title: Decreased sperm DNA fragmentation after surgical varicocelectomy is associated with increased pregnancy rate.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.affiliation: Andrology Unit, Department of Urology and Trials and Research Coordination, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands. m.smit.3@erasmusmc.nl
authors.forename: Marij
authors.initials: M
authors.lastname: Smit
authors.forename: Johannes C
authors.initials: JC
authors.lastname: Romijn
authors.forename: Mark F
authors.initials: MF
authors.lastname: Wildhagen
authors.forename: Joke L M
authors.initials: JL
authors.lastname: Veldhoven
authors.forename: Robertus F A
authors.initials: RF
authors.lastname: Weber
authors.forename: Gert R
authors.initials: GR
authors.lastname: Dohle
mesh_terms: D000328:Adult; D053938:DNA Fragmentation; D005260:Female; D006801:Humans; D007248:Infertility, Male / Q000209:etiology / Q000235:genetics* / Q000601:surgery*; D008297:Male; D011247:Pregnancy / Q000706:statistics & numerical data*; D011446:Prospective Studies; D013076:Sperm Count; D013081:Sperm Motility; D013521:Urologic Surgical Procedures, Male / Q000379:methods; D014646:Varicocele / Q000150:complications / Q000235:genetics* / Q000601:surgery*