Significance of sperm characteristics in the evaluation of adolescents, adults and older men with varicocele.

ABSTRACT

BACKGROUND: No reports have been published about age-related sperm malformations in varicocele patients. AIM: To investigate the distribution of abnormal sperm characteristics in adolescents, adults and older men with varicocele. SETTING AND DESIGN: Records of semen analysis of 143 men aged 14 to 53 years who had evident left-sided varicocele detected by physical examination and confirmed by doppler sonography were selected. MATERIALS AND METHODS: Sperm concentration, vitality, motility, morphology, hypoosmotic swelling test (HOST) and morphology were measured in adolescent males aged 14 to 20 years (n=31), men 21 to 30 years (n=48), 31 to 40 years (n=40) and older men over 40 (n=24) and compared with a control group of fertile men with no varicocele (n=27) and with a group of infertile men with varicocele (n=26). STATISTICAL ANALYSIS: One-way analysis of variance and the Kruskal-Wallis test were used to compare varicocele groups. Comparisons with the control group and infertile group were performed using the unpaired t-test and the Mann-Whitney test. The discriminating ability of significant sperm characteristics in evaluating the sperm quality of varicocele men was also analyzed using receiver operating characteristics curve to select the cut-off level providing the best combination of sensitivity and specificity. RESULTS: Varicocele men displayed similar impairment of vitality, motility and HOST. Sperm morphology analysis revealed a prevalence of small head, slightly and severely amorphous head and particularly combined anomalies in the study groups. Sperm concentration fell within the normal range of the World Health Organization manual. Differences were not significant between the study groups and when compared with infertile group ( P> 0.005). However, a comparative study of the varicocele groups and the infertile group with the control group revealed significant differences in sperm vitality, motility, HOST, morphologically normal sperm, pin-headed, tapered and combined anomalies. Morphologically normal sperm and combined anomalies showed higher accuracy in identifying poor sperm quality in varicocele men (83.7% and 77.9%, at cut-off levels of 9% and 38%, respectively). CONCLUSIONS: Varicocele harms equally the sperm characteristics of adolescents, adults and older men. Apparently, it affects sperm quality more adversely than it does sperm production.