Investig Clin Urol.  2018 May;59(3):182-186. 10.4111/icu.2018.59.3.182.

Microscopic varicocelectomy as a treatment option for patients with severe oligospermia

• Gupta C
• Chinchole
• Shah R
• Pathak H
• Talreja D
• Kayal A

• KMID: 2410591
• DOI: http://doi.org/10.4111/icu.2018.59.3.182

Abstract

PURPOSE
Many studies have shown improved semen parameters after varicocele surgery; however, the benefit in terms of improved pregnancy rates and live births is still disputed in cases of severe oligoasthenozoospermia (OAS). The present study evaluated the outcome of microscopic subinguinal varicocelectomy in terms of the spontaneous pregnancy rate in patients with severe OAS.
MATERIALS AND METHODS
This was a retrospective, observational, analytic study of 56 men with OAS who underwent microscopic varicocelectomy at our center between 2008 and 2015. The subjects were followed for a mean period of 12.4 months. Outcome was compared among groups of men with mild (sperm concentration, 10.2-19 million/mL), moderate (5.7-9.5 million/mL), and severe ( < 5 million/mL) OAS who were operated on during the same period.
RESULTS
A total of 13 of 35 men (37.1%) with severe OAS achieved spontaneous pregnancy. Mean sperm density increased from 2.29 million/mL preoperatively to 14.09 million/mL postoperatively. The mean time to pregnancy from the date of surgery was 8.5 months. The spontaneous pregnancy rate in men with mild and moderate OAS was 62.5% and 46.2%, respectively.
CONCLUSIONS
Although pregnancy rates after varicocele surgery are lower preoperatively in men with severe OAS than in men with mild or moderate OAS, the spontaneous pregnancy rate of 37.1% still compares very favorably with outcomes after a single attempt at in vitro fertilization.

Keyword

Microsurgery; Oligospermia; Pregnancy rate; Varicocele

MeSH Terms

Fertilization in Vitro
Humans
Live Birth
Male
Microsurgery
Oligospermia*
Pregnancy
Pregnancy Rate
Retrospective Studies
Semen
Spermatozoa
Time-to-Pregnancy
Varicocele

Reference

1. Schlesinger MH, Wilets IF, Nagler HM. Treatment outcome after varicocelectomy. A critical analysis. Urol Clin North Am. 1994; 21:517–529. PMID: 8059505.

2. Enatsu N, Yamaguchi K, Chiba K, Miyake H, Fujisawa M. Clinical outcome of microsurgical varicocelectomy in infertile men with severe oligozoospermia. Urology. 2014; 83:1071–1074. PMID: 24674115.

3. Richardson I, Grotas AB, Nagler HM. Outcomes of varicocelectomy treatment: an updated critical analysis. Urol Clin North Am. 2008; 35:191–209. viiiPMID: 18423240.

4. Cayan S, Shavakhabov S, Kadioğlu A. Treatment of palpable varicocele in infertile men: a meta-analysis to define the best technique. J Androl. 2009; 30:33–40. PMID: 18772487.

5. World Health Organization (WHO). WHO laboratory manual for the examination of human semen and sperm-cervical mucus interaction. 4th ed. Cambridge: Cambridge University Press;1999. p. 128.

6. Ficarra V, Novara G, Artibani W, Cestari A, Galfano A, Graefen M, et al. Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a systematic review and cumulative analysis of comparative studies. Eur Urol. 2009; 55:1037–1063. PMID: 19185977.

7. 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. PMID: 17905111.

8. Kim KH, Lee JY, Kang DH, Lee H, Seo JT, Cho KS. Impact of surgical varicocele repair on pregnancy rate in subfertile men with clinical varicocele and impaired semen quality: a meta-analysis of randomized clinical trials. Korean J Urol. 2013; 54:703–709. PMID: 24175046.

9. Ishikawa T, Kondo Y, Yamaguchi K, Sakamoto Y, Fujisawa M. Effect of varicocelectomy on patients with unobstructive azoospermia and severe oligospermia. BJU Int. 2008; 101:216–218. PMID: 17941933.

10. Tournaye H, Merdad T, Silber S, Joris H, Verheyen G, Devroey P, et al. No difference in outcome after intracytoplasmic sperm injection with fresh or with frozen-thawed epididymal spermatozoa. Hum Reprod. 1999; 14:90–95.

11. Palermo GD, Schlegel PN, Hariprashad JJ, Ergün B, Mielnik A, Zaninovic N, et al. Fertilization and pregnancy outcome with intracytoplasmic sperm injection for azoospermic men. Hum Reprod. 1999; 14:741–748. PMID: 10221707.

12. Kupker W, Schlegel PN, Al-Hasani S, Fornara P, Johannisson R, Sandmann J, et al. Use of frozen-thawed testicular sperm for intracytoplasmic sperm injection. Fertil Steril. 2000; 73:453–458. PMID: 10688995.

13. Habermann H, Seo R, Cieslak J, Niederberger C, Prins GS, Ross L. In vitro fertilization outcomes after intracytoplasmic sperm injection with fresh or frozen-thawed testicular spermatozoa. Fertil Steril. 2000; 73:955–960. PMID: 10785220.

14. Mercan R, Urman B, Alatas C, Aksoy S, Nuhoglu A, Isiklar A, et al. Outcome of testicular sperm retrieval procedures in non-obstructive azoospermia: percutaneous aspiration versus open biopsy. Hum Reprod. 2000; 15:1548–1551. PMID: 10875864.

15. Nagy Z, Liu J, Cecile J, Silber S, Devroey P, Van Steirteghem A. Using ejaculated, fresh, and frozen-thawed epididymal and testicular spermatozoa gives rise to comparable results after intracytoplasmic sperm injection. Fertil Steril. 1995; 63:808–815. PMID: 7890067.

16. Gil-Salom M, Mínguez Y, Rubio C, De los Santos MJ, Remohí J, Pellicer A. Efficacy of intracytoplasmic sperm injection using testicular spermatozoa. Hum Reprod. 1995; 10:3166–3170. PMID: 8822436.

17. Hussein AF. The role of color Doppler ultrasound in prediction of the outcome of microsurgical subinguinal varicocelectomy. J Urol. 2006; 176:2141–2145. PMID: 17070279.

18. Orhan I, Onur R, Semerciöz A, Firdolas F, Ardicoglu A, Köksal IT. Comparison of two different microsurgical methods in the treatment of varicocele. Arch Androl. 2005; 51:213–220. PMID: 16025860.