Beneficial effect of microsurgical varicocelectomy on human sperm DNA integrity

Zini, Armand; Blumenfeld, A.; Libman, Jamie; Willis, John

doi:10.1093/humrep/deh701

Cited by 173 publications

(108 citation statements)

References 42 publications

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“…The prevalence of varicocele (63%) was increased in patients with high DFI compared to 35-40% incidence of varicoceles reported for infertile men in general [Zini 2007]. The reduction in levels of ROS and the improvement of sperm DNA integrity has been reported after surgical treatment of varicocele [Zini et al 2005]. We have also observed the positive effect of surgical correction of varicocele on sperm DNA damage.…”

supporting

confidence: 70%

“…Several studies showed positive results in the treatment of patients with moderate DNA damage using oral antioxidants [Agarwal et al 2004;Greco et al 2005;Menezo et al 2007], microsurgical varicocelectomy in patients with varicocele [Zini et al 2005] and antibiotics in patients with Chlamydia and Mycoplasma infection [Gallegos et al 2008]. The data regarding treatment of patients with high DNA damage is lacking.…”

Section: Introductionmentioning

confidence: 99%

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Cause-Specific Treatment in Patients with High Sperm DNA Damage Resulted in Significant DNA Improvement

Moskovtsev

Lecker²,

Mullen

et al. 2009

Systems Biology in Reproductive Medicine

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Assessment of sperm DNA damage has been suggested as a negative predictor of fertility potential. Multiple pathological factors acting at both the intratesticular and post-testicular levels may contribute to sperm DNA damage. The relative contribution of each of these factors in an individual with high DNA damage (430%) is unclear. The management of patients with elevated DNA damage is also challenging. The purpose of our retrospective study was to evaluate the clinical course of patients with sperm DNA damage over 30% and to assess the effect of non-specific (oral antioxidant) and cause-specific treatments on the quality of their sperm DNA. Results of our retrospective study suggest that the evaluated group with high DNA damage was diagnostically heterogeneous and comprised patients with varicoceles, bacteriospermia and idiopathic infertility. A three month course of antioxidant therapy reduced sperm DNA damage in only 30/61 (49%) patients with significant improvement between the initial and post-treatment DNA Fragmentation Index (DFI) results (46.8% AE 14.1 vs. 36.7% AE 16.6, p < .001). The positive effect of antioxidants could be age-dependent, as patients older that 40 years of age showed no improvement after such treatment. The cause-specific treatments showed superior results compared to antioxidants alone. Improvement was observed in 7/9 (78%) of patients after surgical varicocele repair between the initial and post-treatment DFI results (44.7% AE 12.8 vs. 28.4% AE 9.5, p < .03). The majority of the patients 13/14 (93%) with bacteriospermia had improvement in sperm DFI results after antibiotic treatment (50.4% AE 19.1 vs. 38.6% AE 18.7, p < .001).

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supporting

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Cause-Specific Treatment in Patients with High Sperm DNA Damage Resulted in Significant DNA Improvement

Moskovtsev

Lecker²,

Mullen

et al. 2009

Systems Biology in Reproductive Medicine

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“…• Unexplained or idiopathic infertility 26 • When deciding between IUI or IVF/ICSI as therapeutic options 37 • In the setting of varicocele-associated infertility 38 • Recurrent pregnancy loss 39 …”

Section: Sperm Chromatin Dispersionmentioning

confidence: 99%

An Assessment of New Sperm Tests for Male Infertility

Natali

Turek

2011

Urology

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The routine semen analysis, although used for more than 50 years, fails to accurately distinguish between fertile and infertile men. As a consequence, many tests of sperm function (TSF) have been developed. This review discusses both older and newer diagnostic TSF. It outlines the principles underlying each assay and reviews aggregate clinical data to determine its current relevance and utility. It concludes that the relevance of many older TSF is questionable, with the wide acceptance of intracytoplasmic sperm injection (ICSI). Newer TSF have the potential to deliver more clinically relevant information but require more extensive study to better understand their predictive role in the ICSI era. UROLOGY 77: 1027-1034, 2011. © 2011 Elsevier Inc. All rights reserved.I n addition to the medical history and physical examination, the conventional semen analysis has been an essential laboratory test for the evaluation of male fertility for at least 50 years. However, the idea that fertility can be defined by threshold values of semen parameters is a concept that is fundamentally flawed. 1 Although not a true measure of fertility, the semen analysis, if abnormal, suggests that the probability of achieving fertility is lower than normal. 2 Because of biological variability, two semen analyses are generally needed, performed with two to three days of sexual abstinence and evaluated in a standardized fashion. 2 Recognized normal values for semen parameters are given in Table 1 in agreement with the latest recommendations by the World Health Organization (WHO). 2 Traditionally, (except for the latest WHO recommendations), these references are derived by expert consensus and not by prospective clinical trials and thus their true relationship to male fertility is unclear. In addition, the definition of what constitutes "normal" semen parameters is constantly challenged. A meta-analysis of 29 US studies of semen quality from 9612 fertile, or presumably fertile, men suggested that a sperm concentration of 98 million/mL is normal. 3 Although sperm motility is considered the "best" predictor of fertility, normal sperm motility ranges from 53% to 62%. 4 Thus, simply deriving "normal" semen parameters has been a prohibitively lengthy and inconclusive process to date.Finally, other biological variables affect the clinical utility of the semen analysis. In addition to wide intraindividual variation, seasonal 5 and geographic variation 4 further complicate the performance of the semen analysis as a fertility measure. As examples, within-subject, interejaculate coefficients of variation for sperm concentration and motility are estimated at 44.7% and 15% in one study. 1 Thus, even with excellent quality control, wide biological variation in semen quality profoundly challenges the notion that the conventional semen analysis can accurately assess male fertility. OLDER ADJUNCTIVE SPERM TESTSBecause of the need to more precisely characterize normal fertile semen, adjunctive semen testing has become popular (Figure 1). The concept behind de...

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“…Varicoceles have been shown to increase oxidative stress levels in the testes as well as in the semen. Varicocelectomy, in the other hand, may decrease seminal oxidative stress, increase seminal concentrations of antioxidants and also improve sperm quality [39]. In recent years, interest has increased regarding the role of antioxidants and B-vitamins as modulators of fertility [40][41][42][43].…”

Section: What Is New In Treament Antioxidant Therapymentioning

confidence: 99%

“…Several studies have demonstrated that the surgical treatment of clinical varicoceles is highly effective to decrease seminal oxidative stress, to increase seminal concentrations of antioxidants and to improve sperm quality [39,[45][46][47]. However, a meta-analysis of seven randomized, controlled trials of varicocele repair for male subfertility concluded that treatment of varicocele in men from couples with otherwise unexplained subfertility could not be recommended [48].…”

Section: Microsurgical Repair Of Clinical Varicocelementioning

confidence: 99%

What is New in the Clinical Assessment and Treatment of the Infertile Male

Esteves¹

2011

TORSJ

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Male infertility is a fast-evolving area. Recently published evidence has challenged several established concepts and added to the knowledge in the field. Traditionally, the clinical assessment of the subfertile male includes a history and physical examination, hormonal evaluation and semen analyses. Regarding the latter, the World Health Organization has established new reference values that in general include lower limits than those of previous editions. Specialized sperm function assays, such as sperm DNA integrity and measurements of oxidative stress, are now clinically available and may be integrated to the conventional semen analysis to provide a more comprehensive evaluation of a man's fertility status. Also, molecular biology genetic testing involving the Y-chromosome can correctly identify oligozoospermic and azoospermic men misdiagnosed as having idiopathic infertility and be of prognostic value for sperm retrieval in non-obstructive azoospermia. In the field of treatment, emerging evidence suggests that antioxidant therapy along with life-style modifications improve the male reproductive health. Microsurgery has increased the success rates for both varicocele treatment and sperm retrieval for assisted conception. Microsurgical treatment of clinical varicoceles may optimize reproductive outcome of couples undergoing intracytoplasmic sperm injection or microsurgical testicular sperm extraction. Men with non-obstructive azoospermia, elevated follicle-stimulating hormone levels and small testes may no longer be considered sterile. Modern retrieval techniques are used to collect testicular sperm that can be used to produce a healthy biological offspring via assisted conception. This article reviews what is new in the clinical assessment and treatment of the infertile male, including the implications of this increased knowledge in the management of the infertile couple and assisted reproduction technology outcomes.

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Beneficial effect of microsurgical varicocelectomy on human sperm DNA integrity

Abstract: Our data suggest that varicocelectomy can improve human sperm DNA integrity in infertile men with varicocele. These data represent the first report of improved sperm DNA integrity after therapy and further support the beneficial effect of varicocelectomy on human spermatogenesis.

Cited by 173 publications

References 42 publications

Cause-Specific Treatment in Patients with High Sperm DNA Damage Resulted in Significant DNA Improvement

Cause-Specific Treatment in Patients with High Sperm DNA Damage Resulted in Significant DNA Improvement

An Assessment of New Sperm Tests for Male Infertility

What is New in the Clinical Assessment and Treatment of the Infertile Male

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