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Nevertheless, the preceding meta-analysis studies have reported a recent decline in semen quality, which testifies to environmental factors, including chemical exposure and medication use ( Spermatogenesis is the process of sperm development and maturation in mammals, which is composed of two main phases: (i) spermatogenesis, during which spermatogonia undergo successive mitotic divisions to form spermatocytes, which then divide meiotically to form round spermatids, and (ii) spermiogenesis, during which round spermatids undergo morphological changes, thereby maturing into elongated spermatids and into spermatozoa that are adapted for fertilization

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Rare but serious: vascular occlusion (about 1.1% in one large series), skin necrosis, and irreversible blindness

Clostridium butyricum has a documented history of use as a probiotic, particularly in Asian and European markets where it has been commercially available for decades