Document Detail

Decreased sperm DNA fragmentation after surgical varicocelectomy is associated with increased pregnancy rate.
MedLine Citation:
PMID:  19913801     Owner:  NLM     Status:  MEDLINE    
PURPOSE: We prospectively evaluated changes in sperm chromatin structure in infertile patients before and after surgical repair of varicocele, and the impact on the pregnancy rate. MATERIALS AND METHODS: Included in the study were 49 men with at least a 1-year history of infertility, a palpable varicocele and oligospermia. World Health Organization semen analysis and sperm DNA damage expressed as the DNA fragmentation index using the sperm chromatin structure assay were assessed preoperatively and postoperatively. Pregnancy (spontaneous and after assisted reproductive technique) was recorded 2 years after surgery. RESULTS: Mean sperm count, sperm concentration and sperm progressive motility improved significantly after varicocelectomy from 18.3 x 10(6) to 44.4 x 10(6), 4.8 x 10(6)/ml to 14.3 x 10(6)/ml and 16.7% to 26.6%, respectively (p <0.001). The DNA fragmentation index decreased significantly after surgery from 35.2% to 30.2% (p = 0.019). When the definition of greater than 50% improvement in sperm concentration after varicocelectomy was applied, 31 of 49 patients (63%) responded to varicocelectomy. After varicocelectomy 37% of the couples conceived spontaneously and 24% achieved pregnancy with assisted reproductive technique. The mean postoperative DNA fragmentation index was significantly higher in couples who did not conceive spontaneously or with assisted reproductive technique (p = 0.033). CONCLUSIONS: After varicocelectomy sperm parameters significantly improved and sperm DNA fragmentation was significantly decreased. Low DNA fragmentation index values are associated with a higher pregnancy rate (spontaneous and with assisted reproductive technique). We suggest that varicocelectomy should be considered in infertile men with palpable varicocele, abnormal semen analysis and no major female factors.
Marij Smit; Johannes C Romijn; Mark F Wildhagen; Joke L M Veldhoven; Robertus F A Weber; Gert R Dohle
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of urology     Volume:  183     ISSN:  1527-3792     ISO Abbreviation:  J. Urol.     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2009-12-16     Completed Date:  2010-01-06     Revised Date:  2010-09-17    
Medline Journal Info:
Nlm Unique ID:  0376374     Medline TA:  J Urol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  270-4     Citation Subset:  AIM; IM    
Andrology Unit, Department of Urology and Trials and Research Coordination, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.
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MeSH Terms
DNA Fragmentation*
Infertility, Male / etiology,  genetics*,  surgery*
Pregnancy / statistics & numerical data*
Prospective Studies
Sperm Count
Sperm Motility
Urologic Surgical Procedures, Male / methods
Varicocele / complications,  genetics*,  surgery*
Comment In:
J Urol. 2010 Oct;184(4):1577; author reply 1578   [PMID:  20732694 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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