Varicocele grade does not correlate with the severity of sperm DNA fragmentation levels nor with the amount of improvement in DNA fragmentation following varicocele repair

Varicocele is the most common correctable form of male infertility. Varicoceles have been established to result in worsened semen parameters as well as elevate sperm DNA fragmentation (SDF). There is data indicating that varicocele repair improves semen parameters and SDF, however; there is a paucity of data assessing the correlation of varicocele clinical grade with the severity of SDF and the amount of improvement in SDF with varicocele repair based on grade. The purpose of this study was to assess the difference in baseline sperm DNA fragmentation indices (DFIs) in infertile men with varicoceles based on the clinical grade of the varicocele and the amount of improvement in DFI following varicocele repair. A retrospective chart review was performed in men who presented for a fertility evaluation and were diagnosed with a clinical varicocele and underwent varicocele repair with preoperative and 3-month postoperative semen analyses with DFI testing. There was no significant difference in the level of SDF based on the grade of varicocele, and there was not a significant correlation between the grade of the varicocele and the amount of improvement in SDF from baseline to 3 months after varicocele repair. When counseling infertile men undergoing varicocele repair for elevated SDF, the grade of varicocele may not impact the amount of improvement expected in SDF following repair, suggesting that varicocele patients may be counseled similarly on expectations for response regardless of varicocele grade.