To Find the Pregnancy Outcome in Patients After Microsurgical Varicocelectomy Having Sperm Dna Fragmentation

Background: Varicocele is one of the most prevalent and correctable causes of male infertility, often associated with impaired spermatogenesis and elevated sperm DNA fragmentation index (DFI). Its detrimental impact on sperm quality results from oxidative stress and venous reflux within the pampiniform plexus. Microsurgical varicocelectomy has emerged as the preferred surgical intervention, offering precise anatomical correction with minimal complications. While its effectiveness in improving semen parameters is well documented, its influence on natural conception requires further clinical exploration. Objective: To evaluate the effect of microsurgical varicocelectomy on semen quality, sperm DNA integrity, and natural pregnancy outcomes in infertile men with clinical varicocele. Materials and Methods: A prospective observational study was conducted at Civil Hospital, Bahawalpur, from January to June 2024. Ninety infertile males aged 25–45 years with clinical varicocele, oligoasthenozoospermia, and baseline DFI >20% were included. Patients with azoospermia, previous varicocelectomy, or systemic illness affecting fertility were excluded. All participants underwent microsurgical subinguinal varicocelectomy performed by a single experienced surgeon under general anesthesia. Pre- and postoperative semen analyses were performed to assess sperm count, motility, morphology, and DFI. Pregnancy achievement was monitored over a six-month follow-up. Data were analyzed using paired t-tests and chi-square tests, with p < 0.05 considered significant. Results: The mean age of participants was 34.28 ± 5.60 years, and mean BMI was 24.01 ± 3.27 kg/m². Significant postoperative improvements were observed in sperm count (8.09 ± 4.00 to 25.90 ± 7.73 million/mL, p < 0.001), motility (35.39 ± 8.72% to 54.24 ± 8.35%, p < 0.001), morphology (5.68 ± 2.46% to 13.32 ± 4.07%, p < 0.001), and DFI (29.86 ± 5.91% to 17.96 ± 4.30%, p < 0.001). Pregnancy was achieved in 32 (36%) patients. No statistically significant association was found between pregnancy outcomes and variables such as age, obesity, infertility duration, or varicocele grade. Conclusion: Microsurgical varicocelectomy significantly improves semen parameters and sperm DNA integrity, supporting its role as an effective intervention to enhance natural fertility in men with clinical varicocele.