Male oxidative stress infertility (MOSI): Proposed terminology and clinical practice guidelines for management of idiopathic male infertility

Ashok Agarwal, Neel Parekh, Manesh Kumar Panner Selvam, Ralf Henkel, Rupin Shah, Sheryl T. Homa, Ranjith Ramasamy, Edmund Ko, Kelton Tremellen, Sandro Esteves, Ahmad Majzoub, Juan G. Alvarez, David K. Gardner, Channa N. Jayasena, Jonathan W. Ramsay, Chak Lam Cho, Ramadan Saleh, Denny Sakkas, James M. Hotaling, Scott D. LundySarah Vij, Joel Marmar, Jaime Gosalvez, Edmund Sabanegh, Hyun Jun Park, Armand Zini, Parviz Kavoussi, Sava Micic, Ryan Smith, Gian Maria Busetto, Mustafa Emre Bakircioǧlu, Gerhard Haidl, Giancarlo Balercia, Nicolás Garrido Puchalt, Moncef Ben-Khalifa, Nicholas Tadros, Jackson Kirkman-Browne, Sergey Moskovtsev, Xuefeng Huang, Edson Borges, Daniel Franken, Natan Bar-Chama, Yoshiharu Morimoto, Kazuhisa Tomita, Vasan Satya Srini, Willem Ombelet, Elisabetta Baldi, Monica Muratori, Yasushi Yumura, Sandro La Vignera, Raghavender Kosgi, Marlon P. Martinez, Donald P. Evenson, Daniel Suslik Zylbersztejn, Matheus Roque, Marcello Cocuzza, Marcelo Vieira, Assaf Ben-Meir, Raoul Orvieto, Eliahu Levitas, Amir Wiser, Mohamed Arafa, Vineet Malhotra, Sijo Joseph Parekattil, Haitham Elbardisi, Luiz Carvalho, Rima Dada, Christophe Sifer, Pankaj Talwar, Ahmet Gudeloglu, Ahmed M.A. Mahmoud, Khaled Terras, Chadi Yazbeck, Bojanic Nebojsa, Damayanthi Durairajanayagam, Ajina Mounir, Linda G. Kahn, Saradha Baskaran, Rishma Dhillon Pai, Donatella Paoli, Kristian Leisegang, Mohamed Reza Moein, Sonia Malik, Onder Yaman, Luna Samanta, Fouad Bayane, Sunil K. Jindal, Muammer Kendirci, Baris Altay, Dragoljub Perovic, Avi Harlev

Research output: Contribution to journalReview articlepeer-review

251 Scopus citations


Despite advances in the field of male reproductive health, idiopathic male infertility, in which a man has altered semen characteristics without an identifiable cause and there is no female factor infertility, remains a challenging condition to diagnose and manage. Increasing evidence suggests that oxidative stress (OS) plays an independent role in the etiology of male infertility, with 30% to 80% of infertile men having elevated seminal reactive oxygen species levels. OS can negatively affect fertility via a number of pathways, including interference with capacitation and possible damage to sperm membrane and DNA, which may impair the sperm's potential to fertilize an egg and develop into a healthy embryo. Adequate evaluation of male reproductive potential should therefore include an assessment of sperm OS. We propose the term Male Oxidative Stress Infertility, or MOSI, as a novel descriptor for infertile men with abnormal semen characteristics and OS, including many patients who were previously classified as having idiopathic male infertility. Oxidation-reduction potential (ORP) can be a useful clinical biomarker for the classification of MOSI, as it takes into account the levels of both oxidants and reductants (antioxidants). Current treatment protocols for OS, including the use of antioxidants, are not evidence-based and have the potential for complications and increased healthcare-related expenditures. Utilizing an easy, reproducible, and cost-effective test to measure ORP may provide a more targeted, reliable approach for administering antioxidant therapy while minimizing the risk of antioxidant overdose. With the increasing awareness and understanding of MOSI as a distinct male infertility diagnosis, future research endeavors can facilitate the development of evidence-based treatments that target its underlying cause.

Original languageEnglish
Pages (from-to)296-312
Number of pages17
JournalWorld Journal of Men?s Health
Issue number3
StatePublished - 1 Jan 2019
Externally publishedYes


  • Infertility, male
  • MOSI
  • Oxidation reduction potential
  • Oxidative stress
  • Semen

ASJC Scopus subject areas

  • Reproductive Medicine
  • Aging
  • Health Policy
  • Public Health, Environmental and Occupational Health
  • Psychiatry and Mental health
  • Urology
  • Pharmacology (medical)


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