Antioxidant therapy of male infertility in patients with varicocele

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Abstract

BACKGROUND: The study of the relationship between the presence of varicocele and male infertility is the subject of numerous studies, while many aspects of impaired spermatogenesis remain unclear. It has been established that after surgical treatment of varicocele, fertility is not restored in a significant number of patients. In this regard, the search for new and pathogenetically substantiated methods of treating such patients seems to be very relevant.

AIM: To evaluate the effectiveness of antioxidant therapy in spermatogenesis disorders in men with varicocele, prescribed both in combination with surgery and as monotherapy.

MATERIALS AND METHODS: Three groups of infertile men with varicocele were observed, who were treated with Speroton (a complex containing folic acid, L-carnitine, zinc, selenium, vitamin E) 1 sachet once a day, the duration of the course was three months. Patients of the first group (n = 43) were prescribed the drug after the Ivanissevich operation, the patients of the second group (n = 37) received antioxidant therapy during three months before the Ivanissevich operation and continued for three months after it. Patients of the third group (n = 21) did not undergo surgery, but received only antioxidant therapy for six months. The results of the combined treatment and conservative therapy with Speroton were compared with the results of treatment of 65 infertile patients who underwent only Ivanissevich’s operation.

RESULTS: In patients with varicocele with initially pathological parameters of ejaculate, who were prescribed drugs with antioxidant properties in the postoperative period as an adjuvant treatment for 3 months, in 76.7% of cases there was a change in spermogram indicators towards improvement. The most significant changes were observed six months after the operation and subsequent adjuvant therapy. The indicators characterizing sperm motility underwent more noticeable changes. In patients who received only antioxidant therapy for six months, in all cases, there was a statistically significant (p < 0.001) improvement in sperm motility, which persisted for six months and exceeded these changes in groups of patients with adjuvant therapy and neo- and adjuvant therapy.

CONCLUSIONS: The results obtained allow us to conclude that there is no need for surgical treatment for varicocele in order to treat male infertility, since the operation itself can negatively affect the state of spermatogenesis, and conservative antioxidant therapy leads to better results in infertility treatment than the performed operation or any combination of it with antioxidant therapy.

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About the authors

Valentin N. Krupin

Privolzhsky Research Medical University

Email: vn.krupin@mail.ru
ORCID iD: 0000-0002-4887-4888
SPIN-code: 8892-7661
Scopus Author ID: 7003284228
https://famous-scientists.ru/2330

Dr. Sci. (Med.), Professor, Head of the Department of Urology named after E.V. Shakhov

Russian Federation, Nizhny Novgorod

Natalya A. Nashivochnikova

Privolzhsky Research Medical University

Email: dom17.doctor@mail.ru
ORCID iD: 0000-0002-1138-1174
SPIN-code: 5753-4302
Scopus Author ID: 55889021200

Cand. Sci. (Med.), Associate professor

Russian Federation, Nizhny Novgorod

Mikhail N. Uezdnyj

Privolzhsky Research Medical University

Author for correspondence.
Email: uezdny_79@mail.ru
ORCID iD: 0000-0001-5286-4802
SPIN-code: 9545-3730

Postgraduate student

Russian Federation, Nizhny Novgorod

References

  1. Elder J. Does the Evidence Support Adolescent Varicocelectomy? Eur Urol. 2019;75(3):462–463. doi: 10.1016/j.eururo.2018.10.059
  2. Sizonov VV, Makarov AG, Kramarov AI, Kogan MI. Varicocelectomy in adolescents: who and when to operate. Urology. 2015;(2): 107–111. (In Russ.)
  3. Zhou T, Zhang W, Chen Q, et al. Effect of varicocelectomy on testis volume and semen parameters in adolescents: a meta-analysis. Asian J Androl. 2015;17(6):1012–1016. doi: 10.4103/1008-682X.148075
  4. Erdoğan H, Durmaz MS, Özbakır B, et al. Experience of using shear wave elastography in evaluation of testicular stiffness in cases of male infertility. J Ultrasound. 2020;23(4):529–534. doi: 10.1007/s40477-020-00430-5
  5. Bavil’skij VF, Suvorov AV, Kandalov AM, et al. Narushenie spermatogeneza u bol’nyh varikocele do i posle operacii. Andrologija i genital’naja hirurgija. 2000;1(1):42–43. (In Russ.)
  6. Zhiborev BN. O diagnostike i lechebnoj taktike pri varicocele. Andrologija i genital’naja hirurgija. 2000;1(1):39–41. (In Russ.)
  7. Godlevskij DN. Kondakov VT. Funkcional’nye rezul’taty hirurgicheskogo lechenija varikocele u detej i podrostkov. In: Tezisy I Kongressa professional’noj associacii andrologov Rossii. Moscow, 2001. 95 p. (In Russ.)
  8. Shormanov IS, Ryzhkov AI. Varikoceljektomija v lechenii besplodija, associirovannogo s vysokim urovnem antispermal’nyh antitel. Proceedings of the Congress of the Russian Society of Urology and the Russian-Chinese Urology Forum; Ekaterinburg, Nov 8–10 2018. Ekaterinburg, 2018. P. 264. (In Russ.)
  9. Barnes F., Rabara F., Murphy A., et al. Live births after IVF in men with a DNA fragmentation index of 30 % or greater as determined by the sperm chromatin structure assay (SCSA™). Fertil Steril 2004;82(Suppl 2): S47. doi: 10.1016/j.fertnstert.2004.07.121
  10. Markova EV, Zamaj AS. Fragmentacija DNK v spermatozoidah cheloveka. Problemy Reprodukcii. 2006;(4):42–50. (In Russ.)
  11. Korshunov MN, Korshunova ES, Darenkov SP. Sperm DNA fragmentation: etiology, pathogenesis, the influence on reproductive function. Urology reports (St. Petersburg). 2020;10(4):337–345. (In Russ.) doi: 10.17816/uroved44804
  12. Aitken RJ, Jones KT, Robertson SA. Reactive oxygen species and sperm function – in sickness and in health. J Androl. 2012;33(6):1096–1106. doi: 10.2164/jandrol.112.016535
  13. Pavlov VN, Galimova JeF, Kataev VA, et al. The comparative analysis of coenzyme q and l-carnitine antioxidant effects in men with idiopathic pathospermia. Bashkir State Medical University. 2013;8(6):161–163. (In Russ.)
  14. Popova AJu, Gamidov SI, Ovchinnikov RI. Use of antioxidants in a combination therapy of male infertility during inflammatory diseases. Jeffektivnaja Farmakoterapija. Urologija i Nefrologija. 2015;(35): 34–44. (In Russ.)
  15. Greco E, Iacobelli M, Rienzi L, et al. Reduction of the incidence of sperm DNA fragmentation by oral antioxidant treatment. J Androl. 2005;26(3):349–353. doi: 10.2164/jandrol.04146
  16. Kalinina SN, Korenkov DG, Fesenko VN. Treatment of spermatologic disorders and oxidative stress after reproductively significant diseases caused by sexually transmitted infection. Urologicheskie vedomosti. 2018;8(4):5–15. (In Russ.) doi: 10.17816/uroved845-15
  17. Rudneva SA, Bragina EE, Arifulin EA. DNA fragmentation in spermatozoa and its relationship with impaired spermatogenesis. Andrology and Genital Surgery. 2014;15(4):26–33. (In Russ.) doi: 10.17650/2070-9781-2014-4-26-33
  18. Kirilenko EA, Onopko VF. Oxidative stress and male fertility: modern view on the problem. Acta Biomedica Scientifica (East Siberian Biomedical Journal). 2017;2(2):102–108. (In Russ.) doi: 10.12737/article_59a614fd84d146.40261567
  19. Nashivochnikova NA, Krupin VN, Selivanova SA. Antioxidant therapy for infertile couples. Urologiia. 2015;(3):71–74. (In Russ.)
  20. Novikov AI, Fesenko VN, Koren’kov DG, et al. A new look at correction of oxidative stress in seminal plasma of men with pathospermia in infertile couples. Urology and Andrology. 2016;4(3):11–17. (In Russ.) doi: 10.20953/2307-6631-2016-3-11-17
  21. Korenkov DG, Pavlov AL, Kazimzade ED. The influence of BESTFertil towards male reproductive function in idiopathic fertility. Andrology and Genital Surgery. 2018;19(4):54–59. (In Russ.) doi: 10.17650/2070-9781-2018-19-4-54-59
  22. Bozhedomov VA, Shomarufov AB, Bozhedomova GE, et al. Varicocele and reproductive function: pathozoospermia treatment (a prospective comparative study). Urologiia. 2021;(2):62–68. (In Russ.) doi: 10.18565/urology.2021.2.62-68
  23. Weese DL, Peaster ML, Himsl KK, et al. Stimulated reactive oxygen species generation in the spermatozoa of infertile men. J Urol. 1993;149(1):64–67. doi: 10.1016/s0022-5347(17)36000-7
  24. Mazzilli F, Rossi T, Marchesini M, et al. Superoxide anion in human semen related to seminal parameters and clinical aspects. Fertil Steril. 1994;62(4):862–868. doi: 10.1016/s0015-0282(16)57017-4
  25. Allamaneni SS, Naughton CK, Sharma RK, et al. Increased seminal reactive oxygen species levels in patients with varicoceles correlate with varicocele grade but not with testis size. Fertil Steril. 2004;82(6):1684–1686. doi: 10.1016/j.fertnstert.2004.04.071
  26. Wang YJ, Zhang RQ, Lin YJ, et al. Relationship between varicocele and sperm DNA damage and the effect of varicocele repair: a meta-analysis. Reprod Biomed Online. 2012;25(3):307–314. doi: 10.1016/j.rbmo.2012.05.002
  27. Bokov AI, Kyzlasov PS, Abdulhamidov AN. Jeffektivnost’ mikrohirurgicheskoj varikoceljektomii pri muzhskom besplodii s posledujushhej stimuljaciej spermatogeneza. In: Materialy 1-j nauchno-prakticheskoj konferencii urologov Severo-Zapadnogo federal’nogo okruga RF s mezhdunarodnym uchastiem “Aktual’nye voprosy urologii”. Urologicheskie vedomosti. 2015;5(1):38. (In Russ.)
  28. Shestaev AJu, Kushnirenko NP, Pitomcev IM, et al. Vlijanie oksigenobaroterapii i profertila na kachestvo jejakuljata muzhchin posle operativnogo lechenija varicocele. In: Materialy 1-j nauchno-prakticheskoj konferencii urologov Severo-Zapadnogo federal’nogo okruga RF s mezhdunarodnym uchastiem “Aktual’nye voprosy urologii”. Urologicheskie vedomosti. 2015;5(1):50. (In Russ.)
  29. Taktarov VG, Strachuk AG, Gushchina YuSh. Treatment of male infertility in varicocele. Clinical observation. Difficult Patient. 2018;16(11):64–66. (In Russ.) doi: 10.24411/2074-1995-2018-10035
  30. Povelitsa EA, Leanovich VE, Dosta NI, et al. Combined treatment of oligoasthenospermia by postoperative Speroton therapy in patients with varicocele. Andrology and Genital Surgery. 2020;21(2): 64–69. (In Russ.) doi: 10.17650/2070-9781-2020-21-2-64-69

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