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Abstract

Background: Varicocele is a leading cause of male infertility, often contributing to impaired spermatogenesis and elevated sperm DNA fragmentation index (DFI) due to oxidative stress, hypoxia, and testicular hyperthermia. These molecular disruptions adversely affect semen quality, fertilization potential, and reproductive outcomes. Microsurgical varicocelectomy, recognized as the gold standard for varicocele treatment, targets venous reflux correction to improve both conventional semen parameters and sperm DNA integrity. This study aims to evaluate the efficacy of this surgical intervention in restoring male reproductive health.
Objective: To assess the impact of microsurgical varicocelectomy on semen parameters and sperm DNA fragmentation in infertile men with clinically palpable varicocele.
Methods: A prospective study was conducted at the Department of Urology, Civil Hospital, Bahawalpur, from January to June 2024. Twenty-seven infertile men aged 25–45 years with clinical varicocele were enrolled. Semen samples were collected preoperatively and six months postoperatively following WHO guidelines, and assessed for sperm count (million/mL), motility (%), morphology (% normal forms), and DFI (%) using sperm chromatin structure assay (SCSA). Stratified analyses were performed based on age, obesity, duration of infertility, varicocele grade, and smoking status. Statistical analysis was carried out using paired t-tests and subgroup comparisons with SPSS version 25.
Results: Post-surgery, mean sperm count significantly increased from 24.46 ± 12.04 to 38.01 ± 13.88 million/mL (p<0.001), motility improved from 45.40 ± 11.29% to 51.15 ± 10.46% (p=0.040), and morphology rose from 4.90 ± 1.74% to 6.40 ± 1.73% (p=0.002). DFI reduced markedly from 19.37 ± 3.07% to 9.46 ± 3.22% (p<0.001). Subgroup analyses indicated superior outcomes in younger, non-obese patients and those with shorter infertility durations.
Conclusion: Microsurgical varicocelectomy offers significant improvements in semen quality and sperm DNA integrity, making it a critical intervention in the management of varicocele-related male infertility.