Varicocelectomy versus antioxidant therapy in infertile men with isolated asthenozoospermia: Comparative outcomes and predictors of treatment success

Objective To study the role of varicocelectomy in infertile men with clinical varicoceles and isolated asthenzooospermia. The outcomes were the percentage of spontaneous natural pregnancy rates at 12th months, the changes in sperm parameters, sperm DNA fragmentation (SDF), and hormonal profile after the surgery.Methods This is a prospective study that was conducted between November 2021 and October 2024 for infertile men with isolated asthenozoospermia associated with clinical varicoceles. Patients were classified into a study group (varicocelectomy) and a control group (non-surgical treatment with antioxidants). We compared semen analysis, hormonal profile, and sperm DNA fragmentation tests before and 6 months after varicocelectomy or medical therapy. The natural pregnancy rate was reported at 12 months. A logistic regression model was used to detect the predictors of pregnancy rate.Results Overall, 88 patients were recruited for the study, 44 in each group. 4 patients were lost to follow-up in the non-surgical group. The median (Q1.Q3) age of men was 32.0 (29.0, 34.0) years, and wives’ age was 25.00 (24.00, 28.00) years. Six months after surgery or follow-up, sperm concentration, motility, and SDF were statistically improved in both groups (p value < 0.001). Natural pregnancy was achieved in 40% of the varicocelectomy group versus 25% in the control group. In multivariate analysis, the total motile sperm count was the only predictor of achieving spontaneous pregnancy.Conclusion In conclusion, both microscopic varicocelectomy and antioxidant therapy improved sperm parameters, SDF, and increased the pregnancy rate in patients with isolated asthenozoospermia. The total sperm motility was the strongest predictor of the pregnancy outcome.