Astaxanthin Supplementation in Polycystic Ovary Syndrome: Effects on Oxidative Stress, Inflammation, Metabolic Dysfunction, and Assisted Reproductive Outcomes
DOI:
https://doi.org/10.12775/QS.2026.59.72810Keywords
astaxantin, polycistic ovary syndrome, oxidative stress, inflammation, insulin resistance, Assisted reproductive technology (ART)Abstract
Background. Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine-metabolic disorder characterized by hyperandrogenism, ovulatory dysfunction, polycystic ovarian morphology, insulin resistance, and chronic low-grade inflammation. Increasing evidence suggests that oxidative stress, mitochondrial dysfunction, endoplasmic reticulum (ER) stress, and dysregulated apoptosis contribute substantially to both the reproductive and metabolic manifestations of PCOS. Astaxanthin, a xanthophyll carotenoid has recently emerged as a candidate adjunctive therapy in this setting.
Aim. This review synthesizes current evidence regarding astaxanthin supplementation in PCOS, with emphasis on mechanistic plausibility, metabolic endpoints, inflammatory and oxidative stress biomarkers, and assisted reproductive technology (ART) outcomes. Recent randomized clinical trials suggest that astaxanthin may improve selected biochemical and molecular parameters, including total antioxidant capacity, lipid peroxidation markers, inflammatory cytokines, and expression of genes implicated in ER stress and apoptosis. In infertile women with PCOS undergoing ART, astaxanthin has been associated with improvements in intermediate reproductive outcomes such as oocyte maturity, embryo quality, and the number of frozen or high-quality embryos. However, benefits for hard clinical endpoints, especially chemical pregnancy, clinical pregnancy, and live birth, remain inconsistent.
Material and methods. A systematic search was conducted across PubMed and Scopus. The analysis included randomized trials, systematic reviews and clinical guidelines.
Conclusions. Existing data support a biologically plausible and clinically promising, but not yet definitive, role for astaxanthin as an adjunctive nutraceutical in PCOS. Larger multicenter randomized trials with standardized outcomes, rigorous phenotyping, and longer follow-up are needed before astaxanthin can be recommended as part of PCOS management.
References
1. Singh S, Pal N, Shubham S, Sarma DK, Verma V, Marotta F, et al. Polycystic Ovary Syndrome: Etiology, Current Management, and Future Therapeutics. J Clin Med. 2023;12(4):1454. doi:10.3390/jcm12041454. Available from: https://doi.org/10.3390/jcm12041454
2. Teede HJ, Tay CT, Laven JJE, Dokras A, Moran LJ, Piltonen TT, et al. Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Eur J Endocrinol. 2023;189(2):G43-G64. doi:10.1093/ejendo/lvad046. Available from: https://doi.org/10.1093/ejendo/lvad046
3. Dabravolski SA, Nikiforov NG, Eid AH, Nedosugova LV, Starodubova AV, Popkova TV, et al. Mitochondrial Dysfunction and Chronic Inflammation in Polycystic Ovary Syndrome. Int J Mol Sci. 2021;22(8):3923. doi:10.3390/ijms22083923. Available from: https://doi.org/10.3390/ijms22083923
4. Jabarpour M, Aleyasin A, Shabani Nashtaei M, Lotfi S, Amidi F. Astaxanthin treatment ameliorates ER stress in polycystic ovary syndrome patients: a randomized clinical trial. Sci Rep. 2023;13:3376. doi:10.1038/s41598-023-28956-8. Available from: https://doi.org/10.1038/s41598-023-28956-8
5. Kumar S, Kumar R, Diksha, Kumari A, Panwar A. Astaxanthin: A super antioxidant from microalgae and its therapeutic potential. J Basic Microbiol. 2022;62(9):1064-1082. doi:10.1002/jobm.202100391. Available from: https://doi.org/10.1002/jobm.202100391
6. Kohandel Z, Farkhondeh T, Aschner M, Pourbagher-Shahri AM, Samarghandian S. Anti-inflammatory action of astaxanthin and its use in the treatment of various diseases. Biomed Pharmacother. 2022;145:112179. doi:10.1016/j.biopha.2021.112179. Available from: https://doi.org/10.1016/j.biopha.2021.112179
7. Ebrahimi F, Rostami S, Nekoonam S, Rashidi Z, Sobhani A, Amidi F. The Effect of Astaxanthin and Metformin on Oxidative Stress in Granulosa Cells of BALB C Mouse Model of Polycystic Ovary Syndrome. Reprod Sci. 2021. doi:10.1007/s43032-021-00577-4. Available from: https://doi.org/10.1007/s43032-021-00577-4
8. Jabarpour M, Amidi F, Aleyasin A, Shabani Nashtaei M, Saedi Marghmaleki M. Randomized clinical trial of astaxanthin supplement on serum inflammatory markers and ER stress-apoptosis gene expression in PBMCs of women with PCOS. J Cell Mol Med. 2024;28:e18464. doi:10.1111/jcmm.18464. Available from: https://doi.org/10.1111/jcmm.18464
9. Jabarpour M, Aleyasin A, Shabani Nashtaei M, Khodarahmian M, Lotfi S, Amidi F. The modulating effects of astaxanthin on apoptosis in women with polycystic ovarian syndrome: A randomized clinical trial. Avicenna J Phytomed. 2024;14(1):64-77.
doi:10.22038/AJP.2023.23111. Available from: https://dx.doi.org/10.22038/AJP.2023.23111
10. Gharaei R, Alyasin A, Mahdavinezhad F, Samadian E, Ashrafnezhad Z, Amidi F. Randomized controlled trial of astaxanthin impacts on antioxidant status and assisted reproductive technology outcomes in women with polycystic ovarian syndrome. J Assist Reprod Genet. 2022;39(5):1141-1153. doi:10.1007/s10815-022-02432-0. Available from: https://doi.org/10.1007/s10815-022-02432-0
11. Jabarpour M, Aleyasin A, Shabani Nashtaei M, Amidi F. Astaxanthin supplementation impact on insulin resistance, lipid profile, blood pressure, and oxidative stress in polycystic ovary syndrome patients: A triple-blind randomized clinical trial. Phytother Res. 2024;38. doi:10.1002/ptr.8037. Available from: https://doi.org/10.1002/ptr.8037
12. Fereidouni F, Kashani L, Amidi F, Khodarahmian M, Zhaeentan S, Ajabi Ardehjani N, et al. Astaxanthin treatment decreases pro-inflammatory cytokines and improves reproductive outcomes in patients with polycystic ovary syndrome undergoing assisted reproductive technology: A randomized clinical trial. Inflammopharmacology. 2024;32:2337-2347. doi:10.1007/s10787-024-01504-0. Available from: https://doi.org/10.1007/s10787-024-01504-0
13. Mashhadi NS, Zakerkish M, Mohammadiasl J, Zarei M, Mohammadshahi M, Haghighizadeh MH. Astaxanthin improves glucose metabolism and reduces blood pressure in patients with type 2 diabetes mellitus. Asia Pac J Clin Nutr. 2018;27(2):341-346. doi:10.6133/APJCN.052017.11. Available from: https://pubmed.ncbi.nlm.nih.gov/29384321/
14. Roustaei Rad N, Movahedian A, Feizi A, Aminorroaya A, Aarabi MH. Antioxidant effects of astaxanthin and metformin combined therapy in type 2 diabetes mellitus patients: a randomized double-blind controlled clinical trial. Res Pharm Sci. 2022;17(2):219-230. doi:10.4103/1735-5362.335179. Available from: https://doi.org/10.4103/1735-5362.335179
15. Urakaze M, Kobashi C, Satou Y, Shigeta K, Toshima M, Takagi M, et al. The Beneficial Effects of Astaxanthin on Glucose Metabolism and Modified Low-Density Lipoprotein in Healthy Volunteers and Subjects with Prediabetes. Nutrients. 2021;13(12):4381. doi:10.3390/nu13124381. Available from: https://doi.org/10.3390/nu13124381
16. Fu X, Cao W, Ye F, Bei J, Du Y, Wang L. Astaxanthin compound nutrient improved insulin resistance, hormone levels, embryo quality and pregnancy outcomes in polycystic ovary syndrome patients undergoing in vitro fertilization/intracytoplasmic sperm injection. Drug Discov Ther. 2024;18(5):296-302. doi:10.5582/ddt.2024.01036. Available from: https://doi.org/10.5582/ddt.2024.01036
17. Maleki-Hajiagha A, Shafie A, Maajani K, Amidi F. Effect of astaxanthin supplementation on female fertility and reproductive outcomes: a systematic review and meta-analysis of clinical and animal studies. J Ovarian Res. 2024;17. doi:10.1186/s13048-024-01472-7. Available from: https://doi.org/10.1186/s13048-024-01472-7
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Marta Gutkowska, Joanna Jabłońska, Joanna Wasik, Marta Armuła, Claire Bongage, Filip Napieraj, Bartosz Herc, Małgorzata Tesla, Anna Agnieszka Gąska
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 13
Number of citations: 0
