Objective
To examine clinical and laboratory variables to determine which, if any, predict improved
semen parameters and pregnancy after varicocelectomy.
Methods
Surgical logs were reviewed for men who underwent varicocele ligation for a fertility
concern. Clinical, demographic, and laboratory data was obtained through medical chart
review and paired with postoperative reproductive outcomes obtained through chart
review and survey.
Results
Eighty-three subjects met inclusion criteria of which 63 and 24 completed both preoperative
and postoperative basic and advanced semen testing, respectively. There was a statistically
significant improvement in semen concentration, total motile count, sperm DNA fragmentation
index (DFI), and total normal sperm count (TNSC) after varicocelectomy. Motility improved
significantly in patients with preoperative asthenospermia. Concentration and motility
demonstrated mean increases of 5.2 M/mL and 18%, respectively. DFI decreased from
a preoperative mean of 40.8% to a postoperative mean of 24.5%. Fifty-one percent of
couples were able to conceive using natural conception, intrauterine insemination,
or in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). Pregnancy,
regardless of the method used to conceive, was associated with a higher postoperative
motility. The mean postoperative DFI in couples who reported a spontaneous pregnancy
was 34%, which was statistically higher than the mean DFI of 17.5% in couples who
reported a pregnancy with IVF/ICSI (P = .04).
Conclusion
Varicocele ligation improves multiple semen parameters. An increase in motility was
the only variable associated with postoperative pregnancy irrespective of the method
by which pregnancy was obtained. Mean DFI in couples able to achieve spontaneous pregnancy
was above 30% and statistically higher than couples who reported pregnancy via IVF/ICSI.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to UrologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Varicocele and male factor infertility treatment: a new meta-analysis and review of the role of varicocele repair.Eur Urol. 2011; 60: 796-808
- Reassessing the value of varicocelectomy as a treatment for male subfertility with a new meta-analysis.Fertil Steril. 2007; 88: 639-648
- Efficacy of varicocelectomy in improving semen parameters: new meta-analytical approach.Urology. 2007; 70: 532-538
- Pathophysiology of varicoceles in male infertility.Hum Reprod Update. 2001; 7: 473-481
- Varicocele repair: does it still have a role in infertility treatment?.Curr Opin Obstet Gynecol. 2008; 20: 269-274
- Are varicoceles associated with increased deoxyribonucleic acid fragmentation?.Fertil Steril. 2011; 96: 1283-1287
- Clinical correlates of the biological variation of sperm DNA fragmentation in infertile men attending an andrology outpatient clinic.Int J Androl. 2007; 30: 48-55
- TUNEL as a test for sperm DNA damage in the evaluation of male infertility.Urology. 2010; 76: 1380-1386
- Effect of microsurgical varicocelectomy on human sperm chromatin and DNA integrity: a prospective trial.Int J Androl. 2011; 34: 14-19
- Decreased sperm DNA fragmentation after surgical varicocelectomy is associated with increased pregnancy rate.J Urol. 2010; 183: 270-274
World Health Organization, Department of Reproductive Health and Research. WHO laboratory manual for the examination and processing of human semen. 2010. Available at: http://www.who.int/reproductivehealth/publications/infertility/9789241547789/en/index.html. Accessed November 13, 2012.
- Diagnostic value of the total antioxidant capacity (TAC) in human seminal plasma.Fertil Steril. 2009; 91: 805-811
- Quality control of reactive oxygen species measurement by luminol-dependent chemiluminescence assay.J Androl. 2001; 22: 568-574
- Chemiluminescence technique for measuring reactive oxygen species.Reprod Biomed Online. 2004; 9: 466-468
- Semen characteristics and sperm DNA fragmentation in infertile men with low and high levels of seminal reactive oxygen species.Fertil Steril. 2010; 94: 2141-2146
- The impact of varicocelectomy on sperm parameters: a meta-analysis.J Urol. 2012; 187: 1540-1547
- Relationship between oxidative stress, varicocele and infertility: a meta-analysis.Reprod Biomed Online. 2006; 12: 630-633
- Generation of 4-hydroxy-2-nonenal modified proteins in testes predicts improvement in spermatogenesis after varicocelectomy.Fertil Steril. 2006; 86: 233-235
- Seminal reactive oxygen species-antioxidant relationship in fertile males with and without varicocele.Andrologia. 2009; 41: 125-129
- Role of oxidative stress in pathogenesis of varicocele and infertility.Urology. 2009; 73: 461-469
- Attenuation of oxidative stress & DNA damage in varicocelectomy: implications in infertility management.Indian J Med Res. 2010; 132: 728-730
- Attenuation of oxidative stress after varicocelectomy in subfertile patients with varicocele.J Urol. 2008; 179: 639-642
- Effect of spermatic vein ligation on seminal total antioxidant capacity in terms of varicocele grading.Andrologia. 2012; 44: 199-204
- Semen quality and oxidative stress scores in fertile and infertile patients with varicocele.Fertil Steril. 2008; 89: 602-607
- Seminal antioxidant capacity in pre- and postoperative varicocele.J Androl. 2004; 25: 44-49
- Significant decrease in sperm deoxyribonucleic acid fragmentation after varicocelectomy.Fertil Steril. 2008; 90: 1800-1804
- Effects of varicocelectomy on sperm DNA fragmentation, mitochondrial function, chromatin condensation, and apoptosis.J Androl. 2012; 33: 389-396
Article info
Publication history
Published online: February 26, 2013
Accepted:
December 4,
2012
Received:
October 18,
2012
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
Published by Elsevier Inc.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Re: Baker et al.: Pregnancy After Varicocelectomy: Impact of Postoperative Motility and DFI (Urology 2013;81:760-766)UrologyVol. 82Issue 2
- PreviewThrough this study, the authors very well elaborated the positive effects of varicocelectomy in improving pregnancy rates. Various parameters improve after varicocele repair, but the most important predictor of a successful pregnancy is the improvement in sperm motility.1 The sperm DNA fragmentation index (DFI) also decreases after varicocele repair and increases the chances of pregnancy, but the exact role of DFI in affecting the conception rate and subsequent pregnancy is still not clear and remains to be defined.
- Full-Text
- Preview
