Department of Andrology, Sexology & STIs, Faculty of Medicine, Cairo University, Cairo, Egypt.
Andrology. 2018 Jan;6(1):146-150. doi: 10.1111/andr.12445. Epub 2017 Dec 1.
This study aimed to assess the effect of varicocelectomy and/or mast cells (MCs) stabilizer on sperm DNA fragmentation in infertile men with varicocele (Vx). Overall, 120 infertile patients were randomized to three equal treatment arms; patients that underwent varicocelectomy, patients on 1 mg ketotifen twice daily for three months, and patients that underwent varicocelectomy followed with 1 mg ketotifen twice daily for three months. These patients were subjected to history taking, clinical examination, semen analysis, and estimation of sperm DNA fragmentation index (DFI). After 3 months, all investigated groups showed significant improvement regarding the mean total sperm count, sperm concentration, total sperm motility, and sperm normal forms percentage compared with the pre-treatment data. As well, the mean sperm DFI was significantly improved compared with the pre-treatment data; in men that underwent varicocelectomy (34.6% vs. 28.3%), in men on MC stabilizer only (33.4% vs. 27.8%), and in men that underwent varicocelectomy followed by MC stabilizer (34.3% vs. 25.1%). Sperm DFI improvement percentages showed the highest improvement in men that underwent varicocelectomy followed with MC stabilizer compared with the other two groups (26.8% vs. 18.2%, 16.8%). Sperm DFI improvement percentages showed significant increases in the infertile patients with Vx grade III compared to Vx grade II in all investigated groups. It is concluded that in infertile men associated with Vx and high sperm DFI, surgical repair followed with MCs stabilizer significantly improve sperm DFI compared with either surgical repair or MCs stabilizer alone.
本研究旨在评估精索静脉曲张（Vx）伴精子 DNA 碎片化的不育男性精索静脉结扎术和/或肥大细胞（MCs）稳定剂的效果。共有 120 名不育患者随机分为三组：接受精索静脉结扎术的患者、每日两次口服 1mg 酮替芬治疗三个月的患者、以及接受精索静脉结扎术加每日两次口服 1mg 酮替芬治疗三个月的患者。这些患者接受病史询问、临床检查、精液分析和精子 DNA 碎片化指数（DFI）评估。3 个月后，与治疗前数据相比，所有研究组的平均总精子数、精子浓度、总精子活力和精子正常形态百分比均有显著改善。此外，与治疗前数据相比，平均精子 DFI 也有显著改善：接受精索静脉结扎术的患者（34.6%比 28.3%）、仅接受 MC 稳定剂的患者（33.4%比 27.8%）和接受精索静脉结扎术加 MC 稳定剂的患者（34.3%比 25.1%）。与其他两组相比，接受精索静脉结扎术加 MC 稳定剂的患者精子 DFI 改善百分比最高（26.8%比 18.2%、16.8%）。在所有研究组中，与 Vx Ⅱ级相比，Vx Ⅲ级的不育患者的精子 DFI 改善百分比显著增加。结论：对于与 Vx 和高精子 DFI 相关的不育男性，手术修复后加用 MCs 稳定剂可显著改善精子 DFI，优于单独手术修复或 MCs 稳定剂治疗。
