Andrology Unit, Department of Urology and Trials and Research Coordination, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.
J Urol. 2010 Jan;183(1):270-4. doi: 10.1016/j.juro.2009.08.161.
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.
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.
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).
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.
我们前瞻性地评估了精索静脉曲张手术修复前后不育患者精子染色质结构的变化及其对妊娠率的影响。
研究纳入了 49 名至少有 1 年不孕史、可触及精索静脉曲张和少精子症的男性患者。术前和术后分别评估了世界卫生组织精液分析和精子 DNA 损伤，用精子染色质结构分析表示 DNA 碎片化指数。手术后 2 年内记录妊娠（自然妊娠和辅助生殖技术后妊娠）情况。
精索静脉结扎术后精子计数、精子浓度和精子前向运动能力分别从 18.3×10^6 显著提高至 44.4×10^6、4.8×10^6/ml 显著提高至 14.3×10^6/ml 和 16.7%显著提高至 26.6%（p<0.001）。手术后 DNA 碎片化指数从 35.2%显著降低至 30.2%（p=0.019）。当将精索静脉曲张手术后精子浓度提高 50%以上定义为有效时，49 例患者中有 31 例（63%）对精索静脉曲张手术有反应。精索静脉结扎术后，37%的夫妇自然妊娠，24%的夫妇通过辅助生殖技术妊娠。未自然妊娠或通过辅助生殖技术妊娠的夫妇的平均术后 DNA 碎片化指数显著较高（p=0.033）。
精索静脉曲张手术后精子参数显著改善，精子 DNA 碎片化显著降低。低 DNA 碎片化指数与较高的妊娠率（自然妊娠和辅助生殖技术妊娠）相关。我们建议，对于可触及精索静脉曲张、精液分析异常且无主要女性因素的不育男性，应考虑行精索静脉结扎术。
