Evaluation of treatment modalities for pure asthenospermia regarding changes in seminal fluid parameters

Abstract

Background: Asthenospermia is one of the most frequent results seen in semen fluid analysis among infertile males. Even with broad diagnostic workup, the cause is often, sort of, unclear and that leads to ongoing debate about what the best management should actually be. Objective: To assess how well two treatment options work- subinguinal varicocelectomy and oral L-carnitine intake-in men who have pure asthenospermia, by looking at how their seminal fluid measurements change over time. Methods: This prospective study was carried out at AL-Yarmouk Teaching Hospital, Urology Department, Iraq between August 2021 and April 2022. A total of 118 infertile men with documented pure asthenospermia (verified by at least 2 initial semen fluid tests) were included. Participants were divided into a surgical group (n = 71, meaning clinically detected or even subclinical varicoceles) versus a medical group (n = 47, meaning no visible varicoceles). The surgical group received a subinguinal varicocelectomy, while the medical group was given oral L-carnitine 1 g/day. After that, all patients were followed for roughly 6 to 12 months using repeated seminal fluid assessments. Any adverse effects related to treatment were noted during the whole follow up. RESULTS In the surgical arm, there were 26 patients with grade 1, 23 with grade 2, and 12 with grade 3 varicoceles, plus 10 additional men with subclinical varicoceles. In the medical arm, 32 patients had no varicoceles, and 15 had subclinical varicoceles. After varicocelectomy there was a statistically meaningful improvement in total sperm motility, and the extent of gain seemed to track steadily with the varicocele grade. Men with subclinical varicoceles did not show a statistically significant improvement after the operation. L-carnitine supplementation also led to mild or moderate gains in sperm motility, but these changes still did not reach statistical significance, and importantly no important adverse events were recorded. Conclusions: Subinguinal varicocelectomy should be considered the more suitable option for pure asthenospermia in men who have clinically detectable varicoceles, especially because higher-grade disease tends to produce better results. L-carnitine, as a monotherapy, looks safe as an adjunct but it is not enough on its own to restore or normalize sperm motility measures.