Response to varicocelectomy in oligospermic men with and without defined genetic infertility

Objectives, To compare the clinical characteristics of infertile men who ha ve varicocele with and without a genetic anomaly, and report the results of varicocelectomy in these two cohorts of men. Methods, Study subjects included 33 men who underwent genetic counseling an d testing for a diagnosis of oligospermia with varicocele. Seven men were d iagnosed with coexisting genetic infertility (genetic [+]; abnormal karyoty pe in 4, Y chromosome microdeletion in 3), and 26 men with varicocele and n o genetic abnormality (genetic [-]). Five patients (Y chromosome microdelet ions in 2, abnormal karyotype in 3) in the genetic (+) group and 14 patient s in the genetic (-) group underwent microsurgical subinguinal varicocelect omy. Semen and hormonal parameters, physical examination findings, as well as the response to varicocele repair were compared between the two groups. Varicocele response was defined as a 50% increase in total motile sperm cou nt in the ejaculate. Results. Mean preoperative seminal and hormonal parameters were not statist ically significantly different between the two groups. Significant differen ces were observed in the volume of the right and left testicles between the two groups (lft: P = 0.007; right: P = 0.04). Although 7 of 13 evaluable p atients (54%) in the genetic (-) group had a seminal response to varicocele ctomy, none of 5 patients in the genetic (+) group showed improvement in se men quality. Conclusions. From this early experience, men with varicocele and genetic le sions appear to have a poorer response to varicocele repair than men withou t coexisting genetic lesions. These data may have implications for counseli ng male factor infertility patients contemplating varicocele treatment. URO LOGY 57: 530-535, 2001. (C) 2001, Elsevier Science inc.