Evaluation of the Impact of Varicocelectomy with Gubernacular Veins Closure on DNA Fragmentation Index as a Fertility Parameter: A Randomized Controlled Clinical Trial

Namdari F, Karimi A, Behtash N, Hamidi M, Shiri E and Behzadi A

Published on: 2024-09-24

Abstract

Introduction: Studies have claimed that varicocelectomy can improve semen parameters and infertility. In this study we aimed to assess two surgical methods on postoperative fertility function with a focus on DNA fragmentation index as a fertility parameter.

Materials and Methods: This single-blinded randomized controlled clinical trial was conducted at Imam Reza hospital of Tehran during 2020 and 2021 on infertile men with varicocele who had impaired DNA fragmentation index (DFI>30%). Patients were randomly assigned to intervention and control groups. In the control group, patients underwent conventional varicocele surgery. In the intervention group, testicular delivery and gubernacular veins closure was conducted in addition to the conventional varicocelectomy. Demographic and baseline clinical parameters were documented. Primary endpoints were semen analysis parameters (volume, sperm count, progressive motility, normal morphology) and DFI improvement after surgery. Measurements were done at baseline and three months after surgery. IBM SPSS software version 22 was used for statistical analysis.

Results: 36 patients in the intervention group and 37 patients in the control group were analyzed. Demographic and baseline clinical variables showed no significant difference between groups. Comparison of semen analysis changes between two groups showed no significant difference except for progressive motility parameter (p=0.028). DFI decreased from 40.3±6.9 to 33.3±4.6 in the intervention group (p=0.031) and from 39.6±5.1 to 35.7±5.3 in the control group (p=0.047). The reduction in DFI was significant in both groups but also this reduction was significantly more prominent in the intervention group (p=0.013). There was no correlation between study parameters except for inverse correlation of DFI and sperm motility (r=-0.573, p=0.001).

Conclusions: Ligation of gubernacular veins in addition to conventional varicocelectomy can decrease DFI more significantly compared to the standard protocol. The impact of this reduction in DFI after varicocelectomy on pregnancy rates should be evaluated in the future studies.