The effects of varicocelectomy on the DNA fragmentation index and other sperm parameters: a meta-analysis

Abstract

Background Varicocele is one of the most common causes of reversible male infertility, and 15% of the varicocele patients with normal semen analysis are diagnosed as infertile. According to the current guidelines, varicocelectomy is indicated based on abnormal sperm parameters and not abnormal DNA fragmentation index (DFI) values. Thus, in this study, we performed a meta-analysis of the effects of varicocelectomy on the DFI and other conventional sperm parameters, and determined whether DFI could be used to indicate varicocelectomy for varicocele patients. Results Through an electronic search of the PubMed, Scopus, EBSCO, and Cochrane databases, we included 7 prospective studies including a total of 289 patients in this meta-analysis. The results showed that varicocelectomy significantly reduced DNA fragmentation (mean difference: − 6.86; 95% confidence interval [CI]: − 10.04, − 3.69; p < 0.00001) and improved sperm concentration (mean difference: 9.59; 95% CI: 7.80, 11.38; p < 0.00001), progressive motility (mean difference: 8.66; 95% CI: 6.96, 10.36; p < 0.00001), and morphology (mean difference: 2.73; 95% CI: 0,65, 4.80; p = 0.01). Conclusion Varicocelectomy reduced DNA fragmentation and improved sperm concentration, progressive motility, and morphology. Additionally, the analysis showed that an abnormal DFI measurement should be considered as an indication for varicocelectomy.

Sperm DNA damage and cytokines in varicocele: A case‐control study

“…A large systematic review from Roque and Esteves, reported that all considered studies (21 studies, involving more than 1,200 subjects between 3 and 12 months from varicocele repair) showed some degree of SDF reduction (Roque & Esteves, 2018). More recently, a meta‐analysis investigated the effects of varicocelectomy on SDF, including a total of 289 patients from seven different prospective studies (Birowo et al., 2020). Despite significant heterogeneity from the considered studies, Birowo et al (2020) showed that post‐operative DNA integrity significantly improved, with a mean reduction of the percentage of spermatozoa with fragmented DNA of 6.86%.…”

“…More recently, a meta‐analysis investigated the effects of varicocelectomy on SDF, including a total of 289 patients from seven different prospective studies (Birowo et al., 2020). Despite significant heterogeneity from the considered studies, Birowo et al (2020) showed that post‐operative DNA integrity significantly improved, with a mean reduction of the percentage of spermatozoa with fragmented DNA of 6.86%. Considering all available evidence, SDF testing as a mean to identify subjects that could benefit most from the varicocele repair is becoming a widespread topic (Esteves et al., 2020).…”

The benefits of varicocele repair for achieving pregnancy in male infertility: A systematic review and meta-analysis

“…Similarly, a recent meta-analysis revealed that the DFI is significantly reduced after varicocele repair, along with the improvement of all seminal parameters. This result suggests that varicocele repair might increase the pregnancy and live birth rate through this pathway and should be considered in patient with abnormal DFI [ 44 ].…”

The Negative Impact of Varicocele on Basic Semen Parameters, Sperm Nuclear DNA Dispersion and Oxidation-Reduction Potential in Semen

“…In the general population, approximately 15% of adult men have varicoceles, but in the population of infertile men, the prevalence rises to 40% (primary infertility) or even to 80% (secondary infertility) [4][5][6][7][8]. Therefore, proper medical examination of the scrotum is essential for the management of male infertility [4,5,[8][9][10][11][12][13][14][15][16][17].…”