18 years and women aged 18-45 years) planning infertility treatment were enrolled at 4 US reproductive endocrinology and infertility care study centers between June 2013 and December 2017. The last 6-month study visit for semen collection occurred during August 2018, with chart abstraction of live birth and pregnancy information completed during April 2019.
Interventions Men were block randomized by study center and planned infertility treatment (in vitro fertilization, other treatment at a study site, and other treatment at an outside clinic) to receive either 5 mg of folic acid and 30 mg of elemental zinc (n = 1185) or placebo (n = 1185) daily for 6 months.
Main Outcomes and Measures The co–primary outcomes were live birth (resulting from pregnancies occurring within 9 months of randomization) and semen quality parameters (sperm concentration, motility, morphology, volume, DNA fragmentation, and total motile sperm count) at 6 months after randomization.
Results Among 2370 men who were randomized (mean age, 33 years), 1773 (75%) attended the final 6-month study visit. Live birth outcomes were available for all couples, and 1629 men (69%) had semen available for analysis at 6 months after randomization. Live birth was not significantly different between treatment groups (404 [34%] in the folic acid and zinc group and 416 [35%] in the placebo group; risk difference, −0.9% [95% CI, −4.7% to 2.8%]). Most of the semen quality parameters (sperm concentration, motility, morphology, volume, and total motile sperm count) were not significantly different between treatment groups at 6 months after randomization. A statistically significant increase in DNA fragmentation was observed with folic acid and zinc supplementation (mean of 29.7% for percentage of DNA fragmentation in the folic acid and zinc group and 27.2% in the placebo group; mean difference, 2.4% [95% CI, 0.5% to 4.4%]). Gastrointestinal symptoms were more common with folic acid and zinc supplementation compared with placebo (abdominal discomfort or pain: 66 [6%] vs 40 [3%], respectively; nausea: 50 [4%] vs 24 [2%]; and vomiting: 32 [3%] vs 17 [1%]).
Conclusions and Relevance Among a general population of couples seeking infertility treatment, the use of folic acid and zinc supplementation by male partners, compared with placebo, did not significantly improve semen quality or couples』 live birth rates. These findings do not support the use of folic acid and zinc supplementation by male partners in the treatment of infertility.
DOI: 10.1001/jama.2019.18714
Source: https://jamanetwork.com/journals/jama/article-abstract/2758450