Fertility Rate and Sperm DNA Fragmentation Index following Varicocelectomy in Primary Infertile Men with Clinical Varicocele: A Prospective Longitudinal Study

Document Type : Original Article

Authors

1 Urology Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran

2 Department of Urology, Labbafinejad Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IranTehran university of medical science

3 Pars Hospital, Rasht, Iran

4 Department of Urology, Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran

Abstract

Background: Varicocele is one of the most common treatable causes of male infertility, and its treatment may be
beneficial for fertility. This study aimed to evaluate fertility rate and DNA fragmentation index (DFI) following varicocelectomy
in primary infertile men with clinical varicocele.
Materials and Methods: This prospective longitudinal study was conducted on primary infertility men, in a tertiary
center from December 2018 to December 2019 with one-year follow-up. Data of the semen parameters, DFI (%), and
fertility rate were gathered before, as well as 4 and 12 months after undergoing varicocelectomy. For data analysis,
SPSS software and analytical test were used.
Results: Out of 76 patients who were analyzed, 22 (29%) became fertile and 54 (71%) remained infertile. Semen
parameters and DFI (%) were improved significantly following varicocelectomy (P<0.001). Smoking history, occupational
heated exposure, body mass index (BMI), and infertility duration were determined as predictors associated
with fertility status (P<0.05).
Conclusion: Although varicocele repair improved the DFI, the fertility rate was achieved in less than one-third of
patients; it seems that the other parameters, such as the history of smoking, occupational heated exposure, overweight,
and duration of infertility should be considered as predictors of fertility status, in primary infertile men who are a candidate
for varicocelectomy.

Keywords

Main Subjects

References

  1.  

    1. Vander Borght M, Wyns C. Fertility and infertility: definition and epidemiology. Clin Biochem. 2018; 62: 2-10.
    2. Agarwal A, Mulgund A, Hamada A, Chyatte MR. A unique view on male infertility around the globe. Reprod Biol Endocrinol. 2015; 13: 37.
    3. Jungwirth A, Giwercman A, Tournaye H, Diemer T, Kopa Z, Dohle G, et al. European association of urology guidelines on male infertility: the 2012 update. Eur Urol. 2012; 62(2): 324-332.
    4. Esteves SC, Chan P. A systematic review of recent clinical practice guidelines and best practice statements for the evaluation of the infertile male. Int Urol Nephrol. 2015; 47(9): 1441-1456.
    5. Bui AD, Sharma R, Henkel R, Agarwal A. Reactive oxygen species impact on sperm DNA and its role in male infertility. Andrologia. 2018; 50(8): e13012.
    6. Aitken RJ. Oxidative stress and the etiology of male infertility. J Assist Reprod Genet. 2016; 33(12): 1691-1692.
    7. Dorostghoal M, Kazeminejad SR, Shahbazian N, Pourmehdi M, Jabbari A. Oxidative stress status and sperm DNA fragmentation in fertile and infertile men. Andrologia. 2017; 49(10).
    8. Lira Neto FT, Roque M, Esteves SC. Effect of varicocelectomy on sperm deoxyribonucleic acid fragmentation rates in infertile men with clinical varicocele: a systematic review and meta-analysis. Fertil Steril. 2021; 116(3): 696-712.
    9. Afsin M, Otludil B, Dede O, Akkus M. An examination on composition of spermatozoa obtained from pre-operative and post-operative varicocele patients. Reprod Biol. 2018; 18(4): 361- 367.
    10. Agarwal A, Hamada A, Esteves SC. Insight into oxidative stress in varicocele-associated male infertility: part 1. Nat Rev Urol. 2012; 9(12): 678-690.
    11. Jeremias JT, Belardin LB, Okada FK, Antoniassi MP, Fraietta R, Bertolla RP, et al. Oxidative origin of sperm DNA fragmentation in the adult varicocele. Int Braz J Urol. 2021; 47(2): 275-283.
    12. Schauer I, Madersbacher S, Jost R, Hübner WA, Imhof M. The impact of varicocelectomy on sperm parameters: a meta-analysis. J Urol. 2012; 187(5): 1540-1547.
    13. Kadioglu TC, Aliyev E, Celtik M. Microscopic varicocelectomy significantly decreases the sperm DNA fragmentation index in patients with infertility. Biomed Res Int. 2014; 2014: 695713.
    14. Yang H, Li G, Jin H, Guo Y, Sun Y. The effect of sperm DNA fragmentation index on assisted reproductive technology outcomes and its relationship with semen parameters and lifestyle. Transl Androl Urol. 2019; 8(4): 356-365.
    15. Christman MS, Gudeman SR, Nork JJ, Walters RC, L'Esperance JO, Crain DS. Operating characteristics of follicle-stimulating hormone in azoospermic men. Fertil Steril. 2014; 101(5): 1261- 1265.
    16. Foroughi AA, Yazdanpanah E, Nazeri M, Eghbali T, Arasteh P, Ariafar A. Clinical grading and color Doppler ultrasonography-based grading of varicocele: how compatible are the two grading systems? World J Urol. 2019; 37(7): 1461-1465.
    17. Bolat MS, Kocamanoglu F, Gulsen M, Sengul M, Asci R. The impact of age on fertility rate in patients who underwent microsurgical varicocelectomy. Andrologia. 2019; 51(4): e13234.
    18. Birowo P, Rahendra Wijaya J, Atmoko W, Rasyid N. The effects of varicocelectomy on the DNA fragmentation index and other sperm parameters: a meta-analysis. Basic Clin Androl. 2020; 30: 15.
    19. Gul M, Carvajal A, Serefoglu EC, Minhas S, Salonia A. European association of urology guidelines for sexual and reproductive health 2020: what is new? Int J Impot Res. 2020; 32(5): 477-479.
    20. Chiba K, Fujisawa M. Clinical outcomes of varicocele repair in infertile men: a review. World J Mens Health. 2016; 34(2): 101- 109.
    21. Yao H, Li F, Qiu X, Xu Y, Xue P, Chang D. The effect of varicocele repair for sperm DNA fragmentation: A protocol for systematic review and meta-analysis. Medicine (Baltimore). 2020; 99(38): e21960.
    22. Sajadi H, Hosseini J, Farrahi F, Dadkhah F, Sepidarkish M, Sabbaghian M, et al. Varicocelectomy may improve results for sperm retrieval and pregnancy rate in non-obstructive azoospermic men. Int J Fertil Steril. 2019; 12(4): 303-305.
    23. Schlegel PN, Kaufmann J. Role of varicocelectomy in men with nonobstructive azoospermia. Fertil Steril. 2004; 81(6): 1585- 1588.
    24. Ilktac A, Hamidli S, Ersoz C, Dogan B, Akcay M. Efficacy of varicocelectomy in primary infertile patients with isolated teratozoospermia. A retrospective analysis. Andrologia. 2020; 52(11): e13875.
    25. Mohamed EE, Gawish M, Mohamed A. Semen parameters and pregnancy rates after microsurgical varicocelectomy in primary versus secondary infertile men. Hum Fertil (Camb). 2017; 20(4): 293-296.
    26. Ren W, Qu J, Xue B, Hu J, Zu X. Infertility duration and pre-operative sperm progressive motility are significant factors of spontaneous pregnancy after varicocele repair. Am J Reprod Immunol. 2020; 84(6): e13318.
    27. Mohamad Al-Ali B, Eredics K. Synergistic effects of cigarette smoking and varicocele on semen parameters in 715 patients. Wien Klin Wochenschr. 2017; 129(13-14): 482-486.
    28. Choe JH, Seo JT. Is varicocelectomy useful for subfertile men with isolated teratozoospermia? Urology. 2015; 86(6): 1123-1128.
    29. Zampieri N, Bosaro L, Costantini C, Zaffagnini S, Zampieri G. Relationship between testicular sperm extraction and varicocelectomy in patients with varicocele and nonobstructive azoospermia. Urology. 2013; 82(1): 74-77.
    30. Lima TFN, Frech FS, Patel P, Blachman-Braun R, Ramasamy R. Effect of microsurgical varicocelectomy on semen parameters, serum, and intratesticular testosterone levels. BJUI Compass. 2020; 1(3): 93-99.
    31. Alhathal N, San Gabriel M, Zini A. Beneficial effects of microsurgical varicocoelectomy on sperm maturation, DNA fragmentation, and nuclear sulfhydryl groups: a prospective trial. Andrology. 2016; 4(6): 1204-1208.
    32. Smit M, Romijn JC, Wildhagen MF, Veldhoven JL, Weber RF, Dohle GR. Decreased sperm DNA fragmentation after surgical varicocelectomy is associated with increased pregnancy rate. J Urol. 2013; 189 (Suppl 1): S146-S150.
    33. Zini A, Azhar R, Baazeem A, Gabriel MS. Effect of microsurgical varicocelectomy on human sperm chromatin and DNA integrity: a prospective trial. Int J Androl. 2011; 34(1): 14-19.
    34. Li F, Yamaguchi K, Okada K, Matsushita K, Ando M, Chiba K, et al. Significant improvement of sperm DNA quality after microsurgical repair of varicocele. Syst Biol Reprod Med. 2012; 58(5): 274-277.
    35. La Vignera S, Condorelli R, Vicari E, D'Agata R, Calogero AE. Effects of varicocelectomy on sperm DNA fragmentation, mitochondrial function, chromatin condensation, and apoptosis. J Androl. 2012; 33(3): 389-396.
    36.  

     

International Journal of Fertility and Sterility
Volume 18, Issue 2
April 2024
Pages 167-172

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