Varicocelectomy: semen parameters and protamine deficiency

Abstract

Different methods have been used to evaluate the beneficial effect of varicocelectomy; these include semen parameters and pregnancy rate. Because of high biological variability of semen parameters, sperm functional tests have been considered as an efficient end point in assessment of fertility. Therefore, the aim of this study was to evaluate the effect of varicocelectomy on semen parameters and sperm protamine deficiency in 192 patients. The results of the present study show that all the three semen parameters and percentage of sperms with normal protamine content have improved post-surgery. The cumulative pregnancy rate was 34.6%. Comparing the results of the semen parameters and protamine content between patients whose partner became pregnant to those who did not benefit from varicocelectomy before and 6 months after surgery, show that patients may benefit from varicocelectomy that had higher initial semen density and better sperm morphology prior to surgery. Detailed analyses of sperm morphology, along with aforementioned results reveal that the factors which account for pregnancy difference are: (i) improvement in early events of spermatogenesis, possibly during spermatocytogenesis and reduction division; and (ii) late spermiogenesis events. Thus, it can be suggested that patients with low initial sperm count may benefit more from assisted reproductive techniques or varicocelectomy followed by assisted reproduction.

An association between sperm PLCζ levels and varicocele?

“…As expected and in agreement with background literature [42][43][44], the mean percentage of sperm DNA fragmentation was higher in individuals with varicocele compared to fertile men. In addition, Park et al [45] demonstrated a significant correlation between the expression of PLCζ and the DNA oxidation status assessed using 8-hydroxy-2-deoxyguanosine in human spermatozoa [45].…”

Sperm chromatin condensation in infertile men with varicocele before and after surgical repair

“…In agreement, Werthman et al (26) noted that repairing grade III varicocele led to a great decline in sperm DNA fragmentation, and Zini et al (9) reported improved sperm DNA integrity in infertile men with varicocele 6 months after surgery. Nasr-Esfahani et al (27) added that the percentage of stained sperm heads was decreased significantly 3 and 6 months after varicocelectomy compared with the preoperative data. Smit et al (28) showed a significant decreased DNA fragmentation index 3 months after varicocelectomy, and Zini et al (29) reported significant improvement of sperm chromatin 4 months after repair.…”

Are varicoceles associated with increased deoxyribonucleic acid fragmentation?

“…To validate the observed association between varicocele and sperm DNA fragmentation, several investigators have examined the effect of varicocelectomy on sperm DNA damage. There are now three retrospective and nine prospective studies on the effect of varicocelectomy on sperm DNA damage, and these studies have all shown that varicocele repair is associated with reduced sperm DNA damage (8,33,36,(71)(72)(73)(74)(75)(76)(77)(78)(79) (Table 2). Although there are no randomized controlled trials on the role of varicocelectomy on sperm DNA integrity, the published varicocelectomy studies provide indirect evidence in support of the adverse effect of varicocele on sperm DNA integrity.…”