P-024 Effect of microsurgical varicocelectomy on fertility potential in patients with low sperm vitality

Abstract

Abstract Study question Does microsurgical varicocelectomy improve semen parameters and fertility potential in patients with low sperm vitality? Summary answer Micro surgical varicocelectomy in patients with low sperm vitality is beneficial as it results in significant improvement in sperm count and progressive motility. What is known already Low sperm vitality (Necrozoospermia) indicates the presence of higher percentage of necrotic/ dead sperm in the ejaculate which can impair fertility potential. Varicocele induced testicular hyperthermia is among the most common causes of impaired semen quality, including necrozoosprmia. While many studies confirmed the beneficial effect of varicocelectomy on different semen parameters, very few have evaluated its role on sperm vitality in particular. Study design, size, duration A retrospective study of 1521 patients who underwent microsurgical sub inguinal varicocelectomy in our center from 2011–2021. A total of 115 patients with clinical varicocele and low sperm vitality (<58%) were included. Participants/materials, setting, methods The exclusion criteria were history of genitourinary tract infection, exposure to heat, drugs or toxic compounds, hormonal disturbances or prior infertility related treatments. Patients demographics, and clinical data were collected, in addition to the pre- and post-operative Semen analysis (WHO 5th edition), sperm DNA fragmentation (Halosperm) and hormonal profile (estradiol, FSH, LH, Prolactin, Testosterone). Spearman’s correlations and Wilcoxon Signed Ranked Test were used for data analysis. Main results and the role of chance Mean age was 34.9±7.6 years. Varicocelectomy was done on left side in 75 patients and bilateral in 40 patients. Sperm vitality was significantly negatively correlated with sperm DNA fragmentation (-0.618, p = 0.000) and abnormal sperm morphology (-0.435, p = 0.000, while it was significantly positively correlated with total motility (0.674, p = 0.000) & progressive motility (0.272, p = 0.003). The median (IQR) sperm vitality pre-operatively was 41% (30-50) and the level increased post-operatively to 54% (31-63). There was a significant improvement in post-operative sperm count, progressive motility as well as LH and FSH levels. Improvements were also noted in total motility, normal morphology and sperm DNA fragmentation however the result didn’t reach statistical significance. Limitations, reasons for caution The main limitation is the retrospective design of the study and it did not evaluate the pregnancy outcomes. Wider implications of the findings Improvement in semen parameters by microsurgical varicocelectomy in patients with low sperm vitality is important as it may change the management plan for patients and extend their fertility options to natural conception or intrauterine insemination instead of only intracytoplasmic sperm injection. Trial registration number not applicable