Effects of metformin and glutathione alone and in coformulation with other compounds on reproductive health and fertility in diabetic male rodents: A systematic review

Razia Sardar , Fatima Sardar , Nor-Ashikin Mohamed Noor Khan , Fathiah Abdullah , Yuhaniza Shafinie Kamsani

Asian Pacific Journal of Reproduction ›› 2026, Vol. 15 ›› Issue (2) : 57 -66.

PDF (356KB)
Asian Pacific Journal of Reproduction ›› 2026, Vol. 15 ›› Issue (2) :57 -66. DOI: 10.4103/apjr.apjr_154_25
Review Article
research-article
Effects of metformin and glutathione alone and in coformulation with other compounds on reproductive health and fertility in diabetic male rodents: A systematic review
Author information +
History +
PDF (356KB)

Abstract

Objective: To systematically review the effects of administering metformin and glutathione alone and in coformulation with other compounds on the fertility and reproductive health of diabetic male rodents.

Methods: The guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) were followed to conduct this systematic review. Studies published until August 2024 in PubMed, Web of Science, and Scopus databases were searched, identified, screened, and selected for a detailed review. The keywords included metformin, diabetes, reproduction, glutathione, and rodent models.

Results: A total of 166 studies were identified, of which 11 met the inclusion criteria and were included in the qualitative synthesis. One additional study was identified through snowballing and citation tracking, bringing the total to 12 studies. The findings indicate that metformin and glutathione, administered alone or in combination with other compounds, improved sperm count, motility, and morphology; restored reproductive hormone levels; reduced oxidative stress markers; and improved testicular histopathology in diabetic male rodents.

Conclusions: Coformulation of metformin and glutathione with other compounds was found to be more effective in improving fertility and reproductive parameters in diabetic male rodents compared to mono-administration. However, further studies on the coformulation of metformin and glutathione are needed to confirm their efficacy and elucidate the underlying mechanisms.Study registration:The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with registration number CRD42024561820.

Keywords

Diabetes / Met formin / Glutathione / Coformulation / Reproductive health / Infertility

Cite this article

Download citation ▾
Razia Sardar, Fatima Sardar, Nor-Ashikin Mohamed Noor Khan, Fathiah Abdullah, Yuhaniza Shafinie Kamsani. Effects of metformin and glutathione alone and in coformulation with other compounds on reproductive health and fertility in diabetic male rodents: A systematic review. Asian Pacific Journal of Reproduction, 2026, 15 (2) : 57-66 DOI:10.4103/apjr.apjr_154_25

登录浏览全文

4963

注册一个新账户 忘记密码

Conflict of interest statement

The authors declare that there are no conflicts of interest.

Funding

This research was supported by University Technology Mara (UiTM) under grant number 600-IRMI/FRGS 5/3(273/2019).

Authors’ contributions

Razia Sardar and Fatima Sardar contributed to the conception and design of the study. Razia Sardar registered the PROSPERO protocol. Razia Sardar and Fatima Sardar thoroughly reviewed the identified studies, including the assessment of titles, abstracts, and full texts. Nor-Ashikin Mohamed Noor Khan, Fathiah Abdullah, and Yuhaniza Shafinie Kamsani reviewed the identification, screening, and selection process conducted by Razia Sardar and Fatima Sardar. Razia Sardar and Fatima Sardar carried out data extraction. The first draft of the manuscript was written by Razia Sardar and Fatima Sardar, and it was reviewed by all other authors (Nor-Ashikin Mohamed Noor Khan, Fathiah Abdullah, and Yuhaniza Shafinie Kamsani). The final paper was read and approved by all authors. The authors resolved their disagreements through discussion.

Publisher’ s Note

The Publisher of the Journal remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

[1]

Xia Z, Jiang YY, Shang WJ, Guo HJ, Mao F, Dong WL, et al. Long-term effectiveness of group-based diabetes self-management on glycosylated haemoglobin for people with type 2 diabetes in the community: A protocol of systematic review and meta-analysis. BMJ Open 2021; 11(6): e046692.

[2]

Atta MS, Almadaly EA, El-Far AH, Saleh RM, Assar DH, Al Jaouni SK, et al. Thymoquinone defeats diabetes-induced testicular damage in rats, targeting antioxidant, inflammatory, and aromatase expression. Int J Mol Sd 2017; 18(5): 919.

[3]

Cho NH, Shaw JE, Karuranga S, Huang Y, da Rocha Fernandes JD, Ohlrogge A, et al. IDF diabetes atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. DRCP 2018; 138: 271-281.

[4]

International Diabetes Federation. IDF diabetes atlas. 8th ed. Brussels: International Diabetes Federation; 2017 [Online] Available from: http://fmdiabetes.org/wp-content/uploads/2018/03/IDF-2017.pdf [Accessed 10th June 2025].

[5]

Yaribeygi H, Sathyapalan T, Atkin SL, Sahebkar A. Molecular mechanisms linking oxidative stress and diabetes mellitus. Oxid Med Cell Longev 2020; 2020(1): 8609213.

[6]

Dutta S, Majzoub A, Agarwal A. Oxidative stress and sperm function: A systematic review on evaluation and management. Arab J Urol 2019; 17(2): 87-97.

[7]

Huang R, Chen J, Guo B, Jiang C, Sun W. Diabetes-induced male infertility: Potential mechanisms and treatment options. Mol Med 2024; 30(1): 11.

[8]

Omolaoye TS, Skosana BT, du Plessis SS. Diabetes mellitus-induction: Effect of different streptozotocin doses on male reproductive parameters. Acta Histochem 2018; 120(2): 103-109.

[9]

Barkabi-Zanjani S, Ghorbanzadeh V, Aslani M, Ghalibafsabbaghi A, Chodari L. Diabetes mellitus and the impairment of male reproductive function: Possible signaling pathways. Diabetes Metab Syndr 2020; 14(5): 1307-1314.

[10]

Fainberg J, Kashanian JA. Recent advances in understanding and managing male infertility. F1000Res 2019; 8: F1000 Faculty Rev-670. doi: 10.12688/f1000research.17076.1.

[11]

Kaul K, Apostolopoulou M, Roden M. Insulin resistance in type 1 diabetes mellitus. Metabolism 2015; 64(12): 1629-1639.

[12]

Bailey CJ. Metformin: Historical overview. Diabetologia 2017; 60(9): 1566-1576.

[13]

Li Y, Ryu C, Munie M, Noorulla S, Rana S, Edwards P, et al. Association of metformin treatment with reduced severity of diabetic retinopathy in type 2 diabetic patients. J Diabetes Res 2018; 2018: 2801450. doi: 10.1155/2018/2801450.

[14]

Bakhtyukov AA, Derkach KV, Sorokoumov VN, Stepochkina AM, Romanova IV, Morina IY, et al. The effects of separate and combined treatment of male rats with type 2 diabetes with metformin and orthosteric and allosteric agonists of luteinizing hormone receptor on steroidogenesis and spermatogenesis. Int J Mol Sci 2021; 23(1): 198.

[15]

Hyman M. Glutathione: The mother of all antioxidants. The Blog; 2011.2017 [Online] Available from:https://www.huffingtonpost.com/dr-mark-hyman/glutathione-the-mother-of_b_530494.html [Accessed 17th November 2017].

[16]

Galano A, Alvarez-Idaboy JR. Glutathione: Mechanism and kinetics of its non-enzymatic defense action against free radicals. Rsc Advances 2011; 1(9): 1763-1771.

[17]

Hu CY, Lu DL, Wu T, Cheng SL, Wu TT, Wang S, et al. Glutathione-S-transferases M1/T1 gene polymorphisms and male infertility risk in Chinese populations: A meta-analysis. Medicine 2019; 98(6): e14166.

[18]

Abdullah F, Nor-Ashikin MNK, Agarwal R, Kamsani YS, Abd Malek M, Bakar NS, et al. Glutathione (GSH) improves sperm quality and testicular morphology in streptozotocin-induced diabetic mice. Asian J Androl 2021; 23(3): 281.

[19]

Lapenna D. Glutathione and glutathione-dependent enzymes: From biochemistry to gerontology and successful aging. Ageing Res Rev 2023; 92: 102066. doi: 10.1016/j.arr.2023.102066.

[20]

Snezhkina AV, Kudryavtseva AV, Kardymon OL, Savvateeva MV, Melnikova NV, Krasnov GS, et al. ROS generation and antioxidant defense systems in normal and malignant cells. Oxid Med Cell Longev 2019; 2019: 6175804. doi: 10.1155/2019/6175804.

[21]

Bisht S, Faiq M, Tolahunase M, Dada R. Oxidative stress and male infertility. Nat Rev Urol 2017; 14(8): 470-485.

[22]

Walczak-Jedrzejowska R, Wolski JK, Slowikowska-Hilczer J. The role of oxidative stress and antioxidants in male fertility. Cent Eur J Urol 2013; 66(1): 60.

[23]

Nna V, Bakar A, Ahmad A, Mohamed M. Down-regulation of steroidogenesis-related genes and its accompanying fertility decline in streptozotocin-induced diabetic male rats: Ameliorative effect of metformin. Andrology 2019; 7(1): 110-123.

[24]

Ayuob NN, Murad HA, Ali SS. Impaired expression of sex hormone receptors in male reproductive organs of diabetic rats in response to oral antidiabetic drugs. Folia Histochem Cytobiol 2015; 53(1): 35-48.

[25]

Liu Y, Yang Z, Kong D, Zhang Y, Yu W, Zha W. Metformin ameliorates testicular damage in male mice with streptozotocin-induced type 1 diabetes through the PK2/PKR pathway. Oxid Med Cell Longev 2019; 2019: 5681701. doi: 10.1155/2019/5681701.

[26]

Pourheydar B, Azarm F, Farjah G, Karimipour M, Pourheydar M. Effect of silymarin and metformin on the sperm parameters and histopathological changes of testes in diabetic rats: An experimental study. Int J Reprod Biomed 2021; 19(12): 1091.

[27]

Nna VU, Abu Bakar AB, Ahmad A, Eleazu CO, Mohamed M. Oxidative stress, NF-κb-mediated inflammation and apoptosis in the testes of streptozotocin-induced diabetic rats: Combined protective effects of Malaysian propolis and metformin. Antioxidants 2019; 8(10): 465.

[28]

Khorasani MK, Ahangarpour A, Khorsandi L. Effects of crocin and metformin on methylglyoxal-induced reproductive system dysfunction in diabetic male mice. Clin Exp Reprod Med 2021; 48(3): 221.

[29]

Annie L, Jeremy M, Gurusubramanian G, Derkach KV, Shpakov AO, Roy VK. Effect of metformin on testicular expression and localization of leptin receptor and levels of leptin in the diabetic mice. Mol Reprod Dev 2020; 87(5): 620-629.

[30]

Bakhtyukov A, Derkach K, Stepochkina A, Sorokoumov V, Bayunova L, Lebedev I, et al. The effect of metformin therapy on luteinizing hormone receptor agonist-mediated stimulation of testosterone production and spermatogenesis in diabetic rats. J Evol Biochem Physiol 2021; 57: 1382-1393.

[31]

Pimson C, Chatuphonprasert W, Jarukamjorn K. Improvement of antioxidant balance in diabetes mellitus type 1 mice by glutathione supplement. Pak J Pharm Sci 2014; 27(6): 1731-1737.

[32]

Elekofehinti OO, Ariyo EO, Iwaloye O, Obafemi TO. Co-administration of metformin and gallic acid modulates JAK/STAT signaling pathway and glutathione metabolism in fructose-fed streptozotocin diabetic rats. Phytomedicine Plus 2022; 2(1): 100181.

[33]

Hooijmans CR, Rovers MM, De Vries RB, Leenaars M, Ritskes-Hoitinga M, Langendam MW. SYRCLE’s risk of bias tool for animal studies. BMC Med Res Methodol 2014; 14: 1-9.

[34]

Kilkenny C, Browne W, Cuthill IC, Emerson M, Altman DG. Animal research: Reporting in vivo experiments: The ARRIVE guidelines. Br J Pharmacol 2010; 160(7): 1577.

[35]

Tangvarasittichai S. Oxidative stress, insulin resistance, dyslipidemia, and type 2 diabetes mellitus. World J Diabetes 2015; 6(3): 456-480. doi: 10.4239/wjd.v6.i3.456.

[36]

Bhatti JS, Sehrawat A, Mishra J, Sidhu IS, Navik U, Khullar N, et al. Oxidative stress in the pathophysiology of type 2 diabetes and related complications: Current therapeutics strategies and future perspectives. Free Radic Biol Med 2022; 184: 114-134.

[37]

Das SK, Prusty A, Samantaray D, Hasan M, Jena S, Patra JK, et al. Effect of Xylocarpus granatum bark extract on amelioration of hyperglycaemia and oxidative stress-associated complications in STZ-induced diabetic mice. Evid Based Complement Alternat Med 2019; 2019: 8493190. doi: 10.1155/2019/8493190.

[38]

Armandeh M, Bameri B, Haghi-Aminjan H, Foroumadi R, Ataei M, Hassani S, et al. A systematic review on the role of melatonin and its mechanisms on diabetes-related reproductive impairment in non-clinical studies. Front Endocrinol 2022; 13: 1022989.

[39]

Kotian SR, Kumar A, Mallik SB, Bhat NP, Souza AD, Pandey AK. Effect of diabetes on the male reproductive system-A histomorphological study. J Morphol Sci 2019; 36(1): 17-23.

[40]

Wang PT, Sudirman S, Hsieh MC, Hu JY, Kong ZL. Oral supplementation of fucoxanthin-rich brown algae extract ameliorates cisplatin-induced testicular damage in hamsters. Biomed Pharmacother 2020; 125: 109992.

[41]

Ye J, Luo D, Xu X, Sun M, Su X, Tian Z, et al. Metformin improves fertility in obese males by alleviating oxidative stress-induced blood-testis barrier damage. Oxid Med Cell Longev 2019; 2019: 9151067. doi: 10.1155/2019/9151067.

[42]

Yan WJ, Mu Y, Yu N, Yi TL, Zhang Y, Pang XL, et al. Protective effects of metformin on reproductive function in obese male rats induced by a high-fat diet. J Assist Reprod Genet 2015; 32: 1097-1104.

[43]

Abed AF, Jarrar YB, Al-Ameer HJ, Al-Awaida W, Lee SJ. The protective effect of metformin against oxandrolone-induced infertility in male rats. Curr Pharm Des 2022; 28(4): 324-330.

[44]

Zhao J, Yang PC, Yang H, Wang ZB, El-Samahy M, Wang F, et al. Dietary supplementation with metformin improves testis function and semen quality and increases antioxidants and autophagy capacity in goats. Theriogenology 2022; 188: 79-89.

[45]

Sarangarajan R, Meera S, Rukkumani R, Sankar P, Anuradha G. Antioxidants: Friend or foe? Asian Pac J Trop Med 2017; 10(12): 11111116.

[46]

Đorđević M, Mihailović M, Jovanović JA, Grdović N, Uskoković A, Tolić A, et al. Centaurium erythraea methanol extract protects red blood cells from oxidative damage in streptozotocin-induced diabetic rats. J Ethnopharmacol 2017; 202: 172-183.

[47]

Adeoye O, Olawumi J, Opeyemi A, Christiania O. Review on the role of glutathione on oxidative stress and infertility. JBRA Assist Reprod 2018; 22(1): 61.

[48]

Martinov DI, Ayvazova NP, Konova EI, Atanasova MA. Glutathione content and glutathione peroxidase activity of sperm in males with unexplained infertility. J Biomed Clin Res 2021; 14(1): 53-61.

[49]

Alzain SD, Mudawi MM, Mohamed AWH. Review of metformin effect on the male reproductive system. Int J Pharm Res Allied Sci 2020; 9(2): 158-167.

[50]

Tseng CH. Metformin’s effects on varicocele, erectile dysfunction, infertility, and prostate-related diseases: A retrospective cohort study. Front Pharmacol 2022; 13: 799290.

[51]

Yang Y, Chen H, Weng S, Pan T, Chen W, Wang F, et al. In vitro exposure to metformin activates human spermatozoa at therapeutically relevant concentrations. Andrology 2020; 8(3): 663-670.

[52]

Dhaoui A, Trabelsi N, Boussabbeh M, Sallem A, Mehdi M. P-085 Cytoprotective effects of metformin against methotrexate toxicity on human spermatozoa in vitro. Hum Reprod 2025; 40(Suppl_1): deaf097.394.

[53]

Alkumait M, Abdul-Aziz MM, Nima MH. The effect of glutathione versus co-enzyme Q10 on male infertility original study. Medico Leg Update 2020; 20: 409-414.

[54]

Gadallah K, Abeel A. Role of antioxidants in the treatment of male infertility. Surg Med Open Acc J 2018; 1(2): 1-10.

[55]

Alkumait MHMS. The role of glutathione in male infertility. EJMS 2019; 4(1): 24-28.

PDF (356KB)

0

Accesses

0

Citation

Detail

Sections
Recommended

/