Abstract
BACKGROUND: Infertility is detected in 15% of sexually active couples who engage in unprotected sexual intercourse. At the same time, the male factor of infertility accounts from 30 to 50%. It is known that in 15–25% the cause of frozen pregnancy and miscarriage is the male factor of infertility associated with violations of the integrity of sexual chromatin – pathological fragmentation of sperm DNA (FDNAS). One of the main pathophysiological mechanisms of the occurrence of pathozoospermia and FDNAS in secretory male infertility is oxidative stress, which occurs in patients with varicocele. It has been proven that varicocelectomy increases the frequency of spontaneous pregnancy and improves the results of IVF-procedures. However, there are currently insufficient studies devoted to the comparative evaluation of the effectiveness of various methods of varicocelectomy in patients with pathological FDNAS.
AIM: To conduct a comparative assessment of the dynamics of sperm DNA fragmentation after subinguinal and laparoscopic varicocelectomy in male infertility.
MATERIALS AND METHODS: The study included the results of examination and treatment of 87 men who complained of infertility in marriage for 1–9 years (on average, 3.8 ± 2.7 years). The age of the patients was 24–42 years (the average, 28.6 ± 11.3 years). All patients were diagnosed with grade II left-sided varicocele. Other pathological conditions potentially affecting ejaculate parameters were excluded. All patients underwent ejaculate analysis — sperm analysis, determined the degree of FDNAS by TUNEL method and the level of IgG class antisperm antibodies in the ejaculate by direct Mar-test. The patients were divided into 2 groups by randomization. The group 1 included 41 patients who underwent subinguinal varicocelectomy (Marmar operation), the group 2 included 46 patients who underwent laparoscopic varicocelectomy. Studies of the ejaculate — a sperm-analysis (according to WHO criteria, 2010), a MAR test and FDNAS — were carried out before, 3 and 6 months after surgery.
RESULTS: In all patients of both groups in six months after surgical correction of varicocele the concentration of spermatozoa, the number of progressively mobile and normal forms of spermatozoa (according to the strict Kruger criteria) were significantly increased. The MAR test value in all patients of both groups before surgery did not exceed 10%. There were no statistically significant changes in this indicator in the postoperative period. FDNAS values in patients of group 1 before and 3 months after surgical treatment no statistically significant differences were found (27.6 ± 6.7% and 22.4 ± 8.3%, respectively, p 0.1). In patients in group 2, 3 months after surgical treatment a statistically significant decrease in the FDNAS value was noted compared with that before treatment (from 26.1 ± 8.9% to 13.3 ± 7.7%, p 0.001). 6 months after surgery, patients in both groups showed a significant (p 0.001) decrease in FDNAS values compared to the value before treatment: up to 14.6 ± 7.8% in patients of group 1 and up to 12.1 ± 8.0% — in patients of group 2.
CONCLUSIONS: 1. Performing subinguinal and laparoscopic varicocelectomy contributes to the significant improvement of the main parameters of sperm in six months after the surgical operation. 2. The DNA fragmentation level significantly decrease already in 3 months after laparoscopic varicocelectomy, and just in 6 months after Marmar operation.