Improved semen parameters and sperm deoxyribonucleic acid fragmentation following microscopic varicocelectomy: short term results of a prospective study
DOI:
https://doi.org/10.18203/2349-2902.isj20240928Keywords:
Sperm DNA fragmentation, Varicocelectomy, Semen analysisAbstract
Background: Assessment of sperm deoxyribonucleic acid (DNA) damage post varicocelectomy, has brought about new prospects in treating men with infertility. Improvements in spermatogenesis with decrease in sperm DNA damage has been demonstrated which has led to significant enhancement in fertility rates. Therefore, we evaluated the efficacy of microscopic varicocelectomy on the reduction in sperm DNA damage in concurrence to the conventional improvement of semen parameters.
Methods: All patients with a diagnosis of varicocele leading to infertility and planned for microscopic varicocelectomy from January 2013 through September 2019, were included in the study. Sperm chromatin structure assay (SCSA) was done preoperatively and at 3 and 6 months postoperatively for sperm DNA integrity assessment and the results expressed as sperm percentage DFI were compared. A p value <0.05 was considered statistically significant.
Results: 105 infertile men underwent microscopic varicocelectomy. Mean age and infertility period from the date of unprotected sex were 26.5±5.6 years and 30 months respectively. Baseline mean sperm concentration was 29 million/ml, mean progressive motility 24% and a percentage DFI ranged from 5–36% with a mean of 16%. Sperm DNA integrity improved significantly with a DFI decrease from 25±11% to 18±6%, 3 months post-surgery which was consistent at 6 months (13±5%). Sperm concentration and progressive motility increased with a mean sperm count improvement by 21.9 million/ml and mean motility by 20.3%.
Conclusions: Microscopic varicocelectomy provides durable improvement in DNA integrity and semen parameters. Sperm DNA integrity assessment using SCSA is a useful tool to demonstrate change in the semen quality post treatment.
References
Turner KA, Rambhatla A, Schon S, Agarwal A, Krawetz SA, Dupree JM, et al. Male Infertility is a Women's Health Issue-Research and Clinical Evaluation of Male Infertility Is Needed. Cells. 2020;9(4):990.
Cho CL, Agarwal A. Role of sperm DNA fragmentation in male factor infertility: A systematic review. Arab J Urol. 2017;16(1):21-34.
Alvarez Sedó C, Bilinski M, Lorenzi D, Uriondo H, Noblía F, Longobucco V, et al. Effect of sperm DNA fragmentation on embryo development: clinical and biological aspects. JBRA Assist Reprod. 2017;21(4):343-50.
Alahmar AT. Role of Oxidative Stress in Male Infertility: An Updated Review. J Hum Reprod Sci. 2019;12(1):4-18.
Pastuszak AW, Wang R. Varicocele and testicular function. Asian J Androl. 2015;17(4):659-67.
Schlesinger MH, Wilets IF, Nagler HM. Treatment outcome after varicocelectomy: a critical analysis. Urol Clin North Am. 1994;21:517-29.
Shaha C, Tripathi R, Mishra DP. Male germ cell apoptosis: regulation and biology. Philos Trans R Soc Lond B Biol Sci. 2010;365(1546):1501-15.
Bungum M. Sperm DNA integrity assessment: a new tool in diagnosis and treatment of fertility. Obstet Gynecol Int. 2012;531042.
De Iuliis GN, Thomson LK, Mitchell LA, Finnie JM, Koppers AJ, Hedges A, et al. DNA damage in human spermatozoa is highly correlated with the efficiency of chromatin remodelling and the formation of 8-hydroxy-2'-deoxyguanosine, a marker of oxidative stress. Biol Reprod. 2009;81(3):517-24.
Evenson DP, Jost LK, Marshall D, Zinaman MJ, Clegg E, Purvis K, et al. Utility of the sperm chromatin structure assay as a diagnostic and prognostic tool in the human fertility clinic. Hum Reprod. 1999;14:1039-49.
Spano M, Bonde JP, Hjollund HI, Kolstad HA, Cordelli E, Leter G. Sperm chromatin damage impairs human fertility. The Danish First Pregnancy Planner Study Team. Fertil Steril. 2000;:43-50.
Bungum M, Humaidan P, Axmon A, Spano M, Bungum L, Erenpreiss J, Giwercman A. Sperm DNA integrity assessment in prediction of assisted reproduction technology outcome. Hum Reprod. 2007;22(1):174-9.
Zini A, Boman JM, Belzile E, Ciampi A. Sperm DNA damage is associated with an increased risk of pregnancy loss after IVF and ICSI: systematic review and meta-analysis. Hum Reprod. 2008;23(12):2663-8.
Adiga SK, Upadhya D, Kalthur G, Bola Sadashiva SR, Kumar P. Transgenerational changes in somatic and germ line genetic integrity of first-generation offspring derived from the DNA damaged sperm. Fertil Steril. 2010;93(8):2486-90.
Arafa M, ElBardisi H. Clinical implication of DNA fragmentation in male infertility. Transl Androl Urol. 2017;6(4):S656-7.
Cissen M, Wely MV, Scholten I, Mansell S, Bruin JP, Mol BW, et al. Measuring Sperm DNA Fragmentation and Clinical Outcomes of Medically Assisted Reproduction: A Systematic Review and Meta-Analysis. PLoS One. 2016; 11(11):e0165125.
Evenson DP. Evaluation of sperm chromatin structure and DNA strand breaks is an important part of clinical male fertility assessment. Transl Androl Urol. 2017;6(4):S495-500.
Cho CL, Esteves SC, Agarwal A. Novel insights into the pathophysiology of varicocele and its association with reactive oxygen species and sperm DNA fragmentation. Asian J Androl. 2016;18(2):186-93.
Agarwal A, Roychoudhury S, Bjugstad KB, Cho CL. Oxidation-reduction potential of semen: what is its role in the treatment of male infertility? Ther Adv Urol. 2016;8(5):302-18.
Zini A, Blumenfeld A, Libman J, Willis J. Beneficial effect of microsurgical varicocelectomy on human sperm DNA integrity. Hum Reprod. 2005;20(4):1018-21.
