Clinical Outcomes and Management of Post-varicocelectomy on Male Fertility: A Comprehensive Review

Background: Varicocelectomy is one of the main complications that, if left untreated, results in male infertility. Various approaches have been adopted to manage it, but there is a variation in the consensus. Objectives: This systematic review aims to summarize the evidence on the various clinical trials and post-varicocelectomy recovery for patients consuming different supplements or regimens. Methodology: An organized and systematic literature search was conducted in five electronic databases from their inception till 2021. Upon applying the PICOT format and student inclusion criteria, only n = 13 articles fulfilled the eligibility criteria and were selected for this systematic review. Results: A total of 13 studies were included in this systematic review, and different outcomes were measured in all the studies. Generalizing the outcomes measured, they are classified in semen parameters, including sperm count, sperm motility percentage, sperm with standard morphology percentage, semen volume, sperm density, hormonal profile including testosterone (nanograms/liter), follicle-stimulating hormone (international units/liter), luteinizing hormone (international unit/ liter), seminal oxidative stress including total antioxidant capacity (mm Trolox equivalent per liter), and pregnancy outcome. Conclusion: This systematic review suggests improved sperm count and pregnancy outcomes with pharmacotherapeutic interventions. Oral antioxidants, vitamin C, and vitamin E showed marked improvements in sperm density and reduction in sperm DNA damage. Oral supplements, that is, saffron, were also effective but needed larger, well-conducted randomized clinical trials to validate the findings and estimate the overall impact of these interventions in the post-varicocelectomy period.