Purpose: We analyzed the efficacy of varicocele repair in improving semen p
arameters in azoospermic men with spermatogenic failure.
Materials and Methods: After routine clinical evaluation with confirmatory
pellet analysis testicular biopsy and varicocele repair were simultaneously
performed in 28 azoospermic men with a primary diagnosis of unilateral or
bilateral varicocele and spermatogenic failure. Semen analyses were obtaine
d starting 4 months after varicocelectomy.
Results: Repair was bilateral repair in 20 men and unilateral in 8. Of the
28 men 12 (43%) had sperm in the ejaculate with a mean postoperative sperm
count plus or minus standard deviation of 1.2 +/- 3.6 x 10(6)/ml. and an av
erage followup of 24 months. Mean sperm motility was 19 +/- 24% (range 0 to
80). Testicular biopsy was predictive of outcome. Only 9 men with severe h
ypospermatogenesis and 5 with maturation arrest spermatid stage had improve
ment in sperm density. No improvement was seen in 3 men with the Sertoli-ce
ll-only pattern or 3 with maturation arrest spermatocyte stage. No pregnanc
ies by natural intercourse resulted. One couple used fresh ejaculate for in
tracytoplasmic sperm injection and 1 underwent testicular sperm extraction
with intracytoplasmic sperm injection. Both pregnancies resulted in live bi
rths. No other predictive factors were identified.
Conclusions: Varicocele repair can result in sperm in the ejaculate of azoo
spermic men when severe hypospermatogenesis or maturation arrest spermatid
stage is present. Select men with spermatogenic failure and varicoceles may
be candidates for varicocele repair, rather than resorting to testis biops
y for sperm extraction in preparation for intracytoplasmic sperm injection.
However, the couple should be counseled that assisted reproductive technol
ogies will most likely be required to initiate pregnancy.