To study the relationship between sperm DNA fragmentation
(SDF) and reactive oxygen species (ROS) levels in infertile patients with varicocele,
and to examine the beneficial effect of varicocelectomy and elucidate predictors of
improvement after repair.
Patients, subjects and methods: We prospectively studied 60 patients with varicocele
and abnormal semen variables who attended the outpatient clinic complaining
of infertility for 12 months. In all, 25 patients (41.7%) had bilateral varicoceles
and 35 (58.3%) had left varicoceles. The DNA fragmentation index (DFI%, percentage
of sperm with denatured nuclei), ROS and total non-enzymatic antioxidant
capacity (TAC) were measured. Inguinal varicocelectomy was performed in all
patients. At 3–6 months postoperatively, all measurements were repeated. A control
group, comprised of 20 normozoospermic fertile men, was included. Regression
analysis was used to examine predictors of improvement.
Results: The mean (SD) DFI% in the 60 infertile patients with varicocele was
29.9 (8.3) and 7.56 (2.84)% in the controls; ROS levels were 4.49 (0.9) in patients
and 2.62 (0.8) photons/min in controls; and the TAC was 0.97 (0.4) in patients and 1.5 (0.5) mM in controls; with highly significant differences between the patients
and controls. The DFI% showed a positive correlation with ROS levels, whilst the
total motile sperm count (TMSC) had a significant negative correlation with DFI%,
ROS levels and grade of varicocele, whilst there was significant positive correlation
with TAC. The grade of varicocele and duration of infertility were related to the
presence of higher levels of ROS and increased of DFI%. Postoperatively, improvement
(measured as a >50% increase in TMSC) occurred in 40 of 55 (73%) patients
available at follow-up, with a significant reduction in the mean (SD) DFI% from
29.49 (8.58) to 18.78 (7.23)%, ROS levels from 4.49 (0.88) to 3.27 (1.3) photons/
min (both P < 0.001), and a significant increase in the mean (SD) TAC from 1.01
(0.44) to 2.05 (0.51) mM (P < 0.001). Responders had a shorter infertility duration
and lower preoperative DFI% and ROS levels. Regression analysis showed that DFI
% is a predictor of improvement after varicocelectomy.
Conclusion: SDF was shown to have a negative impact on improvement after
varicocelectomy. Hence, DFI% could be recommended as a prognostic test in infertile
patients with varicocele to help decision-making as regards the necessity and the
anticipated outcome of varicocelectomy in patients with infertility.
2017 Arab Association of Urology. Production and hosting by Elsevier B.V. This
is an open access article under the CC BY-NC-ND license (http://creativecommons.
org/licenses/by-nc-nd/4.0/). |
