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Article

Pentoxifylline Enhances Sperm Quality, Reduces Oxidative Stress in Semen, and Decreases Sperm DNA Damage in Men with Asthenozoospermia Undergoing Assisted Reproductive Technology

by
Oumaima Ammar
1,2,*,
Marwa Ben Ali Gannoun
1,3,
Tesnim Ajina
1,
Assila Hadj Ali
1,
Manel Boussabbeh
1,
Amira Sallem
1,3,
Zohra Haouas
1,
Mariarosaria Di Tommaso
2 and
Meriem Mehdi
1,3
1
Faculty of Medicine, Department of Histology, Embryology and Cytogenetics (LR 18 ES 40), University of Monastir, Monastir 5019, Tunisia
2
Department of Health Sciences, Division of Obstetrics and Gynecology, University of Florence, 50134 Florence, Italy
3
Laboratory of Cytogenetics and Reproductive Biology, Fattouma, Bourguiba University Teaching Hospital, Monastir 5019, Tunisia
*
Author to whom correspondence should be addressed.
Oxygen 2025, 5(2), 8; https://doi.org/10.3390/oxygen5020008
Submission received: 10 April 2025 / Revised: 17 May 2025 / Accepted: 21 May 2025 / Published: 31 May 2025
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Abstract

Oxidative stress (OS) contributes to poor sperm parameters and increased sperm DNA fragmentation (sDF), yet effective therapeutic strategies remain limited. This study aimed to evaluate the in vitro efficacy of pentoxifylline (PTX) in improving sperm motility and reducing OS and sDF in men with isolated asthenozoospermia. Thirty semen samples from patients with asthenozoospermia were processed using density gradient centrifugation. Each sample was divided into two aliquots: one treated with PTX at a dose of 3.6 mM and the other without PTX treatment. The sperm viability and motility were assessed at 30 min, 1 h, 2 h, and 24 h post-treatment. OS was evaluated using nitro blue tetrazolium staining and a chemiluminescence assay. sDF was assessed using the alkaline Comet assay. The sperm samples treated with PTX, compared to the controls, exhibited a significant increase in total sperm motility (71.8 ± 23.03% versus 47.47 ± 4.88%, respectively; p < 0.0001). However, no significant difference was observed in the sperm viability. PTX treatment significantly reduced ROS production and sDF levels compared to controls (p < 0.01). These findings suggest that in vitro PTX supplementation enhances sperm motility and reduces the nuclear sperm injury associated with seminal ROS production. Therefore, PTX supplementation in vitro may be beneficial in assisted reproductive technology procedures involving men with asthenozoospermia.

1. Introduction

According to the World Health Organization (WHO), infertility is defined as the inability of a couple to conceive or give birth to a child after one year of regular, unprotected sexual intercourse without contraception [1]. Infertility affects 15–20% of couples of reproductive age, with male factors contributing to nearly 50% of these cases [2,3]. Male infertility is a complex, multifactorial condition with a wide range of phenotypes, including azoospermia, oligospermia, asthenospermia, and abnormal sperm morphology, often caused by low sperm motility, count, or both [4]. Oxidative stress (OS) has emerged as a key contributor to male infertility, particularly through its impact on sperm function and DNA integrity [5,6]. While physiological levels of reactive oxygen species (ROS) are necessary for processes like capacitation and the acrosome reaction, excessive ROS can overwhelm spermatozoa’s limited antioxidant defenses, leading to membrane damage, lipid peroxidation, and DNA fragmentation.
Idiopathic male infertility, which includes cases with abnormal semen parameters but no identifiable underlying cause, as well as those with normal semen profiles but unexplained infertility, is increasingly linked to elevated OS. In such cases, antioxidant strategies have been proposed to counteract OS-induced sperm dysfunction. However, the indiscriminate use of antioxidants may pose risks, such as reductive stress, which can adversely affect sperm function [7]. Therefore, targeted in vitro approaches may provide safer and more individualized options for improving sperm quality.
Recent advances in assisted reproductive technologies (ARTs) have improved our understanding of sperm physiology and highlighted the importance of sperm genomic integrity in achieving successful fertilization and embryo development. In this context, improving sperm quality in vitro has become a critical area of research. Various agents have been explored for their capacity to enhance sperm function, including biological fluids and pharmacologic compounds. Among these, pentoxifylline (PTX), a methylxanthine derivative and non-specific phosphodiesterase inhibitor, has shown promise [8].
PTX is a methylxanthine derivative, structurally similar to caffeine. By inhibiting phosphodiesterase, PTX increases the intracellular cyclic adenosine monophosphate (cAMP) levels, a key regulator of sperm motility, through the protein phosphorylation cascades involved in flagellar movement [9,10].
PTX has been widely used in ARTs to stimulate immotile testicular and ejaculated sperm, and improve motility and fertilization outcomes [11,12,13,14]. However, its clinical utility remains debated. While some studies have found no effect when PTX was added to normozoospermic samples [14,15], others have reported significant improvements in the progressive sperm motility in the patients with asthenozoospermia and/or oligoasthenospermia [15,16,17].
Notably, few studies have explored the effects of PTX on sperm DNA fragmentation (sDF), a critical marker of sperm quality and embryo viability, alongside ROS production following sperm preparation. Our study addresses this gap as we assessed the in vitro effects of PTX on conventional sperm parameters (motility, viability), OS, and DNA integrity after the sperm selection via density gradient centrifugation (DGC). Furthermore, we examined the correlation between the ROS levels, sDF, and sperm motility to better understand PTX’s therapeutic potential and underlying mechanisms.

2. Materials and Methods

2.1. Study Population

Semen samples (n = 30) were obtained from patients attending the infertility consulting clinic at the Department of Cytogenetic and Reproductive Biology, Fattouma Bourguiba University Teaching Hospital, Monastir, Tunisia.
The participants were diagnosed with isolated asthenozoospermia without identifiable causes, defined as total sperm motility < 40% or progressive motility < 32%, with normal sperm concentration and morphology based on the WHO 2010 guidelines [18].
Strict inclusion and exclusion criteria were applied to reduce confounding factors. Men with clinical varicocele, leukocytospermia, chronic illness, history of radiotherapy or chemotherapy, ongoing medication use, or known lifestyle risk factors (e.g., excessive alcohol intake or smoking) were excluded. All the participants were aged 27–46 years and had 3–5 days of sexual abstinence before sample collection.
However, comprehensive lifestyle and environmental data (e.g., occupation, diet, smoking) were not systematically recorded.
The study protocol was approved by the local ethics committee, and written informed consent was obtained from all the participants. A detailed summary of the demographic and clinical characteristics is provided in the updated Table 1.

2.2. Preparation of Pentoxifylline

A stock solution of 30 mg mL−1 PTX (Sigma Chemical Co., St. Louis, MO, USA) was prepared in the RPMI buffer (GIBCO, Grand Island, NY, USA) and then kept refrigerated between 1–6 °C until used. From this stock solution, PTX was diluted to obtain a working solution of 2 mg mL. Then, 100 µL of the working solution was added to a similar volume of the sperm suspension in each test tube to achieve a final concentration (3.6 mM) as reported by [19].

2.3. Preparation and Incubation of Spermatozoa

All the semen samples were collected by masturbation after 3–5 days of abstinence and allowed to liquefy at room temperature. Standard semen parameters were evaluated according to the WHO (2010) guidelines. A morphological assessment followed the modified DAVID classification [20].
The sperm samples were prepared with a 40% density top layer and an 80% density lower layer of SilSelect (FertiPro N.V., Beernem, Belgium) in a test tube by layering 1 mL of 40% over 1 mL of 80% density-gradient medium. The semen sample was placed above the density-gradient media and centrifuged at 1100 rpm for 10 min. Most of the supernatant was removed, and the sperm pellet was washed twice with the supplemented Roswell Park Memorial Institute’s (RPMIs) medium by centrifugation at 2000 rpm for 10 min.
The final pellet was resuspended in an appropriate volume of RPMI, and the suspension was divided into two equal parts, which were subdivided into aliquots of 100 µL.
Each aliquot was then divided into two: one was not treated with PTX, and the other was incubated with an equal volume of the PTX solution in 5% CO2 at 37 °C for several time intervals. Sperm motility and viability were compared among the groups at 30 min, 1 h, 2 h, and 24 h. In addition, a part of the sample is frozen at −20°C for the assessment of sDF and OS.

2.4. Sperm Motility Assessment

Total sperm motility was determined after 30 min, one hour, two hours, and 24 h of treatment with PTX. Motility was expressed as the percentage of progressive and non-progressive spermatozoa by following the guidelines of the WHO 2010.

2.5. Sperm Viability Studies

Viability was determined after 30 min, one hour, two hours, and 24 h of treatment with PTX. Sperm viability was evaluated by the Eosin-Nigrosin test (RAL DIAGNOSTIC). The percentage of dead spermatozoa was determined after assessing a total of 200 spermatozoa for each semen sample.

2.6. Measurement of Sperm ROS Production: Nitro Blue Tetrazolium Staining

ROS production was assessed using a modified colorimetric NBT assay [21]. Sperm samples were incubated with 0.01% NBT at 37 °C for 45 min, washed, centrifuged, and smeared on slides. Slides were stained with Giemsa and examined under a light microscope. A total of 200 sperm cells per slide were evaluated.

2.7. Measurement of Sperm ROS Production: Chemiluminescence Assay

To quantify ROS, a chemiluminescent NBT-based method was also used. After incubation with NBT, sperm samples were centrifuged and washed. Formazan crystals were solubilized with 60 μL of 2 M KOH and 60 μL DMSO. Then, 100 μL of the solution was transferred to a 96-well microplate. Absorbance was read at 630 nm using a microplate reader (Biotek Instruments, Stevens Creek Blvd, Santa Clara, CA, USA) [22].

2.8. Assessment of DNA Fragmentation by the Comet Assay

The alkaline Comet assay was used to evaluate DNA strand breaks as described by Ammar et al. [23]. Semen was embedded in 0.7% low-melting-point agarose, placed on pre-coated slides, and processed through lysis, electrophoresis, and ethidium bromide staining. DNA fragmentation levels were classified into four Comet classes (I–IV), representing increasing levels of DNA damage.

2.9. Statistical Analyses

Statistical analyses were performed using SPSS version 21.0 (SPSS Inc., Chicago, IL, USA). Data are presented as mean ± standard deviation (SD) for normally distributed variables or median with interquartile range (IQR) for non-normally distributed data. Normality of distribution was assessed using the Kolmogorov–Smirnov test.
For comparison between PTX-treated and untreated aliquots of the same sample, the paired t-test was applied for normally distributed variables, and the Wilcoxon signed-rank test was used otherwise. In analyses involving multiple incubation time points (e.g., for the sperm viability), one-way ANOVA followed by Tukey’s post-hoc test were used to detect within-group differences.
Correlations between the oxidative stress markers and sperm DNA fragmentation were evaluated using Spearman’s rank correlation coefficient. A p-value < 0.05 was considered statistically significant, and p < 0.01 was considered highly significant.

3. Results

3.1. Effect of PTX on Sperm Motility

Table 2 shows the differences in the average values of the total sperm motility percentage between the treated samples with PTX (3, 6 mM) and the untreated samples. We have found that PTX increases the total motility of spermatozoa. An optimal effect is observed at 30 min of incubation with PTX (71.8% ± 23.03) as compared to controls (47.47% ± 4.88), p < 0.0001. Also, we detected a marginal difference at one hour and two hours of incubation with PTX, but these differences were not significant (p > 0.05).

3.2. Effects of PTX on Sperm Viability

As shown in Figure 1, we have noticed a marginal and non-significant improvement in the sperm viability after 30 min of incubation with PTX (p > 0.05). In addition, after one hour, two hours, and 24 h of incubation with PTX, the percentage of the viability decreased (p > 0.05).

3.3. Effects of PTX on Sperm ROS Production

  • By using a colorimetric nitro blue tetrazolium (NBT) test
After NBT staining, we have shown a higher level of ROS, as presented by the percentage of spermatozoa producing the superoxide anion (O2−.), in the untreated group compared to the treated one with PTX for 30 min (68.9% ± 12 versus 47.16% ± 15.14, respectively), with statistically significant differences between the two groups (p = 0.027).
  • By using a chemiluminescent assay
The comparison of the averages of the formazan production has shown a significant decrease in the treated samples compared to the untreated samples, respectively (23 µg/mL ± 5.07 versus 59.53 µg/mL ± 10.38) with p < 0.01 (Figure 2B).

3.4. Effects of PTX In Vitro on Sperm DNA Integrity

Table 3 summarizes the effects of PTX on sDF. We have shown that the untreated and treated samples have a high level of sDF, as represented by a decreased Comet class I value (25.11% ± 8.98). After treatment with PTX, we have found a significant decrease in sDF, as represented by a high value of Comet class I (42.29% ± 6.6), and a decreased value of Comet class III and class IV when compared to the PTX-untreated group (11.48% ± 8.3 versus 20.9% ± 11.2 and 2.61 ± 1.9% versus 4.9% ± 2.8, respectively).

3.5. Correlations Between ROS Production with Semen Parameters and sDF

The correlation between the spermatic parameters and sDF with sperm ROS production, as assessed in all the semen samples of the patients with asthenozoospermia, was also investigated in this study and presented in Table 4. The untreated group has shown significant correlations between ROS overproduction and both impaired sperm motility and sperm DNA integrity (p < 0.005). However, following PTX treatment, significant correlations were observed between ROS production, improved motility, and reduced sDF (p < 0.005). However, we have not noticed a significant correlation between the generation of ROS and the viability in the treated group (p = 0.071) (Table 4).

4. Discussion

Asthenozoospermia is one of the major causes of male infertility, especially in moderate to severe cases, and is known to negatively impact pregnancy outcomes in ARTs [24]. Consequently, improving the sperm fertilization potential through pharmacological or in vitro strategies has become a focus of many studies [25,26]. Among the agents investigated, PTX has shown potential for improving sperm motility and function.
PTX’s beneficial effects on sperm kinematics, including velocity and hyperactivation, has been observed in both fresh [8,12,15] and cryopreserved sperm samples [14,15]. However, its precise mechanism of action remains incompletely understood.
To our knowledge, this is the first study to investigate the in vitro effects of PTX on motility, OS, and sDF in spermatozoa selected by DGC. Our findings have shown that PTX significantly enhances total motility after 30 min of incubation, which is consistent with earlier reports by Nassar et al. [12] and McKinney et al. [17]. The stimulating effect on motility after 30 min can be attributed to the increase in intracellular levels of cAMP, which plays a key role in sperm motility [27]. PTX is a phosphodiesterase inhibitor of the methylxanthine group. It inhibits the degradation of cAMP, and the cAMP, in turn, will stimulate a dependent kinase, which itself induces the phosphorylation of a protein present in the tail of the spermatozoa [28]. This generates endogenous adenosine triphosphate (ATP) production that influences the sperm motion characteristics, with, as a consequence, an improvement in motility. However, this stimulatory effect diminished after 60 min, and no further improvement was observed at longer incubation times. These findings suggest that PTX’s motility-enhancing effects are time-dependent, with short incubation offering the most benefit, which is a relevant consideration for clinical semen preparation.
Although PTX has been shown in some studies to affect sperm viability, our results did not reveal any significant changes. These results are in disagreement with Ghasemzadeh et al. [29], which proves that 200 μg/mL of PTX at different times of treatment (45 min, 24 h, 36 h, and 48 h) significantly increased the vitality rate of sperms in infertile men suffering from oligoasthenozoospermia. This may be partly due to the method used, eosin-nigrosin staining, which, while widely used, may lack sensitivity compared to Annexin V-based assays. Previous reports, including that by Kemal et al. [30], highlight the variability in the viability results depending on the technique used. This variability suggests that our observed lack of changes in the viability might reflect the methodological limitations rather than a true absence of effect.
Since PTX was effective only after 30 min of incubation, and a short time for semen preparation is very important for semen undergoing ARTs, we have decided to continue the study by investigating its effects on OS and sDF.
Importantly, we observed a significant reduction in the ROS levels after PTX treatment, supporting its antioxidant effect. This aligns with earlier findings by Okada et al. [27] and Aliabadi et al. [31], who also noted reduced ROS generation following PTX exposure. Our data also show a significant reduction in sDF following PTX incubation, especially at the 30-min time point, indicating that PTX’s protective effects extend to the sperm genome.
A positive correlation between the ROS levels and sDF was also established in our study, which supports the widely accepted role of oxidative stress in promoting the DNA fragmentation in spermatozoa [6,7,23]. Given the limited capacity of spermatozoa to repair DNA damage due to their transcriptionally silent state, strategies that reduce ROS may play a crucial role in improving the sperm’s genomic qualities. PTX, therefore, may mitigate oxidative DNA damage by reducing free radical formation and enhancing the antioxidant milieu of the semen.
While antioxidants like PTX can offer therapeutic benefits, it is important to acknowledge the potential risks of reductive stress, a condition resulting from the over-suppression of ROS, which may impair sperm function. This underscores the value of the targeted, short-duration in vitro antioxidant application as a safer alternative to chronic systemic supplementation [32].
It is also worth noting that sperm motility naturally declines post-ejaculation, which may partly explain the reduced efficacy of PTX at later time points. This highlights the practical importance of optimizing the incubation time during the semen preparation protocols [11].
Despite improvements in sperm function, a direct link between antioxidant treatments and live birth rates remains unproven. Our findings reinforce the need for future clinical studies focusing on ART outcomes, including fertilization rates, embryo quality, and pregnancy rates.
Finally, this study has limitations. The relatively small sample size, strict inclusion and exclusion criteria, lack of comparison with other antioxidants (e.g., vitamin C or E), absence of dose–response assessment, and reliance on certain staining techniques limit the generalizability of our results.

5. Conclusions

To conclude, our findings suggest that the in vitro supplementation with PTX improves the total sperm motility, reduces ROS production, and lowers sDF in asthenozoospermic men undergoing ARTs. These effects appear to be time-sensitive, with the maximum benefit observed at 30 min of incubation.
PTX may provide a valuable tool in ART laboratories for improving sperm quality before fertilization. However, the optimal dosing, duration, and comparative effectiveness against other antioxidants remain to be explored. Further research, particularly studies linked to clinical outcomes, such as fertilization and live birth, are essential to clarify the role of PTX and its mechanisms in male infertility treatment.

Author Contributions

O.A.; conceptualization, methodology, formal analysis, writing original draft, writing review, and editing. M.B.A.G.; methodology, formal analysis, writing the original draft. T.A., A.H.A., M.B. and A.S.; methodology, formal analysis. Z.H.; methodology, validation, funding acquisition. M.D.T.; validation and supervision. M.M.; validation, investigation, supervision, funding acquisition. All authors have read and agreed to the published version of the manuscript.

Funding

This work was supported by funds allocated to the Research Laboratory of Histology and Genetics LR18/ES40 by the Tunisian Ministry of Higher Education and Scientific Research.

Institutional Review Board Statement

The protocol and methods were approved by the local institutional ethics committee, “The Medical Ethics and Research Committee of Farhat Hachad, Sousse, University Teaching Hospital,” date: 15 October 2019 (Tunisia).

Informed Consent Statement

Informed and written consent was obtained from all the subjects involved in the study.

Data Availability Statement

The original contributions presented in this study are included in the article. Further inquiries can be directed to the corresponding author.

Acknowledgments

The authors thank all the couples, doctors, and researchers for their cooperation. We also thank our clinical research team in the reproductive biology and human cytogenetic laboratory for their support.

Conflicts of Interest

The authors declare that they have no conflicts of interest.

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Figure 1. Variation of sperm viability over time between the treated and the non-treated groups with PTX (3.6 mM/30min/1 h, 2 h, and 24 h/n=30).
Figure 1. Variation of sperm viability over time between the treated and the non-treated groups with PTX (3.6 mM/30min/1 h, 2 h, and 24 h/n=30).
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Figure 2. Variation of sperm ROS production as revealed by the nitroblue tetrazolium (NBT) staining test (A) and the chemiluminescence assay (B) between the treated and the non-treated groups with PTX (3.6 mM/30 min/n = 30) * (p < 0.01).
Figure 2. Variation of sperm ROS production as revealed by the nitroblue tetrazolium (NBT) staining test (A) and the chemiluminescence assay (B) between the treated and the non-treated groups with PTX (3.6 mM/30 min/n = 30) * (p < 0.01).
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Table 1. Standard semen parameters of the studied population of men with asthenozoospermia.
Table 1. Standard semen parameters of the studied population of men with asthenozoospermia.
Patients with asthenozoospermia
N = 30		Standard Semen ParametersMean ± SD
Age34 ± 4.75
BMI28.4 ± 4.95
Volume (mL)3.45 ± 1.73
Concentration (106/mL)39.47 ± 15.45
Total motility (%)25.55 ± 8.27
Normal morphology (%)18.56 ± 2.91
Leucocyte concentration (106/mL)0.47 ± 0.01
Sperm vitality (%)75.66 ± 10.35
Sperm parameters are expressed as mean ± SD.
Table 2. Effects of PTX (3.6 mM/30 min, 1 h, 2 h, and 24 h/n = 30) on the percentage of total sperm motility.
Table 2. Effects of PTX (3.6 mM/30 min, 1 h, 2 h, and 24 h/n = 30) on the percentage of total sperm motility.
Total Motility (%)Time Intervals
030 min1 h2 h24 h
PTX-untreated53 ± 11.4447.47 ± 4.8846 ± 10.738 ± 9.0817.06 ± 7.6
PTX-treated68 ± 5.571.8 ± 23.0355 ± 542 ± 10.117 ± 5.09
p value<0.01<0.0001>0.05>0.05>0.05
All values are expressed as mean ± standard deviation and analyzed using the paired t-test. p < 0.05, significant differences within the control group, p < 0.01, highly significant differences within the control group.
Table 3. Effects of PTX (3.6 mM/30 min/n = 30) on the percentage of sDF as evaluated by Comet assay.
Table 3. Effects of PTX (3.6 mM/30 min/n = 30) on the percentage of sDF as evaluated by Comet assay.
%PTX-UntreatedPTX-Treatedp Value
Comet I25.11 ± 8.9842.29 ± 6.6<0.001
Comet II49.07 ± 5.5143.62 ± 3.1>0.05
Comet III20.9 ± 11.211.48 ± 8.3<0.001
Comet IV4.9 ± 2.82.61 ± 1.90.006
All values are expressed as mean ± standard deviation and analyzed using the paired t-test. p < 0.01, highly significant difference with the control group.
Table 4. Correlations between the spermatic parameters and sDF with the level of sperm ROS production evaluated by a chemiluminescence assay.
Table 4. Correlations between the spermatic parameters and sDF with the level of sperm ROS production evaluated by a chemiluminescence assay.
Semen ParametersSperm ROS Production
PTX-UntreatedPTX-Treated
Sperm motility (%)r = −0.479; p = 0.002r = 0.315; p = 0.0164
Sperm viability (%)r = −0.104; p = 0.4357r = 0.237; p = 0.0716
sDF (%) (Comet class IV)r = 0.536; p = 0.0001r = −0.104; p = 0.0125
Statistical analyses were performed using the Spearman rank-order correlation test. p < 0.05; significant correlation; p < 0.01, highly significant correlation.
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Ammar, O.; Ben Ali Gannoun, M.; Ajina, T.; Hadj Ali, A.; Boussabbeh, M.; Sallem, A.; Haouas, Z.; Di Tommaso, M.; Mehdi, M. Pentoxifylline Enhances Sperm Quality, Reduces Oxidative Stress in Semen, and Decreases Sperm DNA Damage in Men with Asthenozoospermia Undergoing Assisted Reproductive Technology. Oxygen 2025, 5, 8. https://doi.org/10.3390/oxygen5020008

AMA Style

Ammar O, Ben Ali Gannoun M, Ajina T, Hadj Ali A, Boussabbeh M, Sallem A, Haouas Z, Di Tommaso M, Mehdi M. Pentoxifylline Enhances Sperm Quality, Reduces Oxidative Stress in Semen, and Decreases Sperm DNA Damage in Men with Asthenozoospermia Undergoing Assisted Reproductive Technology. Oxygen. 2025; 5(2):8. https://doi.org/10.3390/oxygen5020008

Chicago/Turabian Style

Ammar, Oumaima, Marwa Ben Ali Gannoun, Tesnim Ajina, Assila Hadj Ali, Manel Boussabbeh, Amira Sallem, Zohra Haouas, Mariarosaria Di Tommaso, and Meriem Mehdi. 2025. "Pentoxifylline Enhances Sperm Quality, Reduces Oxidative Stress in Semen, and Decreases Sperm DNA Damage in Men with Asthenozoospermia Undergoing Assisted Reproductive Technology" Oxygen 5, no. 2: 8. https://doi.org/10.3390/oxygen5020008

APA Style

Ammar, O., Ben Ali Gannoun, M., Ajina, T., Hadj Ali, A., Boussabbeh, M., Sallem, A., Haouas, Z., Di Tommaso, M., & Mehdi, M. (2025). Pentoxifylline Enhances Sperm Quality, Reduces Oxidative Stress in Semen, and Decreases Sperm DNA Damage in Men with Asthenozoospermia Undergoing Assisted Reproductive Technology. Oxygen, 5(2), 8. https://doi.org/10.3390/oxygen5020008

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