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Abstract

Volume 18, Issue 2 (March 2016) 18, 222–228; DOI:10.4103/1008-682X.171657

An update on the role of medical treatment including antioxidant therapy in varicocele

Harshit Garg, Rajeev Kumar

Department of Urology, All India Institute of Medical Sciences, New Delhi, India.

Correspondence: Dr. R Kumar (rajeev02@gmail.com)

Abstract

Varicocele‑associated male infertility has classically been managed using surgery or assisted reproductive techniques. With increasing
evidence of oxidative stress as a pathophysiological factor in varicocele‑associated infertility, medical therapy especially antioxidants
might become a treatment option with lower risks. We reviewed the existing literature on the role of various medical agents in the
management of male infertility attributed to varicoceles. Medical therapy is typically evaluated in three different situations such
as (a) comparison of two drugs or one drug with placebo, (b) comparison of drugs versus surgery, and (c) comparison of drugs as
adjuvant therapy with surgery versus drug therapy alone. Due to heterogeneity of data and lack of well‑conducted studies, there is
insufficient data to recommend routine use of medical therapy for men with varicocele‑associated infertility and surgery remains
the treatment of choice. Pregnancy and live birth rates are usually not reported in most studies and mere improvement in sperm
parameters or antioxidant capacity is insufficient to support its routine use. Antioxidant therapy is a potential option due to its
theoretical benefit, data from preclinical studies, and lack of major side effects. Adjuvant therapy with antioxidants after surgical
repair of varicocele may improve the outcome and is a potential area for further research.

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