Dr. Goldstein: Changes in sperm DNA quality in infertile men following microsurgical varicocelectomy.

Dabaja A, Bernie AM, Mehta A, Samplaski M, Lo KC, Grober ED, Jarvi K, Goldstein M.  Changes in sperm DNA quality in infertile men following microsurgical varicocelectomy. J Urol, 2014; 191_4):e803-e804. Presented at the 2014 Annual Meeting of the American Urologic Association, Orlando, FL.

Introductions and Objectives
The pathophysiology of the testicular damage secondary to varicoceles is incompletely understood. Varicocele presence is associated with impaired sperm DNA integrity, which frequently is associated with impaired infertility and poor outcomes with IUI, IVF and ICSI. Although varicocelectomy has a beneficial effect on male fertility, its effect on sperm DNA damage has not been well characterized. We performed a multi-institutional prospective cohort analysis to evaluate changes in sperm DNA integrity in infertile men following microsurgical varicocelectomy.

Methods
Medical records of all consecutive men who presented in the andrology clinic with at least a 1-year history of infertility, palpable varicocele, and abnormal semen analysis, who underwent varicocele repair were reviewed. The final analysis included men who had pre- and post-surgical assessment of sperm DNA quality using the sperm chromatin structure assay or TUNEL assay.

Results
74 men were included in the final analysis. The average age was 38.18 (SD 5.52). 27 unilateral and 47 bilateral varicocele repairs were performed. The total motile sperm count improved significantly after varicocelectomy from 57.55 M (SD 66.77) to 95.34 M (SD 114) (P=0.01). Both DNA fragmentation index, and the percent positive TUNEL decreased significantly after surgery from 36.7% to 31.1% (P= 0.0014), and 13.72% to 7.54% (P<0.001) respectively. Sperm morphology increased from 7% to 11.23% (P=0.02), and the changes in the proportion of TUNEL-positive sperm directly correlated with changes in sperm morphology R2=0.39 (P=0.003), and changes in the total motile sperm count R2=0.37 (P=0.005). On multi linear regression analysis, the changes in the TUNEL correlated with changes in the semen analysis (morphology, motility, and sperm concentration) R2=0.57 (P=0.02), with higher grade varicoceles showing the most improvement.

Conclusions
Sperm parameters significantly improved, and sperm DNA damage significantly decreased after varicocelectomy. Sperm DNA damage may be one pathophysiological pathway by which varicoceles causes impaired infertility. Varicocelectomy should be considered in infertile men with palpable varicoceles, abnormal semen parameters, and/or abnormal sperm DNA integrity.