Vitamins as primary or adjunctive treatment in infertile men with varicocele: A systematic review

Georgios Tsampoukas; Kristiana Gkeka; Athanasios Dellis; Dominic Brown; Antigoni Katsouri; Ahmed Alneshawy; Mohamad Moussa; Athanasios Papatsoris; Noor Buchholz

doi:10.1080/2090598X.2021.1932124

Vitamins as primary or adjunctive treatment in infertile men with varicocele: A systematic review

Arab J Urol. 2021 May 29;19(3):264-273. doi: 10.1080/2090598X.2021.1932124. eCollection 2021.

Authors

Georgios Tsampoukas^{1

2}, Kristiana Gkeka³, Athanasios Dellis^{1

4}, Dominic Brown², Antigoni Katsouri⁵, Ahmed Alneshawy^{1

2}, Mohamad Moussa⁶, Athanasios Papatsoris^{1

7}, Noor Buchholz¹

Affiliations

¹ U-merge Ltd. (Urology for Emerging Countries), London, UK.
² Department of Urology, Princess Alexandra Hospital, Harlow, UK.
³ Department of Urology, General Hospital of Patras, Patras, Greece.
⁴ Department of Urology, Aretaieion Academic Hospital, Athens, Greece.
⁵ Department of Pharmacy, University of Patras, Patras, Greece.
⁶ Al Zahraa Hospital, University Medical Center, Lebanese University, Beirut, Lebanon.
⁷ Second Department of Urology, University Hospital of Athens, Athens, Greece.

Abstract

Objective: To investigate the usage and the efficacy of vitamins as primary or adjuvant treatment in infertile men with varicocele.

Methods: A systematic search in PubMed, the Medical Literature Analysis and Retrieval System Online (MEDLINE) and Cochrane Library with the terms (varicocele) AND (vitamins) was performed. We searched for studies: a) reporting the administration of vitamins (individually or as part of a complex) in men with varicocele and infertility, b) primarily or adjuvant to invasive treatment, and c) reporting the impact on semen parameters and/or pregnancy rates. Exclusion criteria were animal, adolescent and non-English studies, grey literature and trials reporting abstracts only.

Results: Seven studies were identified eligible for qualitative analysis. All studies were randomised except one (case series). Vitamins were administered dominantly as part of antioxidant complex and only two studies used vitamins (C and E, respectively) as sole agent. In two studies, vitamin monotherapy resulted in improvement in semen quality, but the effect on pregnancy rates is unknown. One study reported no efficacy of adjuvant multivitamin treatment after embolisation in terms of both semen quality and pregnancy rates. Finally, four studies reported a positive effect of vitamins on semen parameters after varicocelectomy, but the effect on pregnancy rates is conflicting; one study reported improved pregnancy rates with adjuvant treatment, two studies did not evaluate the pregnancy rates, and in one study the outcome was unclear due to missing data.

Conclusions: Vitamins have been used mostly as part of an antioxidant panel for the management of infertile men with varicocele. Most studies have found a positive impact on semen parameters in selected men with varicocele and infertility, as primary or adjuvant treatment. However, the clinical benefit of vitamins administration on pregnancy rate is under-evaluated and should be the target of future research.

Keywords: Male infertility; pregnancy rates; semen parameters; varicocele; vitamins.