Objective: To evaluate if a potential relationship exists between sperm nuclear DNA damage and clinical varicocele and to determine the impact of clinical varicocele on standard semen parameters.
Materials And Methods: A prospective study involving 30 infertile patients with clinical varicocele and 15 controls patients referred to our laboratory for routine spermiological exploration. Spermograms were performed and analyzed according to World Health Organisation (WHO) guidelines 2010. The DNA fragmentation was detected by the terminal desoxynucleotidyl transferase-mediated deoxyuridine triphosphate biotin nick-end labeling (TUNEL) assay.
Results: The DNA fragmentation index (DFI) was significantly higher in patients with clinical varicocele compared to controls (13.3±3.4% versus 6.1±2.5%, P=0.0001). In addition, the DFI was positively and significantly correlated with the degree of severity of varicocele thus the DFI was 15.24±1.9% in patients with grade 3 versus 12.92±3.5% in those with grade 2(P<0.0001). However, an abnormality of at least one of the spermatic parameters was found in 90% of varicocele patients, and all semen characteristics such as sperm count, vitality, mobility and typical forms were decreased compared to the controls. Furthermore, statistically significant negative correlations were noted between sperm DNA fragmentation index and sperm concentration (P=0.0001), motility (P=0.03), and normal sperm morphology (P=0.03).
Conclusion: Clinical varicocele generates a significant increase of sperm abnormalities and DNA damage, and these changes are positively correlated with varicocele grade. Sperm DNA damage independent of its cause, may affect the quality of the ejaculated sperm and may have implications on patient's fertility potential.
Level Of Evidence: 3.
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