Response of routine semen analysis and critical assessment of sperm morphology by kruger classification to therapeutic varicocelectomy

Purpose: We studied the effect of varicocelectomy on Kruger morphology and semen parameters. Materials and Methods: A total of 33 subfertile men diagnosed with varicoceles was evaluated 3 months before, and 3 to 4 and 6 to 8 months after varicocelectomy. Evaluation involved routine semen analysis and sperm morphology using Kruger classification. Results: Significant improvement in sperm concentration and count was found after varicocelectomy (sperm count preoperatively 117.1 ± 29, 3 to 4 months postoperatively 162.5 ± 41 and 6 to 8 months postoperatively 139.8 ± 25 million sperm, p = 0.0095). Using Kruger classification, evaluation of sperm morphology revealed overall significant increase in percentage of normal A forms at 3 to 4 and 6 to 8 months after surgery (from 9.8 ± 5.8 % A forms, 13.6 ± 7.7 % A forms, and 14.5 ± 7.5 % A forms, respectively, p = 0.0002, normal greater than 14%). Twelve of the 26 patients (46%) with abnormal sperm morphology preoperatively and greater than 4% A forms reached normal levels S months postoperatively. Six months after surgery only 6 patients maintained normal values and 3 of the initial 14 nonresponders became normal (9 of 26, 36%). Three patients with severe teratozoospermia (less than 4% A forms) showed improvement in sperm morphology. Four patients with normal sperm morphology preoperatively were not affected by varicocelectomy. Conclusions: Surgical correction of varicocele was associated with significant improvement in sperm morphology evaluated using Kruger classification. Concentration and count improved after varicocelectomy. Changes were observed as early as 3 months after surgery.