Evaluation of Treatment Modalities for Pure Asthenospermia Regarding Changes in Seminal Fluid Parameters

Abstract

Background: Asthenospermia is one of the most common findings in the seminal fluid analysis of patients with infertility. In spite of a full diagnostic workup, the causes of Asthenospermia are not always clear; accordingly, there are a lot of controversies about the best treatment for such a condition. Aim of the study: To evaluate the validity of two treatment modalities for patients with pure Asthenospermia, one surgical (varicocelectomy) and the other medical (L-carnitine supplementation), by following changes in seminal fluid parameters. Patients and methods: A prospective study was conducted at AL-Yarmouk Teaching Hospital/Urology Department from 23rd August 2021 to 18th April 2022. One hundred eighteen infertile male patients were included. Patients were divided in two groups: Surgical arm (71 patients with different grades of varicoceles) and the medical arm (47 patients with no overt clinical varicoceles). For all patients, a full assessment had been done, including at least two seminal fluid analyses as a baseline (to document the presence of pure Asthenospermia). Surgical arm patients were treated with subinguinal varicocelectomy, and medical arm patients were treated with oral supplementation of L-carnitine 1 gm/day. Patients in both groups were followed for 6-12 months by repeated seminal fluid analyses to check the changes in sperm motility. Adverse effects of the treatment were also checked during follow-up visits. Results and Discussion: Surgical arm patients included were 26,23, and 12 patients with varicocele grades 1,2, and 3, respectively, and ten patients with subclinical varicoceles. Medical arm patients included were 32 patients with no varicoceles and 15 patients with subclinical varicoceles. Changes in seminal fluid parameters (total Sperms motility status) after treatment were statistically significant in the varicocelectomy group, and improvement in the seminal fluid parameters was directly related to the grade of the varicoceles with no significant improvement in the patients with subclinical varicoceles. In the medical arm, we achieved an improvement in sperm motility status, but it was not statistically significant. Conclusion: Patients with pure Asthenospermia and clinically detected varicoceles are best treated by varicocelectomy, and the more grade varicoceles, the better results are achieved. L-carnitine supplementation for patients with pure Asthenospermia proved to be beneficial and safe, but when given alone, it was not enough to raise sperm motility status to normal values.