We aimed to investigate the combined effects of alpha-lipoic acid (ALA) and sildenafil citrate (SC) on sperm quality during freeze-thawing in asthenozoospermic men. We categorized thirty semen samples from astheno- zoospermic into five different groups for analysis: Control (fresh), Freeze, Freeze + SC, Freeze + ALA, and Freeze + SC + ALA. We evaluated sperm parameters in each group, including motility, viability, morphology, plasma membrane integrity, DNA fragmentation, mitochondrial membrane potential, protamine deficiency, acrosome integrity, malondialdehyde, tumor necrosis factor-alpha (TNF- α ), antioxidants (Superoxide dismutase, Gluta- thione, Catalase), and gene expression of HSP70 and Bcl-2. The Freeze group showed significant declines in viability, motility, morphology, membrane integrity, antioxidants, and mitochondrial membrane potential, with increases in protamine deficiency, abnormalities, DNA fragmentation, TNF- α , and malondialdehyde compared to control (p = 0.000). These effects were significantly reversed in all treatment groups (p = 0.000). Bcl-2 and HSP70 expression increased significantly in all groups (p = 0.000). Acrosomal integrity decreased significantly (p = 0.000) in the Freeze group compared to controls and in the Freeze + SC group compared to the Freeze group. However, acrosomal integrity significantly increased (p = 0.000) in the Freeze + SC + ALA group compared to the Freeze + SC group and in the Freeze + ALA group compared to other treatments. Our findings indicate that the simultaneous addition of SC and ALA in the freezing media yielded increased sperm quality. This enhancement was evidenced by reductions in oxidative stress, inflammation, and apoptosis, along with partial prevention of premature acrosome reactions induced by SC.
