International Surgery Journal | May 2024 | Vol 11 | Issue 5 Page 748 International Surgery Journal Nagabhairava MK et al. Int Surg J. 2024 May;11(5):748-752 http://www.ijsurgery.com pISSN 2349-3305 | eISSN 2349-2902 Original Research Article Improved semen parameters and sperm deoxyribonucleic acid fragmentation following microscopic varicocelectomy: short term results of a prospective study Manu K. Nagabhairava, Vivek Meyyappan, Manasa Thimmegowda, Tarun Javali*, Gopal K. S. Rao INTRODUCTION Male can be the sole factor responsible for infertility with a frequency almost as high 20-25% of the time. 1 Although various factors are responsible for male infertility, abnormal semen analysis is pivotal to its diagnosis. A routine semen analysis may not provide adequate information and fails to meet the current demands of artificial conception techniques. This calls for the use of advanced and reliable indicators in diagnosing male factor infertility. Evaluation of sperm deoxyribonucleic acid (DNA) damage is one such indicator which may aid in specific case scenarios. Sperm DNA fragmentation (SDF) is noted to be significantly higher in patients with infertility leading to poorer outcomes of natural conception. 2 Sperm DNA integrity is considered vital to normal embryogenesis, and ABSTRACT Background: Assessment of sperm deoxyribonucleic acid (DNA) damage post varicocelectomy, has brought about new prospects in treating men with infertility. Improvements in spermatogenesis with decrease in sperm DNA damage has been demonstrated which has led to significant enhancement in fertility rates. Therefore, we evaluated the efficacy of microscopic varicocelectomy on the reduction in sperm DNA damage in concurrence to the conventional improvement of semen parameters. Methods: All patients with a diagnosis of varicocele leading to infertility and planned for microscopic varicocelectomy from January 2013 through September 2019, were included in the study. Sperm chromatin structure assay (SCSA) was done preoperatively and at 3 and 6 months postoperatively for sperm DNA integrity assessment and the results expressed as sperm percentage DFI were compared. A p value <0.05 was considered statistically significant. Results: 105 infertile men underwent microscopic varicocelectomy. Mean age and infertility period from the date of unprotected sex were 26.5±5.6 years and 30 months respectively. Baseline mean sperm concentration was 29 million/ml, mean progressive motility 24% and a percentage DFI ranged from 5–36% with a mean of 16%. Sperm DNA integrity improved significantly with a DFI decrease from 25±11% to 18±6%, 3 months post-surgery which was consistent at 6 months (13±5%). Sperm concentration and progressive motility increased with a mean sperm count improvement by 21.9 million/ml and mean motility by 20.3%. Conclusions: Microscopic varicocelectomy provides durable improvement in DNA integrity and semen parameters. Sperm DNA integrity assessment using SCSA is a useful tool to demonstrate change in the semen quality post treatment. Keywords: Sperm DNA fragmentation, Varicocelectomy, Semen analysis Department of Urology, M.S. Ramaiah Medical College, Bengaluru, Karnataka, India Received: 15 March 2024 Revised: 30 March 2024 Accepted: 31 March 2024 *Correspondence: Dr. Tarun Javali, E-mail: tarunjavali@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: https://dx.doi.org/10.18203/2349-2902.isj20240928