210 The Effect of Antioxidant Supplementation on Operated or Non-Operated Varicocele-Associated Infertility: A Systematic Review and Meta-Analysis

Abstract

Introduction In patients with varicocele-associated infertility, the effect of antioxidant supplementation on fertility is unknown. Objectives To perform a systematic review and meta-analysis exploring the role of antioxidant supplementation in patients with operated or non-operated varicocele. Methods We searched PubMed, Cochrane Library, Web of Science and Scopus databases, as well as sources of grey literature until May 2021 (PROSPERO: CRD42021248195). We produced a qualitative synthesis of the main results extracted from the included studies. Based on data availability, we undertook an inverse variance, random effects meta-analysis of odds ratios (ORs) to determine the pregnancy rate after antioxidant supplementation versus no treatment in patients undergoing surgical repair of varicocele at three and six months of treatment. In these patients, we determined the effect of antioxidant supplementation versus no treatment or placebo on semen parameters (concentration, motility, morphology, and DNA fragmentation). Results We included 14 studies (980 individuals) in the systematic review. Of the 14 studies, 2 explored the effect of antioxidant supplementation in patients with non-operated varicocele, 1 compared antioxidants versus surgical repair of varicocele, while 11 explored antioxidants after surgical repair of varicocele and were also included in the meta-analysis. Regarding pregnancy rates, no significant differences were demonstrated after treatment with antioxidants versus no treatment at three (OR: 2.28, 95% CI: 0.7–7.48) and six months (OR: 1.88, 95% CI: 0.62–5.72). Accordingly, contradictory findings were reported in sperm concentration, morphology, and motility, as well as DNA fragmentation. Conclusions Our findings indicate that antioxidant supplementation does not improve pregnancy rates and semen parameters in patients with varicocele-associated infertility, in the absence of previous screening for oxidative stress. Based on the previous notion, most included studies also raised methodological concerns. Therefore, definitive conclusions about the efficacy of antioxidant supplementation in this setting cannot be drawn and further research on the field is mandatory. Disclosure Work supported by industry: no.

Consensus and Diversity in the Management of Varicocele for Male Infertility: Results of a Global Practice Survey and Comparison With Guidelines and Recommendations

“…However, one-third of the respondents felt that there was no need to rush into VR and that patients may benefit from an initial trial with medical management before considering surgery. This is in concordance with a recent meta-analysis which suggested that while antioxidants (AOX) did not improve pregnancy rates in men who had VR, AOX may be of benefit in men with unoperated varicoceles [19]. Giving a couple time to conceive naturally without rushing into VR, especially if they are young, is supported by a study that showed similar pregnancy rates between conservative and surgical approaches when the duration of infertility was short, but greater chances of pregnancy after VR if the couple has been infertile for more than 2 years [20].…”

Semen Analysis and Infertility

“…While a varicocelectomy can improve sperm motility, other sperm parameters are still controversial [30][31][32][33]. Adjuvant therapy using antioxidant supplements to improve sperm quality [34,35] has had conflicting outcomes [36].…”

Improvement in sperm quality by oral antioxidant supplementation in infertile men with varicocele who have not undergone surgical repair: Systematic review and meta‐analysis

“…On the other hand, the use of antioxidants in men with infertility and VCL who have not undergone surgical repair has recently been in the focus of interest, although the existing evidence is scarce and conflicting (Busetto et al, 2018; Cavallini et al, 2004; Festa et al, 2014; Gual‐Frau et al, 2015; Oliva et al, 2009; Pyrgidis et al, 2021; Sofimajidpour et al, 2016).…”