Pregnancy Outcome in Patients after Microsurgical Varicocelectomy having Sperm DNA Fragmentation

Male factor infertility is one of the factors that make couples unable to achieve pregnancy and varicocele is one of the most commonly identified and even reversible causes. The effect of varicocele has been traditionally tested using traditional semen parameters that include a sperm concentration, motility, and morphology. Nevertheless, these parameters are not sufficient to describe the reproductive dysfunction of a significant percentage of infertile men, which raises the concern of more practical markers of sperm quality [1-3].

Sperm DNA fragmentation has become a significant parameter of male reproductive potential, which is a manifestation of the destruction of the genetic material that spermatozoa carries. High rates of DNA fragmentation have been linked to low fertilization, embryo development, the risk of a miscarriage, and low live births. Oxidative stress caused by varicocele, disrupted testicular microenvironment and high scrotal temperature are thought to play a primary role in causing such DNA damage [4-6].

Microsurgical varicocelectomy is generally considered the best way of doing the surgery because its complications and recurrence rates are few. Whereas the enhancement in traditional semen parameters after varicocelectomy is well-established, the mounting evidence can indicate that the intervention can also result in significant changes in sperm DNA fragmentation. Nevertheless, there is limited and heterogeneous data on how these improvements are directly correlated with the outcomes of pregnancy [7-9].

The present study was undertaken to assess the effect of microsurgical varicocelectomy on sperm DNA fragmentation and to examine its relationship with subsequent pregnancy outcomes. By focusing on men with elevated baseline DNA fragmentation, this study aims to provide clinically relevant insight into the role of varicocelectomy in improving reproductive success beyond traditional semen analysis.

The participants of the study were 72 men diagnosed with clinical varicocele and high sperm DNA fragmentation. The age and body mass index of the participants were in the reproductive age and most of them presented with primary infertility. High-grade and left-sided varicoceles were more common and this was in line with the common clinical presentation in infertile men.

Table 1. Baseline Demographic and Clinical Characteristics of Patients (n = 72)

The results of semen parameters measured before and after microsurgical varicocelectomy showed statistically significant and positive changes in all the measured variables. After surgery, significant changes in the sperm concentration, motility, and morphology were seen. The results suggest a positive varicocelectomy impact on the spermatogenic functions.

Table 2. Semen Parameters Before and After Microsurgical Varicocelectomy (n = 72)

Fragments of sperm DNAs were significantly lessened after micro-surgical varicocelectomy. The decline in the mean DFI was employed significantly which shows that the sperm nuclear integrity was enhanced following the surgical correction. This decrease encourages the use of varicocelectomy to reduce oxidative and DNA-damaging impact of varicocele.

Table 3. Sperm DNA Fragmentation Index (DFI) Before and After Surgery (n = 72)

A significant number of couples became pregnant during the time frame of follow-up. The number of pregnancies through natural conception was the most common and assisted reproductive techniques provided other successful cases. The monitored live birth rate also demonstrates the clinical significance of varicocelectomy in men with high sperm DNA fragmentation.

Table 4. Pregnancy Outcomes after Microsurgical Varicocelectomy (n = 72)

Pregnant patients that had a significantly lower value of postoperative DFI and larger decreases in DFI than those who did not. The levels of DFI that were preoperative were not significantly different in the two groups. These results indicate that successful pregnancy depends closely on the postoperative enhancement of sperm DNA integrity.

Table 5. Association between Postoperative DFI Improvement and Pregnancy Outcome

Figure 1. Mean sperm DNA fragmentation index (DFI%) before and after microsurgical varicocelectomy among infertile men (n = 72).

Varicocele has traditionally been known as a reversible cause of male infertility by the negative effects it produces on spermatogenesis and sperm activity. Sperm DNA fragmentation has been in the main focus in recent years and has been treated as a key determinant of male reproductive potential especially in couples with unexplained infertility or frequent failure of assisted reproductive technologies. The current research compared the birth outcomes of those who received microsurgical varicocelectomy with men who had high levels of sperm DNA fragmentations and showed a significant enhancement of the quality of the semen, integrity of the DNA fragments and eventual reproductive success [10-12].

The research results indicated that there was significant decrease in the sperm DNA fragmentation index after microsurgical varicocelectomy. This is finding is consistent with the emerging evidence of the role of varicocele-related oxidative stress to the onset of DNA damage in spermatozoa. It is believed that surgical correction is beneficial to testicular microcirculation, scrotal hyperthermia, and oxidative damage, thus permitting partial recovery of sperm nuclear integrity. The biological explanation of varicocelectomy effect on seminal parameters in addition to traditional operations can be supported by the fact that it shows a significant postoperative drop in the DNA fragmentation of this cohort [13-15].

This study has revealed that the index of sperm DNA fragmentation decreased significantly after the microsurgical varicocelectomy procedure. This finding is consistent with the increasing body of literature indicating that oxidative stress related to varicocele has a significant impact on the DNA damage of spermatozoa. It is believed that surgical correction will enhance testicular microcirculation, decrease scrotal hyperthermia, and alleviate oxidative damage to enable some restoration of sperm nuclear integrity. The pronounced decrease in DNA fragmentation during the postoperative period in this group of patients is indicative of the biological nature of the varicocelectomy, other than the traditional semen parameter augmentation [16-18].

Along with DNA integrity, the traditional semen parameters also provided statistically significant improvement postoperative. There were also increases in sperm concentration, motility and morphology which point to increased spermatogenic efficiency after venous ligation. Although the progress in the conventional semen analysis has been adequately reported in previous researches, the current results are remarkable in the sense that they are directly related to men who have high baseline DNA fragmentation, which is a population that is usually believed to have worse reproductive prognosis [19].

The clinical significance of raising sperm DNA quality is further highlighted by the pregnancy outcomes that were recorded in this study. Afterwards, about two-fifths of the couples would get pregnant, and a significant number of them would get pregnant through natural conception. Notably, men who were able to get pregnant showed considerably less DNA fragmentation of postoperative and larger decreases in DNA damage than did men who were unable to conceive. This implies that it is possible that postoperative increase in the DNA integrity, and not the preoperative levels alone, is a major determinant of reproductive success [20].

The correlation between lessening DNA fragmentation and enhanced pregnancy outcomes witnessed in this study are congruent with those reported in the literature that high DNA damage has a negative impact on embryo growth, implantation and pregnancy preservation. The miscarriage rate in this study was not too high, which also contributes to the idea that a better sperm DNA integrity can play an important role in the parameters of the conception process as well as the endurance of the pregnancy. These results support the need to include the sperm DNA fragmentation test in the assessment and treatment of infertile men with varicocele.

This study has limitations even though it has its strengths. There was no non-surgical control group and hence direct causal inference could not be done, even the female partner factors, though screened, could not be completely standardized. Also, the single DNA fragmentation assay could be disadvantageous in terms of comparability with other studies that have used other testing models. However, the potential design, the standardized surgeon procedure, and the follow up enhance the validity of the findings.

Microsurgical varicocelectomy in infertile men with elevated sperm DNA fragmentation is associated with significant improvement in sperm DNA integrity, enhancement of semen parameters, and favorable pregnancy outcomes. Reduction in postoperative DNA fragmentation appears to be a meaningful predictor of conception, highlighting the importance of addressing sperm nuclear quality in the management of varicocele-related infertility. These findings support the role of varicocelectomy as a valuable therapeutic option in selected patients with high sperm DNA fragmentation.

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