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It is also capable of directly reducing OS through scavenging free radicals.[55] In vitro studies have demonstrated a beneficial role for NAC on germ cell survival as a result of its antioxidant properties.[56] The incubation of semen samples with NAC for 20 min significantly reduced ROS levels and resulted in an improvement of sperm motility.[57] In a randomized placebo-controlled study of 120 patients with idiopathic infertility, treatment with 600 mg of NAC daily resulted in a significant improvement in sperm motility in comparison to placebo.[27] In addition, authors evaluated OS measures and reported higher serum total antioxidant capacity and lower total peroxide and OS index in the NAC-treated group compared with the placebo group

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In our study, we observed significant decreases of alanine, ornithine, and urea in the BPD group, with MSEA linking these changes to a significant decrease in urea cycle metabolism