Impact of Varicocele on Semen Parameters and Sperm DNA Integrity: A Prospective Analysis

Introduction: Varicocele, characterized as a palpable, dilated, and tortuous pampiniform plexus of testicular veins, is present in approximately 35% of men with primary infertility. While the exact mechanisms underlying varicocele-associated infertility remain unclear, evidence indicates reduced sperm concentration, impaired motility, oxidative stress, and increased sperm DNA fragmentation (SDF) as contributing factors. This study prospectively evaluates the effects of varicoceles on conventional semen parameters and SDF. Materials and Methods: Sixty semen samples from men with (30) and without (30) varicocele were analyzed to assess semen parameters and SDF. Varicocele presence was clinically evaluated and confirmed through color Doppler sonography. Semen parameters were assessed according to the World Health Organization 2021 6 th edition guidelines, with sperm concentration measured using a Makler counting chamber and computer-assisted semen analysis. SDF was evaluated in both groups using the sperm chromatin dispersion test (Halosperm kit). Results for semen parameters and DNA fragmentation index were compared between the varicocele and nonvaricocele groups. Results: The study evaluates the impact of varicocele on fertility, lifestyle habits, semen parameters, and DNA fragmentation. Primary infertility was more prevalent in both groups, affecting 63.3% of varicocele and 56.7% of nonvaricocele patients. Lifestyle analysis showed significantly higher smoking (33.3%, P = 0.010) and multiple habits (26.6%, P = 0.039) in the varicocele group, while nonvaricocele patients were more likely to have no habits (56.6%, P = 0.001). Semen analysis revealed significant impairments in varicocele patients, including lower sperm count, total sperm number, total motility, nonprogressive motility, and normal morphology ( P 30% fragmentation compared to 40% in nonvaricocele patients ( P = 0.009). Normal semen parameters were observed in only 13.3% of varicocele patients compared to 60% in nonvaricocele patients ( P = 0.001). Conclusions: This study highlights that infertile men with varicoceles exhibit significant abnormalities in semen quality, coupled with elevated levels of sperm nuclear DNA fragmentation, suggesting the critical role of varicoceles in male infertility.