RESPONSE OF ROUTINE SEMEN ANALYSIS AND CRITICAL ASSESSMENT OF SPERM MORPHOLOGY BY KRUGER CLASSIFICATION TO THERAPEUTIC VARICOCELECTOMY

Abstract

Purpose We studied the effect of varicocelectomy on Kruger morphology and semen parameters. Materials and Methods A total of 33 subfertile men diagnosed with varicoceles was evaluated 3 months before, and 3 to 4 and 6 to 8 months after varicocelectomy. Evaluation involved routine semen analysis and sperm morphology using Kruger classification. Results Significant improvement in sperm concentration and count was found after varicocelectomy (sperm count preoperatively 117.1 +/− 29, 3 to 4 months postoperatively 162.5 +/− 41 and 6 to 8 months postoperatively 139.8 +/− 25 million sperm, p = 0.0095). Using Kruger classification, evaluation of sperm morphology revealed overall significant increase in percentage of normal A forms at 3 to 4 and 6 to 8 months after surgery (from 9.8 +/− 5.8 % A forms, 13.6 +/− 7.7 % A forms, and 14.5 +/− 7.5 % A forms, respectively, p = 0.0002, normal greater than 14%). Twelve of the 26 patients (46%) with abnormal sperm morphology preoperatively and greater than 4% A forms reached normal levels 3 months postoperatively. Six months after surgery only 6 patients maintained normal values and 3 of the initial 14 nonresponders became normal (9 of 26, 36%). Three patients with severe teratozoospermia (less than 4% A forms) showed improvement in sperm morphology. Four patients with normal sperm morphology preoperatively were not affected by varicocelectomy. Conclusions Surgical correction of varicocele was associated with significant improvement in sperm morphology evaluated using Kruger classification. Concentration and count improved after varicocelectomy. Changes were observed as early as 3 months after surgery.