CoChat
Sign Up
Cited by 7Sperm and Testicular FunctionMale Reproductive Health StudiesReproductive Health and Technologies

Varicocelectomy versus antioxidants in infertile men with isolated teratozoospermia: A retrospective analysis

Open access
Fathi, Atef, Castiglione, Fabio, Mohamed, Omar, Alsagheer, Gamal A., Mahmoud, Osama, Saber-Khalaf, Mohammed·2021·Urology Research and Practice
DOI 10.5152/tju.2021.21013PMC PMC9612765
Open this paper in CoChat — free accountOpen PDF

Abstract

Objective: To compare the outcome of microscopic subinguinal varicocelectomy versus oral antioxidants for the management of male infertility due to isolated teratozoospermia. Material and methods: Clinical patients’ database of a tertiary infertility referral center was retrospectively reviewed to collect data on male infertility due to isolated teratozoospermia from July 2014 to January 2019. Seventy-two patients who underwentmicroscopic subinguinal varicocelectomy for their clinically palpable varicoceles were considered as a study group, while 60 patients who were treated with antioxidants (L-carnitine, vitamin C, and vitamin E) were included as controls. The improvement in the sperm morphology, sperm DNA fragmentation (SDF), and the achievement of natural pregnancy were compared between the two groups. Results: In the varicocelectomy group, all sperm parameters and SDF statistically improved 6months after the operation (P-value <.001). In the control group, the percentage of sperm morphology and SDF statistically improved 6months after the treatment (P-value <.05). The improvement in sperm parameters, SDF, and the pregnancy rate was statistically higher in the varicocelectomy group compared to the control group. Within the range of follow-up (12-18 months), 30.5% of patients’ partners achieved natural pregnancy in the varicocelectomy groups compared to 16.7% in the control group. Conclusion: We believe that varicocelectomy has a positive effect on the sperm morphology, SDF, and pregnancy rate in male infertility caused by isolated teratozoospermia. Cite this article as: Fathi A, Castiglione F, Mohamed O, Alsagheer GA, Mahmoud O, Saber-Khalaf M. Varicocelectomy versus antioxidants in infertile men with isolated teratozoospermia: A retrospective analysis. Turk J Urol. 2021;47(4):279-284.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.5152/tju.2021.21013

Cites

4 of 4 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Several studies have evaluated the role of varicocelectomy and antioxidants in improving sperm morphology, particularly for immature sperm and those with head and tail defects based on Kruger's classification.

    “Several studies have evaluated the role of varicocelectomy and antioxidants in improving sperm morphology, particularly for immature sperm and those with head and tail defects based on Kruger’s classification (97-104).”

    From Isolated teratozoospermia: revisiting its relevance in male infertility: a narrative review (2024) · cites this paper as [97]

    The Discussion reports that both varicocelectomy and oral antioxidants improved overall sperm morphology, and it describes earlier varicocelectomy studies using Kruger’s strict criteria. It does not report treatment effects specifically for immature sperm or sperm with head and tail defects; its mention of fewer head abnormalities concerns an association with natural pregnancy. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • In men with isolated teratozoospermia and clinical varicocele, antioxidants (L-carnitine, vitamin C, and vitamin E) significantly improve sperm morphology (0.9% vs 1.5%, P=0.04) after 6 months of treatment.

    “Fathi et al. showed that the use of antioxidants (L-carnitine, vitamin C, and vitamin E) could significantly improve sperm morphology (0.9% vs. 1.5%, P=0.04) and SDF rates (33% vs. 29%, P=0.03) after 6 months of treatment (97) among men with isolated teratozoospermia and clinical varicocele.”

    From Isolated teratozoospermia: revisiting its relevance in male infertility: a narrative review (2024) · cites this paper as [97]

    The Methods passage (Varicocelectomy) identifies the antioxidant regimen and six-month treatment period, and the Results report a statistically significant improvement in sperm morphology in the antioxidant control group. The passages available from our copy do not establish the specific change from 0.9% to 1.5% or P=0.04. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • In men with isolated teratozoospermia and clinical varicocele, antioxidants (L-carnitine, vitamin C, and vitamin E) significantly improve SDF rates (33% vs 29%, P=0.03) after 6 months of treatment.

    “Fathi et al. showed that the use of antioxidants (L-carnitine, vitamin C, and vitamin E) could significantly improve sperm morphology (0.9% vs. 1.5%, P=0.04) and SDF rates (33% vs. 29%, P=0.03) after 6 months of treatment (97) among men with isolated teratozoospermia and clinical varicocele.”

    From Isolated teratozoospermia: revisiting its relevance in male infertility: a narrative review (2024) · cites this paper as [97]

    The Abstract and Results report that the antioxidant-treated group had a statistically significant reduction in SDF after six months, and the Varicocelectomy section identifies the treatment as L-carnitine, vitamin C, and vitamin E. Our copy does not show the claimed SDF values of 33% and 29% or the exact P value of 0.03; the Results give only P<0.05 for the antioxidant group. Page numbers are unavailable in our copy. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • In men with isolated teratozoospermia and clinically palpable varicocele, varicocelectomy lowers SDF compared to antioxidant-only control.

    “A study on men with isolated teratozoospermia and clinically palpable varicocele reported an increase in all sperm parameters (concentration, motility, and morphology), lower SDF, and a higher rate of natural pregnancy at 30.5% in the varicocelectomy groups compared to 16.7% pregnancy rate in the control group that only received an antioxidant (L-carnitine, vitamin C, and vitamin E) (97).”

    From Isolated teratozoospermia: revisiting its relevance in male infertility: a narrative review (2024) · cites this paper as [97]

  • In men with isolated teratozoospermia and clinically palpable varicocele, varicocelectomy results in a higher natural pregnancy rate (30.5% vs 16.7%) compared to antioxidant-only control.

    “A study on men with isolated teratozoospermia and clinically palpable varicocele reported an increase in all sperm parameters (concentration, motility, and morphology), lower SDF, and a higher rate of natural pregnancy at 30.5% in the varicocelectomy groups compared to 16.7% pregnancy rate in the control group that only received an antioxidant (L-carnitine, vitamin C, and vitamin E) (97).”

    From Isolated teratozoospermia: revisiting its relevance in male infertility: a narrative review (2024) · cites this paper as [97]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 24

  1. Clavijo RI, Carrasquillo R, Ramasamy R. Varicoceles: Preva- lence and pathogenesis in adult men. Fertil Steril. 2017;108(3):364-369. [CrossRef] · DOI
  2. Gorelick JI, Goldstein M. Loss of fertility in men with varicocele. Fertil Steril. 1993;59(3):613-616. [CrossRef] · DOI
  3. Schauer I, Madersbacher S, Jost R, Hu ¨bner WA, Imhof M. The impact of varicocelectomy on sperm parameters: A meta-analy- sis. J Urol. 2012;187(5):1540-1547. [CrossRef] · DOI
  4. Baazeem A, Belzile E, Ciampi A, Dohle G, Jarvi K, Salonia A, et al. Varicocele and male factor infertility treatment: A new meta-analysis and review of the role of varicocele repair. Eur Urol. 2011;60(4):796-808. [CrossRef] · DOI
  5. Said TM, Agarwal A, Sharma RK, Thomas AJ Jr, Sikka SC. Impact of sperm morphology on DNA damage caused by oxidative stress induced by beta-nicotinamide adenine dinucleotide phosphate. Fertil Steril. 2005;83(1):95-103. [CrossRef] · DOI · Paper page
  6. Ammar O, Mehdi M, Muratori M. Teratozoospermia: Its associa- tion with sperm DNA defects, apoptotic alterations, and oxidative stress. Andrologia. 2020;8(5):1095-1106. [CrossRef] · DOI · Paper page
  7. Agarwal A, Saleh RA, Bedaiwy MA. Role of reactive oxygen species in the pathophysiology of human reproduction. Fertil Steril. 2003;79(4):829-843. [CrossRef] · DOI
  8. Danis RB, Samplaski MK. Sperm morphology: History, chal- lenges, and impact on natural and assisted fertility. Curr Urol Rep. 2019;20(8):43. [CrossRef] · DOI
  9. Vazquez-Levin MH, Friedmann P, Goldberg SI, Medley NE, Nagler HM. Response of routine semen analysis and critical assessment of sperm morphology by Kruger classification to ther- apeutic varicocelectomy. J Urol. 1997;158(5):1804-1807. [CrossRef] · DOI
  10. Okeke L, Ikuerowo O, Chiekwe I, Etukakpan B, Shittu O, Ola- pade-Olaopa O. Is varicocelectomy indicated in subfertile men with clinical varicoceles who have asthenospermia or teratosper- mia and normal sperm density? Int J Urol. 2007;14(8):729-732. [CrossRef] · DOI · Paper page
  11. Cakan M, Bakirtas H, Aldemir M, Demirel F, Altug U. Results of varicocelectomy in patients with isolated teratozoospermia. Urol Int. 2008;80(2):172-176. [CrossRef] · DOI · Paper page
  12. Cakiroglu B, Sinanoglu O, Gozukucuk R. The effect of varicoce- lectomy on sperm parameters in subfertile men with clinical vari- coceles who have asthenozoospermia or teratozoospermia with normal sperm density. ISRN Urol. 2013;2013:698351. [Cross- Ref] · DOI · Paper page
  13. Cooper TG, Noonan E, Von Eckardstein S, et al. World health organization reference values for human semen characteristics. Hum Reprod Update. 2010;16(3):231-245. [CrossRef] · DOI · Paper page
  14. Ferna ´ndez JL, Muriel L, Rivero MT, Goyanes V, Vazquez R, Alvarez JG. The sperm chromatin dispersion test: A simple method for the determination of sperm DNA fragmentation. J Androl. 2003;24(1):59-66. [CrossRef] · DOI · Paper page
  15. Agarwal A, Cho C-L, Majzoub A, Esteves SC. The society for translational medicine: Clinical practice guidelines for sperm DNA fragmentation testing in male infertility. Transl Androl Urol. 2017;6(Suppl. 4):S720-S733. [CrossRef] · DOI
  16. Goldstein M, Gilbert BR, Dicker AP, Dwosh J, Gnecco C. Micro- surgical inguinal varicocelectomy with delivery of the testis: An artery and lymphatic sparing technique. J Urol. 1992;148(6):1808-1811. [CrossRef] · DOI
  17. Delaroche L, Yazbeck C, Gout C, Kahn V, Oger P, Rougier N. Intracytoplasmic morphologically selected sperm injection (IMSI) after repeated IVF or ICSI failures: A prospective compar- ative study. Eur J Obstetr Gynecol Reprod Biol. 2013;167(1):76- 80. [CrossRef] · DOI
  18. Ilktac A, Hamidli S, Ersoz C, Dogan B, Akcay M. Efficacy of varicocelectomy in primary infertile patients with isolated terato- zoospermia: A retrospective analysis. Andrologia. 2020;28: E13875. [CrossRef] · DOI
  19. Wang YJ, Zhang RQ, Lin YJ, Zhang RG, Zhang WL. Relation- ship between varicocele and sperm DNA damage and the effect of varicocele repair: A meta-analysis. Reprod Biomed Online. 2012;25(3):307-314. [CrossRef] · DOI
  20. Chen SS, Huang WJ, Chang LS, Wei YH. Attenuation of oxida- tive stress after varicocelectomy in subfertile patients with varico- cele. J Urol. 2008;179(2):639-642. [CrossRef] · DOI
  21. Colpi GM, Francavilla S, Haidl G, et al. European academy of andrology guideline management of oligo-astheno-teratozoosper- mia. Andrology. 2018;6(4):513-524. [CrossRef] · DOI
  22. Moslemi MK, Tavanbakhsh S. Selenium-vitamin E supplementa- tion in infertile men: Effects on semen parameters and pregnancy rate. Int J Gen Med. 2011;4:99-104. [CrossRef] · DOI
  23. Lenzi A, Sgro `P, Salacone P, et al. A placebo-controlled double- blind randomized trial of the use of combined l-carnitine and l- acetyl-carnitine treatment in men with asthenozoospermia. Fertil Steril. 2004;81(6):1578-1584. [CrossRef] · DOI
  24. Majzoub A, Agarwal A. Systematic review of antioxidant types and doses in male infertility: Benefits on semen parameters, advanced sperm function, assisted reproduction and live-birth rate. Arab J Urol. 2018;16(1):113-124. [CrossRef · DOI

Cited by

Sorted by citations

Authors
Fathi, A., Castiglione, F., Mohamed, O., Alsagheer, G. A., Mahmoud, O., & Saber-Khalaf, M.
Affiliations
  • South Valley University (EG)
  • University College London (GB)
ORCID
Venue
Urology Research and Practice
Publisher
AVES YAYINCILIK A.Ş.
Published
2021-07-01
Volume
47
Issue
4
Pages
279-284
ISSN
  • 1300-5804 (ISSN-L)
  • 2980-1478
DOI
10.5152/tju.2021.21013
PMC
PMC9612765
OpenAlex
W3178165222
Cited by
7
References
4
Citations by year
2026: 1 · 2025: 1 · 2024: 3 · 2023: 1 · 2022: 1
FWCI
1.08
Type
journal article
Language
en
Open access
Locations
  • Urology Research and Practice (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics
  • Health Sciences › Medicine › Reproductive Medicine › Sperm and Testicular Function
  • Health Sciences › Health Professions › General Health Professions › Male Reproductive Health Studies
  • Health Sciences › Medicine › Reproductive Medicine › Reproductive Health and Technologies
Keywords
varicocelectomy, antioxidants, male infertility, teratozoospermia, varicocele, sperm morphology, sperm DNA fragmentation, L-carnitine, vitamin C, vitamin E, spontaneous conception, subinguinal varicocelectomy

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review