Abstract
OBJECTIVE: To compare the outcomes of microscopic subinguinal varicocelectomy versus oral antioxidants in managing male infertility associated with isolated teratozoospermia. METHODS: This multicenter randomized controlled trial was conducted between January 2022 and January 2024. A total of 81 patients with isolated teratozoospermia and clinical varicoceles completed the study; 40 patients underwent varicocele ligation (group A), and 41 patients received oral antioxidants (L-carnitine, vitamin C, and vitamin E) (group B). Sperm morphology, sperm DNA fragmentation (SDF), and the achievement of natural pregnancy were compared between the two groups. Additionally, predictive factors for improvement were analyzed. RESULTS: All sperm parameters improved significantly following either varicocele ligation or antioxidant treatment. SDF decreased significantly in both groups (p<0.001). The increase in the percentage of normal sperm forms and the reduction in SDF were significantly greater in the varicocele surgery group compared to the antioxidant group (p=0.007 and p=0.013, respectively). The natural pregnancy rate was higher in the varicocele ligation group, with nine patients (22.5%) achieving pregnancy compared to five patients (12.5%) in the antioxidant group. Moreover, the presence of pinpoint and round head abnormalities predicted significantly poorer outcomes following varicocele ligation (p=0.003). CONCLUSION: Varicocelectomy appears to be more effective than antioxidants in improving sperm morphology, reducing SDF, and enhancing the natural pregnancy rate in male infertility due to isolated teratozoospermia.