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Effect of adjuvant vitamin E supplementation on sperm parameters after varicocelectomy: a systematic review and meta-analysis.

  • 2026-05-20
  • Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica 98(2)
    • Nafis Audrey Febriansyah
    • Agustin J Nanda De Niro
    • Fikri Rizaldi

Study Design

Type
Meta-Analysis
Sample size
n = 408
Population
408 participants (from five studies on varicocelectomy patients)
Methods
Systematic review and meta-analysis following PRISMA 2020; searched PubMed, ScienceDirect, Cochrane, Springer, and Scopus through February 16, 2026; included studies evaluating vitamin E, alone or in antioxidant combinations, after varicocelectomy

Introduction and objectives

Varicocele is associated with oxidative stress and impaired semen quality. Vitamin E is a lipid-soluble antioxidant that may augment postoperative recovery after varicocelectomy, but clinical evidence remains inconsistent. This study evaluated the effect of adjuvant vitamin E-based supplementation on semen parameters and pregnancy outcomes after varicocelectomy.

Materials and methods

This systematic review and meta-analysis followed PRISMA 2020 and was registered in PROSPERO (CRD420261309544). PubMed, ScienceDirect, Cochrane, Springer, and Scopus were searched through February 16, 2026. Studies evaluating vitamin E, alone or in antioxidant combinations, after varicocelectomy were included. Primary outcomes were sperm concentration and motility; secondary outcomes included morphology, sperm DNA fragmentation, pregnancy, and safety. Risk of bias was assessed using RoB 2.0 for randomized trials and the Newcastle-Ottawa Scale for the cohort study.

Results

Five studies involving 408 participants were included. Pooled analysis of two randomized trials showed no significant additional benefit of vitamin E versus control for sperm concentration (SMD 0.09, 95% CI-0.59 to 0.76; p = 0.80) or sperm motility (SMD 0.15, 95% CI-0.19 to 0.49; p = 0.39). Morphology and pregnancy outcomes were reported heterogeneously. Comparative studies suggested that varicocelectomy was superior to antioxidant-only regimens for morphology, sperm DNA fragmentation, and natural pregnancy, whereas vitamin E as a postoperative adjuvant did not show a consistent incremental benefit.

Conclusions

Current evidence does not demonstrate a consistent improvement in key semen parameters with adjuvant vitamin E supplementation after varicocelectomy. Larger trials with standardized regimens and clinically relevant outcomes are needed.

Research Insights

  • Vitamin E→Improved Sperm Concentration

    Pooled analysis of two randomized trials showed no significant additional benefit of vitamin E versus control for sperm concentration (SMD 0.09, 95% CI-0.59 to 0.76; p = 0.80)

    Effect
    Neutral
    Effect size
    Small
  • Vitamin E→Improved Sperm Motility

    Pooled analysis of two randomized trials showed no significant additional benefit of vitamin E versus control for ... sperm motility (SMD 0.15, 95% CI-0.19 to 0.49; p = 0.39)

    Effect
    Neutral
    Effect size
    Small
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