P-45: Does Anti-Oxidant Therapy Add AnyExtra Benefit to Standard Inguinal Varicocelectomy in Terms of DNA Damageor Sperm Quality Factor Indices: A Randomized Study

Background: Varicocele occurs in approximately 15 to 20% of the general male population and it is the most common cause of poor semen production and decreased semen quality. It has been demonstrated that patients with varicocele have a significantly higher DNA damage and spermatozoa with nuclear anomalies than healthy men. Previously it was documented that antioxidant therapy or varicocelectomy will improve DNA damage separately. we proposed to evaluate if antioxidant therapy adds any extra benefit to standard inguinal varicocelectomy in improvement of DNA damage by using Terminal deoxynucleotidyl transferase dUTP Nick End Labeling (TUNEL) assay analysis. Materials and Methods: We prospectively evaluated changes in sperm chromatin structure in patients with varicocele before and after varicocelectomy. A 100 men with varicocele were enrolled in this study and divided into 2 groups. Fifty men underwent inguinal varicocelectomy and second group underwent varicoceletomy and received L- carnitine 250 mg 3 times / day for 6 months. World Health Organization (WHO) semen analysis and sperm DNA damage by using TUNEL assay were assessed before 3 and 6 months post-operatively. Results: There was no difference between two groups in age and varicocele grade at the beginning of the study. Mean percentage of DNA damage by TUNEL assay was not different between two groups at baseline. [14.08 (± 10.57%) in operation group vs. 13.97 (± 5.33%) in operation-drug group]. In analyzing the DNA damage by TUNEL, a statistically significant improvement was observed in both groups. DNA fragmentation test results showed a decreasing trend from 14.08 to 10.43 and 9.54% in the operation group and from 13.97 to 9.25 and 8.49>% in the operation-drug group respectively at baseline, three and six months post-operatively; (p value=0.02 vs, respectively=0.000). A more improved slope was observed in group 2 (5.48% reduction in six months in operation-drug group vs. 4.54% in operation group) but the observed difference was not statistically different (p value= 0.255) Conclusion: In this study, we found the positive effect of varicocelectomy on improving DNA damage but failed to show that anti-oxidant therapy can add extra benefits to this effect in terms of improving DNA damage.