Preoperative and postoperative examination of ultrastructural composition of spermium taken from patients who have varicocele

Varicocele is defined as an excessive dilation and tortuous shape of testicular veins in plexus pampiniformis and it is an important factor in the etiology of male infertility which can be surgically improved. Clinically, varicocele is diagnosed in 15-20% of adult males, 35-40% of males who has primer infertility and 60-80 % of males with secondary infertility. The aim of this study is to investigate the effect of varicocele operation on spermium parameters and examine the number, movement, morphology and DNA fragmantation of spermiums in semen taken before and after 3rd, 6th and 12nd months from the patients who admitted to hospital with groin pain, infertility, swelling and sag in the testicles complaints. Semen samples were obtained from 40 patients. Samples were collected by masturbation after 3 days of sexual abstinence. The number and movement of spermiums were evaluated according to the WHO criteria by Makler camera after liquefaction. The spermium morphology was examined by using of spermac painting technique. The ultrastructural morphology of spermium were investigated with transmission electron microscope and TUNEL technique was used to assess the structure of DNA fragmantetion index. The patients median age was 22 (15-30). While the preoperative average concentration of spermium was deteremined as 45.25 Million/ml, the postoperative average concentrations were detected as 48.85 at 3rd month, 51.72 Million/ml at 6th month and 49.63 Million/ml at 12nd month. Before varicocelectomy A+B motil sperm count was 35.5%, after varicocelectomy, the spermium counts were found as 42.65%, 43% and 44% at 3rd, 6th, 12nd months, respectively. The main purpose of morphological evaluation is to distinguish normal and abnormal spermium. In our study, there were no significant difference between preoperation and postoperation normal spermium morphology because, while normal spermium morphology average before operation was 3.15%, after operation the average were 3.20%, 2.97%, 3.27% at 3rd, 6th and 12nd months respectively. We found minor differences in sperm morphology between groups when we examined the four different groups ultrastructurally. It was found that varicocele surgery did not make any positive impact on spermium morphology, especially, when we consider the spermium nucleus, acrosome, mitochondria and microtubules on tail structure. Environmental factors are play a role in increase of spermium DNA damage. This factors can cause disruption in DNA structure, disrupt or decrease DNA repair mechanism through out spermatogenesis or cause apoptosis in the cell. While DNA fregmantation index average level (DFI %) was 20.57 % before surgery, after operation it was 17.27% at 3rd month, 15.5% at 6th month and 15.3% at 12nd month. According to these results it could be suggested that there was a significant statistical difference between preoperation and postoperation periods. Consequently, before and after operation when we evaluated the number, morphology and DNA fragmentation of the varicocele patients' spermium, it was observed a slight improvement in DNA fragmentation and increase in counts and mobility. We detected that although there was an increase in spermium counts, there was no morphological change in spermium structure but there was a significant increase in mobility of spermium. These findings; we believe that these findings can be guide to future research about varicocele.