1991 EFFECT OF MICROSURGICAL VARICOCELE LIGATION ON SPERM DNA FRAGMENTATION, SPERM CONCENTRATION, AND TOTAL MOTILE SPERM COUNT IN SUBFERTILE MEN

Abstract

You have accessJournal of UrologyInfertility: Therapy1 Apr 20121991 EFFECT OF MICROSURGICAL VARICOCELE LIGATION ON SPERM DNA FRAGMENTATION, SPERM CONCENTRATION, AND TOTAL MOTILE SPERM COUNT IN SUBFERTILE MEN John McGill, MD Karen Baker, MD Rakesh Sharma, PhD Ashok Agarwal, andPhD Edmund SabaneghMD John McGillJohn McGill Cleveland, OH More articles by this author , Karen BakerKaren Baker Cleveland, OH More articles by this author , Rakesh SharmaRakesh Sharma Cleveland, OH More articles by this author , Ashok AgarwalAshok Agarwal Cleveland, OH More articles by this author , and Edmund SabaneghEdmund Sabanegh Cleveland, OH More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.2152AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Despite the well-established link between varicoceles and male subfertility, it remains difficult to predict which couples will benefit from surgery. The aims of our study were 1) to determine the effect of microsurgical varicocelectomy on sperm DNA fragmentation and oxidative stress levels and 2) to identify preoperative clinical and laboratory data which could predict postoperative improvements in semen parameters after varicocelectomy. METHODS Subinguinal microsurgical varicocelectomies performed by a single surgeon (ES) between OCT 2008 and OCT 2011 were identified through surgical logs. Clinical characteristics and laboratory data to include patient demographics, hormone levels, semen analysis, semen reactive oxygen species (ROS), total antioxidant capacity (TAC), and DNA fragmentation by TUNEL assay were recorded. Postoperative changes in semen parameters were calculated and significance determined using Wilcoxon signed-rank test. Regression was performed to identify predictors for postoperative improvement. RESULTS Eighty-two patients underwent subinguinal microsurgical varicocelectomy for infertility during the study period with a mean follow up period of 665 days. Sixty patients had both preoperative and postoperative semen analyses. Evaluation revealed a mean increase in semen concentration of 3.4 M/ml (p=0.023), motility of 4.8% (NS), strict morphology of 0.4% (NS) and total motile sperm count (TMC) of 15.8 M (p = 0.014). Sperm DNA fragmentation improved after varicocelectomy from 40% to 25% (p = 0.005). Regression analysis revealed the presence of a grade 3 varicocele predicted postoperative improvement in concentration and TMC. Longer duration of infertility and higher preoperative sperm DNA fragmentation predicted greater improvements in postoperative sperm DNA integrity. Additional parameters to include age, testicular volume by US, preoperative hormone levels, TAC and ROS did not appear to independently predict postoperative outcomes. CONCLUSIONS Sperm concentration, TMC and sperm DNA damage improved to a statistically significant degree after varicocelectomy. Higher varicocele grade predicted improvement in postoperative concentration and TMC. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e803 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information John McGill Cleveland, OH More articles by this author Karen Baker Cleveland, OH More articles by this author Rakesh Sharma Cleveland, OH More articles by this author Ashok Agarwal Cleveland, OH More articles by this author Edmund Sabanegh Cleveland, OH More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...