Korean J Urol.  2009 Jan;50(1):39-45. 10.4111/kju.2009.50.1.39.

Factors Related to Improvement or Normalization of Semen Parameters after Microsurgical Subinguinal Varicocelectomy

• Choi WS
• Kim TB
• Paick JS
• Kim SW

• KMID: 2140112
• DOI: http://doi.org/10.4111/kju.2009.50.1.39

Abstract

PURPOSE: To determine factors related to improvement or normalization of semen parameters after varicocelectomy, we retrospectively analyzed patients who underwent semen evaluation before and after varicocelectomy.
MATERIALS AND METHODS
A total of 133 patients undergoing left-sided microsurgical subinguinal varicocelectomy for clinically palpable varicoceles with at least one abnormal semen parameter were included in this study. Preoperative and postoperative semen parameters were analyzed. We defined improvement in semen parameters as a greater than 20% change in preoperative values. Several potential predictors of improvement or normalization of each semen parameter were analyzed by multivariate logistic regression model.
RESULTS
Of 133 patients, 64, 105, and 68 patients had abnormal sperm concentration, motility, and morphology, respectively. Postoperative mean values of each parameter were significantly improved after varicocelectomy. In subgroup analyses of the patients with oligospermia, asthenospermia, or teratospermia, improvement in each parameter (concentration, motility, morphology) was observed in 65.6% (42/64), 71.4% (75/105), and 51.5% (35/68) of the patients, respectively, and normalization of each parameter was observed in 42.2%, 29.5%, and 57.4% of the patients, respectively. Absence of testicular size discrepancy and preoperative sperm concentration were independent predictive factors for normalization of the sperm concentration. For improvement of sperm motility, a significant correlation was found with grade of varicocele. Meanwhile, for normalization of sperm motility, significant correlations were found with age and preoperative sperm motility.
CONCLUSIONS
Substantial improvement and normalization in each semen parameter was observed after microsurgical subinguinal varicocelectomy. There were different independent predictive factors for improvement or normalization of each semen parameter.

Keyword

Varicocele; Semen

MeSH Terms

Humans
Logistic Models
Male
Oligospermia
Retrospective Studies
Semen
Sperm Motility
Spermatozoa
Varicocele

Reference

1. World Health Organization. The influence of varicocele on parameters of fertility in a large group of men presenting to infertility clinics. Fertil Steril. 1992. 57:1289–1293.

2. Gorelick JI, Goldstein M. Loss of fertility in men with varicocele. Fertil Steril. 1993. 59:613–616.

3. Witt MA, Lipshultz LI. Varicocele: a progressive or static lesion? Urology. 1993. 42:541–543.

4. Tulloch WS. Varicocele in subfertility: results of treatment. Br Med J. 1955. 2:356–358.

5. MacLeod J. Seminal cytology in presence of varicocele. Fertil Steril. 1965. 16:735–757.

6. Lipshultz LI, Thomas AJ Jr, Khera M. Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA, editors. Surgical management of male infertility. Campbell-Walsh urology. 2007. 9th ed. Philadelphia: Saunders;654–717.

7. Pryor JL, Howards SS. Varicocele. Urol Clin North Am. 1987. 14:499–513.

8. Tinga DJ, Jager S, Bruijnen CL, Kremer J, Mensink HJ. Factors related to semen improvement and fertility after varicocele operation. Fertil Steril. 1984. 41:404–410.

9. Okuyama A, Fujisue H, Matsui T, Doi Y, Koh E, Kondoh N, et al. Preoperative parameters related to the improvement of semen characteristics after surgical repair of varicocele in subfertile men. Eur Urol. 1988. 14:442–446.

10. Matkov TG, Zenni M, Sandlow J, Levine LA. Preoperative semen analysis as a predictor of seminal improvement following varicocelectomy. Fertil Steril. 2001. 75:63–68.

11. Hussein AF. The role of color Doppler ultrasound in prediction of the outcome of microsurgical subinguinal varicocelectomy. J Urol. 2006. 176:2141–2145.

12. Shindel AW, Yan Y, Naughton CK. Does the number and size of veins ligated at left-sided microsurgical subinguinal varicocelectomy affect semen analysis outcomes? Urology. 2007. 69:1176–1180.

13. Dubin L, Amelar RD. Varicocelectomy: 986 cases in a twelve-year study. Urology. 1977. 10:446–449.

14. Park K, Kim SW, Paick JS. Microsurgical subinguinal varicocelectomy. Korean J Urol. 1999. 40:372–376.

15. Sigman Mark, Jarow JP. Ipsilateral testicular hypotrophy is associated with decreased sperm counts in infertile men with varicoceles. J Urol. 1997. 158:605–607.

16. Diamond DA, Zurakowski D, Bauer SB, Borer JG, Peters CA, Cilento BG Jr, et al. Relationship of varicocele grade and testicular hypotrophy to semen parameters in adolescents. J Urol. 2007. 178:1584–1588.

17. World Health Organization. WHO laboratory manual for the examination of human semen and sperm-cervical mucus interaction. 1999. 4th ed. Cambridge: Cambridge University Press;19–22.

18. Al-Said S, Al-Naimi A, Al-Ansari A, Younis N, Shamsodini A, A-sadiq K, et al. Varicocelectomy for male infertility: a comparative study of open, laparoscopic and microsurgical approaches. J Urol. 2008. 180:266–270.

19. Marmar JL, Agarwal A, Prabakaran S, Agarwal R, Short RA, Benoff S, et al. Reassessing the value of varicocelectomy as a treatment for male subfertility with a new meta-analysis. Fertil Steril. 2007. 88:639–648.

20. Agarwal A, Deepinder F, Cocuzza M, Agarwal R, Short RA, Sabanegh E, et al. Efficacy of varicocelectomy in improving semen parameters: new meta-analytical approach. Urology. 2007. 70:532–538.

21. Goldstein M, Gilbert BR, Dicker AP, Dwosh J, Gnecco C. Microsurgical inguinal varicocelectomy with delivery of the testis: an artery and lymphatic sparing technique. J Urol. 1992. 148:1808–1811.

22. Cayan S, Erdemir F, Ozbey I, Turek PJ, Kadioğlu A, Tellaloğlu S. Can varicocelectomy significantly change the way couples use assisted reproductive technologies? J Urol. 2002. 167:1749–1752.

23. Kamal KM, Jarvi K, Zini A. Microsurgical varicocelectomy in the era of assisted reproductive technology: influence of initial semen quality on pregnancy rates. Fertil Steril. 2001. 75:1013–1016.

24. Jungwirth A, Gögüs C, Hauser G, Gomahr A, Schmeller N, Aulitzky W, et al. Clinical outcome of microsurgical subinguinal varicocelectomy in infertile men. Andrologia. 2001. 33:71–74.

25. Kibar Y, Seckin B, Erduran D. The effects of subinguinal varicocelectomy on Kruger morphology and semen parameters. J Urol. 2002. 168:1071–1074.

26. Marmar JL, Kim Y. Subinguinal microsurgical varicocelectomy: a technical critique and statistical analysis of semen and pregnancy data. J Urol. 1994. 152:1127–1132.