Differences in supplements tested, study duration and design, as well as the different interventions, populations, and measured outcomes make it extremely difficult to compare these trials. Several RCTs have tested the effect of food and nutrients on male fertility parameters. Such trials are considered the gold standard in terms of scientific evidence if the quality of design of the interventions and the execution of the trial are high, because they enable strong conclusions to be drawn and can be used for future clinical and public health recommendations. In addition to observational studies, which are important for creating new hypotheses, randomized clinical trials (RCTs) are also needed. Indeed, several observational studies that explored the associations between dietary patterns, food and nutrient consumption, and sperm quality suggest that adhering to a healthy diet (e.g., the Mediterranean diet) may improve male sperm quality parameters ( 3). Investigating modifiable lifestyle factors that influence human fertility-such as stress, drug use, smoking, alcohol intake, and diet-is of major clinical and public health importance for understanding the problem. Research aimed at revealing the causes and implications of this decline is therefore urgently needed. These data strongly suggest a significant decline in male reproductive health, with crucial implications for human reproduction and perpetuation of the species. In the case of male fertility, a recent meta-regression analysis reported a significant worldwide decline in total sperm counts between 19 ( 2). Infertility, which affects ∼15% of the world's population, is a global public health issue recognized by the WHO ( 1). The present study and the corresponding search protocol were registered at the PROSPERO registry at as CRD42017058380. However, results must be cautiously interpreted due to the limited sample size of the meta-analyzed studies and the considerable observed interstudy heterogeneity. This meta-analysis of RCTs suggests that some dietary supplements could beneficially modulate sperm quality parameters and affect male fertility. In total, 28 articles were included for qualitative analysis and 15 for quantitative meta-analysis. A systematic review and meta-analysis of randomized clinical trials (RCTs) from the MEDLINE-PubMed database was conducted to assess the effect of nutrients, dietary supplements, or food on sperm quality parameters. Therefore, it is of major clinical and public health importance to investigate whether modifiable lifestyle factors-such as stress, drug use, smoking, alcohol intake, and diet-may influence human fertility. Infertility, which affects ∼15% of the world's population, is a global public health issue recognized by the WHO.
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