This randomized, placebo-controlled pilot study aims to evaluate the effects of probiotic supplementation on sperm quality in male patients diagnosed with infertility. Male infertility accounts for approximately 40% of all infertility cases and is closely related to abnormalities in sperm count, motility, and morphology. Factors such as oxidative stress, inflammation, and DNA fragmentation are known to impact sperm function and subsequent fertilization potential negatively.

Probiotics are microorganisms that confer health benefits by improving the intestinal microenvironment and regulating immunity. Emerging research suggests that probiotics may reduce oxidative stress and DNA fragmentation in men with asthenozoospermia; however, clinical data on human sperm remains limited. This study seeks to determine whether specific probiotic strains can improve sperm parameters and function in patients with unexplained oligozoospermia, asthenozoospermia, or oligoasthenoteratozoospermia.

The study will enroll 60 male participants aged 20 to 45 who meet specific inclusion criteria, including a sperm concentration of less than 50 million/mL, motility less than 40%, and normal morphology (Kruger) less than 4%. Participants will be randomly assigned to either an experimental group receiving probiotics or a control group receiving a placebo for approximately 100 days.

Semen samples will be collected and analyzed at three time points: before the intervention (Day 0), during the intervention (Day 60), and at the end of the study (Day 100). The primary objective is to assess changes in sperm concentration, motility, and morphology using the Computer-Aided Sperm Analysis (CASA) system. Secondary objectives include evaluating sperm DNA integrity using the Sperm Chromatin Structure Assay (SCSA) by flow cytometry and assessing sperm function via the acrosome reaction assay. The results of this pilot study will help determine the potential therapeutic role of probiotics in the management of male infertility.

Content: Male infertility accounts for approximately 40% of infertility cases and is often characterized by abnormalities in sperm count, motility, and morphology. Factors such as oxidative stress, environmental hormones, and inflammation can lead to sperm DNA fragmentation and mitochondrial dysfunction, ultimately affecting fertilization potential. While probiotics are known to improve gut microbiome balance and regulate immunity, limited studies suggest they may also improve sperm motility and reduce DNA fragmentation in men with asthenozoospermia.

This pilot study employs a randomized, placebo-controlled design to evaluate the efficacy of probiotic supplementation in improving sperm quality. A total of 60 male participants with unexplained infertility (specifically oligozoospermia, asthenozoospermia, or oligoasthenoteratozoospermia) will be recruited. Participants will be divided into two groups: an experimental group receiving probiotics and a control group receiving a placebo.

The study duration for each participant is approximately 100 days, with semen samples collected at three distinct time points:

1. Day 0 (Start Test): Baseline sample collection.
2. Day 60 (Mid Test): Interim sample collection.
3. Day 100 (Final Test): Post-intervention sample collection.

Semen analysis will be conducted using the following methodologies:

• Sperm Concentration and Motility: Analyzed using a Computer-Aided Sperm Assay (CASA) to measure parameters including total motility, progressive motility, VAP, VCL, VSL, Straightness, and Linearity.
• Sperm DNA Integrity: Assessed via the Sperm Chromatin Structure Assay (SCSA) using flow cytometry. Sperm are treated with acridine orange; red fluorescence indicates single-stranded DNA (fragmentation), while green fluorescence indicates double-stranded DNA. Results are expressed as the DNA Fragmentation Index (DFI).

Sperm Function (Acrosome Reaction): Evaluated using Peanut Agglutinin (PNA) staining. The assay determines the percentage of sperm capable of undergoing the acrosome reaction, a necessary step for fertilization.

Inclusion Criteria

• Gender: Male.

• Age: 20 to 45 years old.

• Diagnosis: Diagnosed with unexplained oligozoospermia, asthenozoospermia, or oligoasthenoteratozoospermia.

• Semen Parameters:

  • Sperm concentration < 5×106/mL (Note: Source indicates "5x10/mL", contextually adjusted to standard unit for oligozoospermia).

  • Sperm motility < 40%.

  • Sperm morphology (Kruger strict criteria) < 4%. Exclusion Criteria

    1. History of hormonal disorders or epididymo-orchitis.
    2. Substance abuse, including drugs or excessive alcohol consumption.
    3. Diabetes mellitus.
    4. Kidney disease (defined as a doubling of creatinine levels or more).
    5. Chronic liver disease.
    6. Varicocele.
    7. Current use of medications that interfere with hormones.
    8. Occupational or environmental exposure to pesticides, heavy metals, or solvents.
    9. Intake of antioxidant supplements within the past three months.
    10. Body Mass Index (BMI) of 30 kg/m² or higher.

Inclusion Criteria:

• Males aged 20 to 45 years
• Diagnosis of unexplained oligozoospermia, asthenozoospermia, or oligoasthenoteratozoospermia
• Sperm concentration < 5 x 10^6/mL
• Sperm total motility < 40%
• Sperm morphology (Kruger strict criteria) < 4%

Exclusion Criteria:

• History of hormonal disorders or epididymo-orchitis
• Substance abuse, including drugs or excessive alcohol consumption
• Diabetes mellitus
• Kidney disease (defined as a doubling of creatinine levels or more)
• Chronic liver disease
• Varicocele
• Current use of medications that interfere with hormones
• Occupational or environmental exposure to pesticides, heavy metals, or solvents
• Intake of antioxidant supplements within the past three months
• Body Mass Index (BMI) of 30 kg/m^2 or higher

The control group receives a placebo identical in dosage form and appearance to the probiotic supplement, to ensure masking of participants and investigators.