Varicocele does not always lead to infertility; varicocelectomy does not always improve sperm. Objective: to evaluate the standardized effect (Es) of nutrient therapy, microsurgical and laparoscopic varicocelectomy for pathozoospermia. Study design: a multicenter case-control study with stratified randomization. Materials and methods: data of a clinical and laboratory examination of patients with clinical varicocele over a 3-month period in the groups: A) the observation/control group (n=33), B) the group treated with nutrients (n=63), C) the group of patients after microsurgical varicocelectomy with a subinguinal mini access (n=86), D) the group of patients following laparoscopic surgery (n=36). The ejaculate was evaluated according to WHO-2010, DNA fragmentation by chromatin dispersion in an agarose gel. Results. After 3 months, varicocelectomy leads to an increase in sperm concentration and motility: the median of the total number of progressively motile spermatozoa in the ejaculate in A is +0.4 million;
B – +1.9 million; C – +17.1 million (p<0.05); D – +21.2 million (p<0.05). A clinically significant increase in this indicator after varicocelectomy was found in 2/3 of cases: 65% (B; p<0.05) and 67% (G; p<0.05) with 38% (A) and 42% (B). Varicocelectomy leads to a decrease in sperm DNA fragmentation by an average of 5.5% (p<0.05) with an improvement in 59% of patients, but a 3-month therapy with nutrients reduces DNA fragmentation in a similar way: 5.5% (p<0.05), 66% of improvement cases. The differences in effect between B and D are insignificant (p>0.05). The laparoscopic surgery demonstrated higher Es than microsurgical operation (Es=0.70 and 0.44, with 0.29 in the patient receiving nutrients and 0.22 in the patients in the control group) Conclusion Varicocelectomy significantly improves sperm quality in 2/3 of cases, including 5.5% decrease in DNA fragmentation. Nutrient therapy produces similar DNA fragmentation improvement. Further research is necessary to identify who really requires varicocelectomy and who does not.

Keywords: DNA fragmentation, spermogram, varicocelectomy, male infertility, varicocele