The Clinical Prognostic Utility of DNA Fragmentation Index (DFI) on the result of sperm analysis befor and after Varicocelectomy Outcomes of Infertile Men

Document Type : Original Article


1 Assistant professor, Department of Urology, Kidney Transplantation Complications Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

2 General Physician, Kidney Transplantation Complications Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

3 Associate Professor, Department of Social Medicine, Clinical Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

4 Resident, Department of Urology, Kidney Transplantation Complications Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

5 Bachelor of Medical Education, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran


Introduction: Studies have shown that conventional sperm analysis does not represent fertility status completely. About 15% of infertile men have normal clinical and laboratory investigation. DNA fragmentation index (DFI) measures the DNA damage. Also, 20% of men with unexplained infertility have increased DFI level compared to the normal level. The present study was performed with aim to evaluate the clinical utility of DFI as an indicator for varicocelectomy.
Methods: This longitude observational study was performed in 2020-2021 on 60 patients who underwent varicocelectomy due to infertility in Imam Reza Hospital of Mashhad. The patients were divided into three groups based on DFI levels (DFI ≤15%, 15-30%, and >30%) considered as excellent, moderate, and poor fertility, respectively. Then, pre- and post-operational semen analysis was performed. Data were analyzed by SPSS software (version 24) and paired-t, Wilcoxon, and analysis of variance tests. P<0.05 was considered statistically significant.
Results: The mean DFI in the excellent fertility group was 10.83 ± 2.92, in the moderate 21.10 ± 6.05, and in the poor fertility 46.56 ± 10.73. The moderate and poor fertility participants experienced statistically significant improvement in sperm count, motility, and morphology. On average, the number of 8.92±16.91 million per cc, the motility of 13.93±19.73% and the morphology of 3.17±3.57% improved after the operation.
Conclusion: The higher the pre-operative DFI, the more significant increase in sperm analysis factors is expected. DFI has a prognostic value for varicocele patients, especially those with higher DFI.People who have a higher pre operative DFI score will improve more after operation.


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