EVALUATION OF THE RELATIONSHIP BETWEEN SEMEN PARAMETERS, PREGNANCY RATE OF WIVES OF INFERTILE MEN WITH VARICOCELE, AND GONADOTROPIN-RELEASING-HORMONE TEST BEFORE AND AFTER VARICOCELECTOMY

Objectives. To determine whether the gonadotropin-releasing hormone (G nRH) test can serve as an indicator for the need and timing of surgery in infertile men with varicocele. Methods. The GnRH test was performe d in 121 infertile men with varicocele before surgical correction and 4 to 6, 9 to 12, and 16 to 18 months after. Levels of follicle-stimula ting hormone (FSH) and luteinizing hormone (LH) were evaluated immedia tely before the test and 45 minutes after intravenous injection of 100 mu g Relisorm L (a synthetic GnRH analogue). Eighteen fertile men wit h normal semen parameters sewed as control patients for defining the p reoperative hormone levels. A more than twofold increase in FSH and a more than fivefold increase in LH/was considered a positive result. Fi ndings were correlated with semen parameters and rate of pregnancy in the patients' wives at 18 months postoperatively. Results. Of the 121 patients, 89 (73.5%) had a positive GnRH test result, and 32 had a neg ative result. Semen parameters were improved postoperatively in 72 of the GnRH-positive patients (80.9%) and in only 6 of the GnRH-negative patients (18.7%). Corresponding pregnancy rates at 18 months in the tw o subgroups were 60 (67.4%) and 3 (9.3%), respectively. Conclusions. A positive preoperative GnRH test is a good predictor of improvement in semen parameters and pregnancy after varicocele surgery. We suggest t hat the GnRH test can serve as an additional indicator for varicocelec tomy. (C) 1998, Elsevier Science Inc. All rights reserved.