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

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.

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.

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.

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.