The impact of ipsilateral testicular atrophy on semen analysis and DNA fragmentation response to varicocele repair

Abstract

The purpose of this study is to assess the response in semen parameters and sperm DNA fragmentation index (DFI) in men with ipsilateral testicular atrophy secondary to a varicocele in comparison to men without testicular atrophy. A retrospective chart review was performed. Men who underwent varicocele repair for subfertility were categorized into 2 groups, those with testicular atrophy (TA) in the ipsilateral testicle and those with no testicular atrophy (NTA). Semen parameters and DFI in both groups were compared preoperatively and 3 months postoperatively. Morphology was not included due to lack of standardization of criteria in different labs with some using WHO 4th edition criteria and others using strict Kruger morphology criteria. From 10/2010 and 1/2019, 359 varicocele repairs were performed by a single microsurgeon and 141 varicocele repairs met inclusion criteria. Exclusion criteria included men who underwent bilateral varicocele repairs, men with bilateral testicular atrophy, men with a history of cryptorchidism or testicular torsion, men who underwent varicocele repair for hypogonadism or orchialgia and not for fertility, men who were azoospermic preoperatively, and men who did not obtain a 3-month postoperative semen analysis because they achieved a pregnancy prior to then or who did not follow up. Student’s test was used with a p value of < 0.05 considered statistically significant. Results were expressed as means ± standard deviations. Of the 141 men who were included, 20 were in the TA group and 121 were in the NTA group. There was no statistically significant difference in age between the 2 groups, 34.3 (6.5) in TA group and 34.1 (5.8) in the NTA group. The grades of varicoceles were similar in both groups: TA group had 10% grade 1, 55% grade 2, 35% grade 3; while the NTA group had 6.7% grade 1, 58.7% grade 2, and 34.7% grade 3. There was no statistically significant difference in preoperative semen parameters between the two groups including semen volume, sperm concentration, motility, forward progressive motility (FP), and total motile count (TMC). The NTA group had a higher preoperative DFI than the TA group: 35.3% vs 29.7% respectively. Although both groups revealed an improvement in semen parameters postoperatively, the TA group only showed a statistically significant improvement in DFI from 29.7% (5) to 22% (0), whereas the NTA group showed statistically significant improvements in concentration, motility, FP, TMC, and DFI. The mean change in preoperative to postoperative parameters when comparing groups only revealed a significant difference in TMC and DFI, with a larger mean improvement in the NTA group than the TA group. Men with ipsilateral testicular atrophy secondary to varicoceles have improved overall semen parameters and DFI after varicocele repair, but do not get as significant of an improvement as men without testicular atrophy. However, only TMC and DFI have a significantly greater mean change in preoperative to postoperative response in the NTA group compared to the TA group.