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NO is an active molecule produced by the nitric oxide synthase (NOS) protein family, which directly binds and inactivates iron-containing enzymes [48] or reacts with superoxide anion radical O2 to form a highly active peroxy sulfoxide Nitrates (ooo-), which can attack membrane lipids and proteins of the pathogens, especially protein thiols [49]

While lifestyle management remains the internationally recommended first-line treatment, current clinical management, primarily relying on combined oral contraceptives and metformin, offers symptomatic relief or masking of the phenotype but fails to adequately disrupt this core pathophysiological loop, while also carrying potential intergenerational safety concerns

it has a free thiol group, which is likely to confer particular properties on functional sites of proteins that contain this highly conserved residue

After a period 3 months, zinc therapy alone or in combination with Vitamin E or Vitamin E + C was associated with significant improvement in sperm parameters and reduction in OS, sperm apoptosis, and SDF.[20] The results of this study are limited due to small sample size