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Effects of supplement therapy on sperm parameters, protamine content and acrosomal integrity of varicocelectomized subjects

Journal of Assisted Reproduction and Genetics volume 30, pages 593–599 (2013)Cite this article

Abstract

Purpose

Surgical repair of varicocele has long been a procedure to correct spermatogenesis. However, the outcome has been reported to be inadequate. We combined varicocelectomy with supplement therapy to evaluate the concurrent effect of these procedures.

Methods

A prospective randomized controlled study was undertaken to investigate the effects of zinc sulfate, folic acid and zinc sulfate/folic acid on sperm quality, protamine content and acrosomal integrity following surgical repair of varicocele. Male subjects with palpable varicocele were included in the study and randomized into four groups. Subjects received Zinc sulfate, Follic acid, Zinc sulfate/Follic acid or placebo for 6 months. A semen sample was obtained before surgery and 3 and 6 months after surgical repair. Semen samples were evaluated for sperm parameters as well as chromatin content and acrosomal integrity.

Results

Most of the evaluated parameters showed a mild improvement after varicocelectomy in the placebo group. Interestingly, co-administration of Zinc sulfate and folic acid improved most factors significantly. Folic acid administration but not zinc sulfate could increase sperm number. Hence, Zinc sulfate was better than folic acid when change in morphology was assessed, and none of them was significantly effective in sperm motility. In Zinc sulfate and Follic acid groups, protamine content and halo formation rate significantly improved.

Conclusions

We may conclude that co-administration of zinc and folic acid significantly improved sperm parameters and increased varicocelectomy outcomes. So, medical treatment with compatible drugs after surgery might be advantageous for obtaining acceptable results.

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References

  1. Mohammed A, Chinegwundoh F. Testicular varicocele: an overview. Urol Int. 2009;82(4):373–9.

    PubMed  Article  Google Scholar 

  2. Ozturk U et al. The effects of experimental left varicocele on the epididymis. Syst Biol Reprod Med. 2008;54(4–5):177–84.

    PubMed  Article  Google Scholar 

  3. Agarwal A et al. Role of oxidative stress in pathogenesis of varicocele and infertility. Urology. 2009;73(3):461–9.

    PubMed  Article  Google Scholar 

  4. Li F et al. Significant improvement of sperm DNA quality after microsurgical repair of varicocele. Syst Biol Reprod Med. 2012;58(5):274–7.

    PubMed  Article  Google Scholar 

  5. Wu AK et al. Bilateral but not unilateral testicular hypotrophy predicts for severe impairment of semen quality in men with varicocele undergoing infertility evaluation. Urology. 2008;71(6):1114–8.

    PubMed  Article  Google Scholar 

  6. Marmar JL. The pathophysiology of varicoceles in the light of current molecular and genetic information. Hum Reprod Update. 2001;7(5):461–72.

    PubMed  CAS  Article  Google Scholar 

  7. French DB, Desai NR, Agarwal A. Varicocele repair: does it still have a role in infertility treatment? Curr Opin Obstet Gynecol. 2008;20(3):269–74.

    PubMed  Article  Google Scholar 

  8. Erkan E et al. Expression of NOS isoforms in internal spermatic veins of infertile men with varicocele. Syst Biol Reprod Med. 2012;58(5):268–73.

    PubMed  CAS  Article  Google Scholar 

  9. Pasqualotto FF et al. Semen quality and oxidative stress scores in fertile and infertile patients with varicocele. Fertil Steril. 2008;89(3):602–7.

    PubMed  Article  Google Scholar 

  10. Agarwal A, Said TM. Role of sperm chromatin abnormalities and DNA damage in male infertility. Hum Reprod Update. 2003;9(4):331–45.

    PubMed  CAS  Article  Google Scholar 

  11. Shiraishi K, Naito K. Effects of 4-hydroxy-2-nonenal, a marker of oxidative stress, on spermatogenesis and expression of p53 protein in male infertility. J Urol. 2007;178(3 Pt 1):1012–7. discussion 1017.

    PubMed  CAS  Article  Google Scholar 

  12. Nasr-Esfahani MH et al. Varicocelectomy: semen parameters and protamine deficiency. Int J Androl. 2009;32(2):115–22.

    PubMed  CAS  Article  Google Scholar 

  13. Smit M et al. Decreased sperm DNA fragmentation after surgical varicocelectomy is associated with increased pregnancy rate. J Urol. 2010;183(1):270–4.

    PubMed  Article  Google Scholar 

  14. Fisher L, Sandlow J. The role of varicocele treatment in the era of assisted reproductive technology. Clin Urol. 2001;27:19–25.

    Google Scholar 

  15. Evers JL, Collins JA. Assessment of efficacy of varicocele repair for male subfertility: a systematic review. Lancet. 2003;361(9372):1849–52.

    PubMed  Article  Google Scholar 

  16. Zini A et al. Beneficial effect of microsurgical varicocelectomy on human sperm DNA integrity. Hum Reprod. 2005;20(4):1018–21.

    PubMed  CAS  Article  Google Scholar 

  17. Moskovtsev SI et al. Cause-specific treatment in patients with high sperm DNA damage resulted in significant DNA improvement. Syst Biol Reprod Med. 2009;55(2):109–15.

    PubMed  CAS  Article  Google Scholar 

  18. Ebisch IMW et al. The importance of folate, zinc and antioxidants in the pathogenesis and prevention of subfertility. Hum Reprod. 2006;p. 163–174.

  19. Favier AE. The role of zinc in reproduction. Hormonal mechanisems. Biol Trace Elem Res. 1992;32:363–82.

    PubMed  CAS  Article  Google Scholar 

  20. Zago M, Oteiza PI. The antioxidant properties of zinc: interactions with iron and antioxidants. Free Radic Biol and Med. 2001;31:266–74.

    CAS  Article  Google Scholar 

  21. Chimienti F et al. Zinc homeostasis regulating proteins: new drug tergets for triggering cell fate. Curr Drug Targets. 2003;4:323–38.

    PubMed  CAS  Article  Google Scholar 

  22. Ando S. et al. Phosphatase and zinc levels in the seminal plasma of varicocele. Int J Fertil. 1990;p. 249–252.

  23. Joshi R et al. Free radical scavenging behavior of folic acid: evidence for possible antioxidant activity. Free Radic Biol and Med. 2001;30:1390–9.

    CAS  Article  Google Scholar 

  24. Wong W et al. Effect of folic acid and zinc sulphate on male factor subfertility: a double-blind, randomized, placebo-controlled trial. Fertil Steril. 2002;77:491–8.

    PubMed  Article  Google Scholar 

  25. World Health Organization. Laboratory manual for the examination of human semen and semen-cervical mucus interaction. Cambridge: Cambridge University Press; 1992.

    Google Scholar 

  26. Nasr-Esfahani MH, Razavi S, Mardani M. Relation between different human sperm nuclear maturity tests and in vitro fertilization. J Assist Reprod Genet. 2001;18:219–25.

    PubMed  CAS  Article  Google Scholar 

  27. Al Bakri A. et al. Time for improvement in semen parameters after varicocelectomy. J Urol. 2011.

  28. Madgar I et al. Controlled trial of high spermatic vein ligation for varicocele in infertile men. Fertil Steril. 1995;63(1):120–4.

    PubMed  CAS  Google Scholar 

  29. Yamamoto M et al. Effect of varicocelectomy on sperm parameters and pregnancy rate in patients with subclinical varicocele: a randomized prospective controlled study. J Urol. 1996;155(5):1636–8.

    PubMed  CAS  Article  Google Scholar 

  30. Girardi SK, Goldstein M. Varicocele. Curr Ther Endocrinol Metab. 1997;6:355–8.

    PubMed  CAS  Google Scholar 

  31. Chemes HE, Rawe VY. Sperm pathology: a step beyond descriptive morphology. Origin, characerization and fertility potential of abnormal sperm phenotypes in infertile men. Hum Reprod Update. 2003;9:405–28.

    PubMed  Article  Google Scholar 

  32. Nematollahi-Mahani SN et al. Effect of folic acid and zinc sulphate on endocrine parameters and seminal antioxidant level after varicocelectomy. Andrologia. 2013. doi:10.1111/and.12067.

  33. Ebisch IM et al. Homocysteine, glutathione and related thiols affect fertility parameters in the (sub)fertile couple. Hum Reprod. 2006;21(7):1725–33.

    PubMed  CAS  Article  Google Scholar 

  34. Boxmeer JC et al. Low folate in seminal plasma is associated with increased sperm DNA damage. Fertil Steril. 2009;92(2):548–56.

    PubMed  CAS  Article  Google Scholar 

  35. Blount BC et al. Folate deficiency causes uracil misincorporation into human DNA and chromosome breakage: implications for cancer and neuronal damage. Proc Natl Acad Sci U S A. 1997;94(7):3290–5.

    PubMed  CAS  Article  Google Scholar 

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Acknowledgements

Kerman medical University infertility center members are acknowledged for their warm cooperation in this study

Declaration of interest

The authors have no conflict of interest to declare.

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Authors and Affiliations

  1. Department of Urology, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran

    Gholamabbas Azizollahi

  2. Physiology Research Center, Kerman University of Medical Sciences, Kerman, Iran

    Gholamabbas Azizollahi & Seyed Noureddin Nematollahi-mahani

  3. Department of Anatomy, Division of Reproductive Biology, Tehran University of Medical Sciences, Tehran, Iran

    Saeid Azizollahi

  4. Department of Clinical Sciences, Faculty of Veterinary Medicine, Shahid Bahonar University of Kerman, Kerman, Iran

    Homayoon Babaei

  5. Food and Drug Laboratory, Vice Chancellor of Food and Drug, Kerman University of Medical Sciences, Kerman, Iran

    Mohammadali Kianinejad

  6. Research Center for Modeling in Health, Kerman University of Medical Sciences, Kerman, Iran

    Mohammad Reza Baneshi

  7. Department of Anatomy, Afzalipour School of Medicine, Kerman University of Medical Sciences, Kerman, Iran

    Seyed Noureddin Nematollahi-mahani

  8. Afzal Resaerch Institute (NGO), Kerman, Iran

    Seyed Noureddin Nematollahi-mahani

Authors
  1. Gholamabbas Azizollahi
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  2. Saeid Azizollahi
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  3. Homayoon Babaei
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  4. Mohammadali Kianinejad
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  5. Mohammad Reza Baneshi
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  6. Seyed Noureddin Nematollahi-mahani
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Correspondence to Seyed Noureddin Nematollahi-mahani.

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Capsule In a prospective randomized trial, 6 months supplement therapy in varicocelectomized patients improved sperm parameters, acrosomal integrity and chromatin content.

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Azizollahi, G., Azizollahi, S., Babaei, H. et al. Effects of supplement therapy on sperm parameters, protamine content and acrosomal integrity of varicocelectomized subjects. J Assist Reprod Genet 30, 593–599 (2013). https://doi.org/10.1007/s10815-013-9961-9

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  • DOI: https://doi.org/10.1007/s10815-013-9961-9

Keywords

  • Zinc sulfate
  • Folic acid
  • Sperm parameters
  • Protamine
  • Acrosomal integrity
  • Varicocelectomy