Varicocele repair improves semen parameters in azoospermic men with spermatogenic failure

Citation
Ed. Kim et al., Varicocele repair improves semen parameters in azoospermic men with spermatogenic failure, J UROL, 162(3), 1999, pp. 737-740
Citations number
25
Categorie Soggetti
Urology & Nephrology","da verificare
Journal title
JOURNAL OF UROLOGY
ISSN journal
00225347 → ACNP
Volume
162
Issue
3
Year of publication
1999
Part
1
Pages
737 - 740
Database
ISI
SICI code
0022-5347(199909)162:3<737:VRISPI>2.0.ZU;2-U
Abstract
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.