Preoperative seminal plasma disturbed oxidant/antioxidant milieu could predict failure of varicocelectomy as a therapeutic modality for male infertility

Aim. The aim of this study was to evaluate seminal plasma (SP) malonaldehyde (MDA), superoxide desmutase (SOD) and CoQ10 levels in infertile men with and without varicocele as a trial to evaluate the predictability of their preoperative estimation for postoperative (PO) improvement of seminal parameters. Methods. Seventy infertile men; with (N.=35) and without (N.=35) and 20 fertile men with (N.=10) and without (N.=10) clinically and ultrasonographically diagnosed varicocele. Infertile men with varicocele were assigned to undergo bilateral varicocelectomy using subinguinal approach. All infertile patients had preoperative hormonal profile. Semen samples were obtained from all men for standard semen analysis and SP estimation of CoQ10 using high-performance liquid chromatography (HPLC), SP MDA using a thiobarbituric acid reactive substances (TBARS) assay and SP SOD activity by chemiluminescence. Another semen sample was obtained PO for standard semen analysis. Results. Baseline data showed a significant decrease of sperm concentration and percentage of sperms with rapid progressive motility with significantly higher percentage of sperms with abnormal morphology and significantly lower SP CoQ10 and SOD levels with significantly higher SP MDA levels in infertile men compared to fertile men with significant difference among infertile men in favor of those free of varicocele. In all infertile men, there was negative significant correlation between SP MDA and CoQ10 levels and a positive significant correlation between SP SOD and CoQ10 levels with higher significance in those had varicocele. In infertile men free of varicocele, there was a negative correlation between sperm count and SP MDA with a positive significant correlation with SP SOD levels, while in infertile men with varicocele, the correlation was significant between SP SOD and the three seminal parameters and between the percentage of abnormal sperm forms and SP MDA and CoQ10. PO sperm count showed a negative significant correlation with preoperative SP MDA levels, while the correlation was positive significant with SP CoQ10 and SP SOD levels. Regression analysis identified high preoperative SP SOD level as significant predictor of improvement of sperm count after varicocelectomy. ROC curve analysis defined preoperative SOD level at >= 88 U/mL as a specific predictor for PO improvement of sperm count, while identified preoperative SP MDA level at >= 0.53 nmol/mL and SP CoQ10 at cut-off point of 0.12 mu g/mL could identify infertile men with varicocele most probably will not get benefit of varicocelectomy. Conclusion. Combined varicocele and disturbed oxidant/antioxidant system could be the underlying mechanism for varicocele associated male infertility and highly disturbed oxidant/antioxidant system could influence the outcome of varicocelectomy as a therapeutic modality. Preoperative estimation of SP levels of MDA and SOD could aid to predict the outcome of varicocelectomy.