Diagnosis – the first step to a baby

“Micronutrients as an alternative to fertility management in men with subclinical varicocele”

Schauer I., Jost R., Imhof M.;
presented at EAU Bratislava 2010;
presented at Fortbildungstagung der Österr. Gesellschaft für Urologie und Andrologie, Linz, Austria 2010
 


Approximately 15-20% of all adult males have a varicocele. In men with primary fertility this rate increases to 40%, in men with secondary infertility, i.e. previous and current infertility, it even goes up to 70% (ASRM: Practice Committee 2006). The precise mechanism for the harmful effect of varicocele on testes, sperm quality or ultimately reproductive capacity has not been conclusively established and appropriate treatment and indication is still subject of on-going discussion.

Varicocele and oxidative stress

One of the most important pathophysiological and therapeutic approaches indicates high levels of oxidative stress in the testes of men with varicocele. It has been established that varicocele patients have an imbalance between reactive oxygen species and antioxidant capacity, as well as the suspected inadequate biosynthesis of the antioxidant coenzyme Q10; both are the primary causes of oxidative damage. These manifest themselves particularly in the cell membranes with a high portion of unsaturated fatty acids, such as the membranes of sperm.

How to handle varicocele?

While micronutrients and antioxidants are often used with good results in men with idiopathic infertility, they are still relatively unexplored as further option for men with varicocele. With varicocele, the typical approach would be to improve the environment by reducing inflammation and oxidative stress with anti-inflammatory drugs (NSAIDs) as well as antioxidant substances such as vitamin E, glutathione and coenzyme Q10. The use of L-carnitine and L-acetylcarnitine, both of which are essential for the transport of fatty acids, either alone or in combination with an anti-inflammatory drug, also appears to be a viable dietary management option.

Study design:

In this study at the Fertility Centre at the Medical University of Vienna (Austria), after exclusion of infections, aspermia and hormone disorders, 55 men (ages: 18-43; average age 32) with subclinical varicocele (WHO classification 0.1), two abnormal semen analyses (at least one month apart) and infertility for more than two years (average 2.7 years) were given a combination of micronutrients (PROfertil®), containing L-carnitine, L-arginine, vitamin E, folic acid, zinc, selenium, glutathione, and coenzyme Q10 over a period of three months.


Study results

The post-trial evaluation resulted in an improvement of all sperm parameters and the occurrence of a pregnancy in 41.18%.25

Conclusion

  • The post-trial evaluation resulted in improvement of all sperm parameters and the occurrence of pregnancy in 41.18%
  • Supplementation with specific micronutrients seems to offer a possibility of improving sperm quality and thus fertility particularly for men with subclinical and low-grade varicoceles, for whom a surgical or interventional cure is not indicated or holds more risk than benefit
  • No adverse effects