RESPONSE OF ROUTINE SEMEN ANALYSIS AND CRITICAL-ASSESSMENT OF SPERM MORPHOLOGY BY KRUGER CLASSIFICATION TO THERAPEUTIC VARICOCELECTOMY

Purpose: We studied tile effect of varicocelectomy on Kruger morpholog y and semen parameters, Materials and Methods: A total of 33 subfertil e men diagnosed with varicoceles was evaluated 3 months before, anti 3 to 4 and 6 to 8 months after varicocelectomy. Evaluation involved rou tine 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 postopera tively 139.8 +/- 25 million sperm, p = 0.0095). Using Kruger classific ation, evaluation of sperm morphology revealed overall significant inc rease in percentage of normal A forms at 3 to 4 and 6 to 8 months afte r 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 preoper atively and greater than 4% A forms reached normal levels 3 months pos toperatively. Six months after surgery only 6 patients maintained norm al values and 3 of the initial 14 nonresponders became: normal (9 of 2 6, 36%). Three patients with severe teratozoospermia (less than 4% A f orms) showed improvement in sperm morphology. Four patients with norma l sperm morphology preoperatively were not affected by varicocelectomy . Conclusions: Surgical correction of varicocele was associated with s ignificant; improvement in sperm morphology evaluated using Kruger cla ssification. Concentration and count improved after varicocelectomy. C hanges were observed as early as 3 months after surgery.