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American Journal of  Medical 
Science and Innovation (AJMSI) 

Positive Outcomes of  Ozone and NAD Therapy in Infertility Treatment: A Retrospective 
Observational Case Series

 Michael Fakih1, Muhammad Akhtar1, Mouna Fawaz1*

Volume 3 Issue 2, Year 2024
ISSN: 2836-8509 (Online)

DOI: https://doi.org/10.54536/ajmsi.v3i2.3203
https://journals.e-palli.com/home/index.php/ajmsi

Article Information ABSTRACT

Received: August 20, 2024
Accepted: September 24, 2024
Published: September 27, 2024

This retrospective observational case series aims to delineate the positive effects of  ozone 
and NAD therapy on patients dealing with infertility. Conducted at First IVF Fertility 
Centre, the study examined six female patients who had previously experienced multiple 
IVF failures. We meticulously analyzed these cases, noting remarkable improvements 
following the integration of  alternative therapeutic modalities, particularly ozone therapy, 
into their treatment regimens. Each of  the six cases demonstrated a discernible positive 
outcome, characterized by the acquisition of  euploid, transferable embryos or successful 
pregnancies. The findings suggest that the integration of  ozone and NAD therapy can 
significantly benefit patients dealing with infertility. To comprehensively ascertain the impact 
of  these alternative therapies, a rigorous evaluation, such as a randomized pilot study, is 
recommended. This empirical approach would empower patients and healthcare providers 
to make well-informed decisions regarding the potential benefits and associated risks of  
these innovative treatment avenues, fostering a proactive and collaborative approach to 
fertility care and ultimately enhancing patient outcomes.

Keywords
Infertility, In Vitro Fertilization 
(IVF), Recurrent IVF 
Failures, Nicotinamide Adenine 
Dinucleotide (NAD), Ozone 
Therapy

1 First IVF Fertility Centre Abu Dhabi, United Arab Emirates
* Corresponding author’s e-mail: mona.fawaz@yahoo.fr

INTRODUCTION
Infertility is one of  the prevailing global concerns that 
impacts millions of  couples worldwide (Obeagu et al., 
2023). In this context, In Vitro Fertilization (IVF) stands 
as a miracle of  modern medication for couples grappling 
with conception challenges (Inhorn, 2021). Assisted 
reproduction involves multiple complex steps, from 
ovarian stimulation and egg retrieval to fertilization and 
embryo transfer. Despite advancements in IVF techniques, 
a subset of  patients confronts the disheartening reality 
of  recurrent IVF failures, often attributed to factors 
such as inadequate embryo development leading to the 
absence of  viable blastocysts for transfer (Fodina et al., 
2021). This subset poses a formidable challenge within 
the realm of  fertility treatment. This phenomenon 
not only leads to emotional distress for couples but 
also emphasizes the need for alternative approaches to 
improve IVF outcomes (Wu et al., 2023). Emerging as an 
innovative medical intervention such as ozone therapy 
or Nicotinamide adenine dinucleotide (NAD) therapy 
may have the potential to enhance IVF success rates and 
revolutionize the landscape of  fertility treatment (Merhi 
et al., 2019).
Medical advancements have highlighted the connection 
between free radicals and various diseases. Therefore, 
the chances of  developing various diseases due to stress 
are increased by a lifestyle, exposure to chemicals and 
pollution, smoking cigarettes, using drugs, experiencing 
illness and dealing with stress (Pădureanu et al., 2022). 
Antioxidants are substances that can counteract the 
effects of  radicals and reduce the occurrence of  damage 

caused by oxidative stress. One of  the causes of  infertility 
is inflammation (Ravel et al., 2021; Yuxin et al., 2021)
and Ozone therapy, a therapeutic approach utilizing a 
mixture of  ozone and oxygen, has garnered attention 
due to its potential to modulate oxidative stress, enhance 
circulation, and stimulate tissue regeneration (Scassellati 
et al., 2020). 
These ozone therapy attributes are promising for 
addressing the challenges posed by repeated IVF failures. 
Oxidative stress and inflammation have been linked to 
impaired embryo development and implantation, which 
are critical factors in IVF success. Ozone therapy’s ability 
to mitigate oxidative stress and promote tissue repair could 
contribute to a more favourable uterine environment for 
embryo implantation (Escandón et al., 2020).
NAD has grown beyond its role in metabolism to become 
a crucial regulator of  various physiological processes. 
These processes include DNA repair, autophagy adaptive 
stress responses, maintaining stability and ensuring cell 
survival (Srinivas et al., 2019). Notably, studies have 
indicated that NAD+ levels decline with age in tissues 
and are associated with age-related diseases (McReynolds 
et al., 2020).
The inclusion of  alternative therapies as an adjunct to 
standard IVF treatment represents a novel avenue for 
addressing the unmet needs of  patients with recurrent 
IVF failures (Dias et al., 2023).

MATERIALS AND METHODS
This case study was designed using a retrospective 
and systematic approach to evaluate the potency of  



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adjunctive therapies of  ozone and Nicotinamide 
adenine dinucleotide (NAD) sessions in improving IVF 
outcomes among women experiencing recurrent failures 
(Moreira, 2021). Before starting this study on patients, 
approval from the Institutional Review Board (IRB) was 
obtained, ensuring compliance with ethical guidelines 
and protecting participant rights. Subsequently, patients 
with documented recurrent IVF failure history were 
carefully selected for inclusion in the case series, with all 
participants providing informed consent prior to their 
involvement.
The patients’ ages ranged from 29 to 43 years. They had 
underlying causes of  infertility, including diminished 
ovarian reserve and endometriosis. Detailed data on the 
six participants’ IVF treatment history, past failures and 
outcomes, were meticulously collected and analyzed. 
Then, therapies and their frequency and dosage were 
systematically integrated into treatment regimens 
with standardized protocols for five to eight sessions 
per patient. Strict quality control measures and staff  
training guaranteed data accuracy and reliability. Patient 
responses to the integrated treatments were observed and 
evaluated to identify potential advancements, utilizing 
statistical analysis techniques to assess efficacy. Treatment 
outcomes, including acquiring transferable embryos or 
successful pregnancies, were compared to previous IVF 
attempts. Individual case conclusions were drawn to 
provide insights into the potential efficacy of  ozone and 
NAD therapy in addressing recurrent IVF failures.

RESULTS AND DISCUSSION
Results
The results of  this case study are presented as a series of  
case studies, each highlighting the outcomes of  integrating 
alternative approaches, ozone and NAD therapies. The 
following findings elucidate the potential efficacy of  these 
therapies in making IVF successful and also the challenges 
faced by patients seeking successful pregnancies.

Case Studies
The first case was of  a 29-year-old woman, married, 
with a history of  primary infertility, who carries genetic 
traits for autosomal recessive blindness and Thalassemia. 
Her AMH (Anti-Müllerian Hormone) level register was 
2.93 ng/ml. Having undergone seven prior IVF cycles 
elsewhere, she encountered a lone embryo transfer that 
yielded no pregnancy. Following three intravenous and 
one vaginal ozone session, she embarked on an IVF 
cycle that led to the development of  a normal (euploid) 
embryo and resulted in a successful pregnancy after 
embryo transfer.
In the second case, a 42-year-old woman experienced 
secondary infertility and an AMH level of  1 ng/ml. After 
three previous IVF cycles that led to aneuploid embryos, 
she integrated antioxidant sessions, including 11 sessions 
of  NAD, and underwent eight intravenous ozone therapy 
sessions. Two subsequent IVF cycles ensued, one yielding 
a single euploid embryo. 
Thirdly, a 41-year-old woman with secondary infertility, 
endometriosis stage IV, and an AMH level of  0.07 ng/
ml underwent multiple unsuccessful IVF cycles. Upon 
beginning five sessions of  NAD and five sessions of  
intravenous ozone therapy, her subsequent IVF cycles 
showed a significant shift in outcomes. One cycle resulted 
in a genetically normal embryo and a successful embryo 
transfer, leading to a positive pregnancy.
In the fourth case, a 41-year-old woman in her third 
marriage, without prior children, confronted poor ovarian 
reserve (AMH: 0.2 ng/ml). Three prior IVF cycles yielded 
abnormal embryos. Following two NAD sessions and 
five intravenous ozone therapy sessions, she underwent 
two IVF cycles, each resulting in a single euploid embryo, 
thus marking a noteworthy improvement.
In the fifth case, a 41-year-old woman with primary 
infertility and an AMH level of  0.35 ng/ml underwent 
eight IVF cycles, producing aneuploid embryos with 
just one normal embryo. After seven intravenous ozone 

Table 1: Summary of  case series
Case Patient’s Age Diagnosis Previous IVF 

Cycles
Alternative 
Therapies

Outcomes

1 29 Primary infertility, autosomal 
recessive blindness, 
Thalassemia

7 3 IV + 1 
v a g i n a l 
ozone

Successful pregnancy

2 42 Secondary infertility 3 11 NAD + 8 
IV ozone

1 euploid embryo

3 41 Secondary infertility, 
endometriosis stage IV

Multiple 5 NAD + 5 
IV ozone

1 euploid embryo, 
successful pregnancy

4 41 Poor ovarian reserve, no prior 
children

3 2 NAD + 5 
IV ozone

2 euploid embryos

5 41 Primary infertility 8 7 IV ozone 2 euploid embryos, 
successful pregnancy

6 40 Secondary infertility, 
previously a miscarriage

6 5 NAD 2 euploid embryos, 
successful pregnancy



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sessions, two IVF cycles ensued, each yielding a euploid 
embryo. A successful transfer led to a positive pregnancy 
outcome.
The last case was a 40-year-old woman experiencing 
secondary infertility who had a miscarriage from a 
spontaneous pregnancy. Her Anti Hormone (AMH) 
level is 1.27 ng/ml. She underwent six rounds of  in 
vitro fertilization (IVF), and all the embryos produced 
in these cycles were abnormal due to aneuploidy. After 
receiving five sessions of  NAD (each containing 250mg 
of  NAD) as advised by her physician, she decided to try 
another IVF cycle that led to two euploid embryos being 
successfully transferred, and pregnancy occurred.
Table 1 summarises each case, including age, previous 
IVF Cycles, alternative therapies used and outcomes 
achieved.

Discussion
The cases presented in this series highlight the potential 
benefits of  incorporating antioxidant therapies, 
specifically Nicotinamide adenine dinucleotide (NAD) 
and intravenous ozone sessions, into the treatment 
protocols of  women facing infertility challenges (Dias 
et al., 2023). These cases underscore the importance of  
individualized care and the exploration of  innovative 
approaches in assisted reproductive medicine (Sunderam, 
2019). Antioxidant therapies appear to have played a 
pivotal role in enhancing the quality of  embryos, resulting 
in genetically normal embryos available for transfer. 
NAD and intravenous ozone therapy emerged as valuable 
adjunctive treatments, contributing to the overall success 
of  the IVF cycles, evidenced by the development of  
euploid embryos and successful pregnancies (Hussain et 
al., 2021; Sunderam, 2019).
In reviewing the literature, it is evident that there is a 
growing trend towards the use of  alternative medicine 
(AM) in treating infertility, challenging traditional 
therapies. However, some randomized controlled trials 
(RCTs) have shown that complementary and alternative 
medicine (CAM) does not consistently impact infertility, 
and there remains no consensus on its mechanism of  
action on fertility. (Saha et al., 2021; Sharifi et al., 2021)
Nevertheless, therapies such as ozone therapy have 
shown promise in enhancing aspects of  reproductive 
function, including clearing blockages in the fallopian 
tubes, protecting against infections, and potentially 
reducing damage to the ovaries while improving ovarian 
reserve. The potential of  ozone therapy to reduce 
inflammatory responses and adhesions suggests its value 
as a component of  IVF treatments.(Dias et al., 2023; 
Merhi et al., 2019)
Additionally, the decline in NAD availability with age 
significantly impacts egg quality and overall fertility, 
highlighting the potential of  NAD supplementation as 
a therapy for addressing infertility challenges associated 
with ageing. Future research targeting women with 
repeated miscarriages, poor responses to IVF treatments, 
endometrial lining problems, or decreased ovarian reserve 

is warranted to further elucidate the effectiveness of  
alternative therapies in complex infertility(Wu et al., 2019).
Moreover, each patient in this case series presented a 
unique clinical profile. Therefore, findings from this 
discussion underscore the importance of  a personalized 
approach to treatment and the exploration of  innovative 
therapies in addressing complex infertility cases and 
innovation in the evolution of  personalized medicine 
in reproductive health. Further research is needed to 
understand alternative therapies’ mechanisms of  action 
and efficacy in improving fertility outcomes. 

CONCLUSION
Incorporating ozone therapy and complementary 
treatments reflects a comprehensive strategy for tackling 
intricate infertility cases, potentially paving the way for 
advancements in fertility treatment outcomes.
While these instances offer encouraging glimpses into the 
potential advantages of  antioxidant therapies, additional 
research is necessary to confirm their effectiveness and 
safety. Furthermore, further investigation is needed to 
elucidate the exact mechanisms through which NAD 
and intravenous ozone therapy can impact embryo 
development. Ongoing research and broader-scale studies 
are imperative to validate these findings and enhance 
treatment protocols in reproductive medicine.

Data Availability Statement
The data supporting the findings of  this study are stored in 
software called MEDITEX, which is designed specifically 
for In Vitro Fertilization (IVF) clinics. MEDITEX serves 
as a tool for managing and documenting patient data 
within Assisted Reproduction organizations. However, 
it’s important to note that there are restrictions on 
accessing this data due to licensing agreements for this 
study. Therefore, provided database was retrieved from 
MEDITEX Internal Data Management System and 
cannot be accessed publicly. Nevertheless, the authors of  
the study are willing to access to the data upon request.
The data and materials used in this case series are available 
upon reasonable request for transparency. Access requests 
should be directed to the corresponding author.

Abbreviation List
In vitro fertilization (IVF);Anti-Müllerian hormone 
(AMH);Nicotinamide adenine dinucleotide (NAD)

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