Microscopic subinguinal varicocelectomy results in improvement of multiple semen parameters, with a natural pregnancy rate of 34% and an overall pregnancy rate of approximately 63%.
Milwaukee-Microscopic subinguinal varicocelectomy results in improvement of multiple semen parameters, with a natural pregnancy rate of 34% and an overall pregnancy rate of approximately 63%.
In addition, the presence of grade 3 varicocele, irrespective of other preoperative variables, predicts the most successful increase in total motile sperm count.
Those findings were presented at the 2015 AUA annual meeting in New Orleans by Dane Johnson, MD, a urology resident at Medical College of Wisconsin, Milwaukee, working with Jay Sandlow, MD.
Varicocele is found in 35% to 40% of men with infertility. Several meta-analyses have demonstrated that varicocelectomy improves semen parameters and pregnancy rates, but which patients will benefit from this procedure is still not clear.
An Institutional Review Board retrospective study was conducted on all patients undergoing microscopic subinguinal varicocelectomy for infertility >1 year with abnormal semen parameters and palpable varicocele between 2005 and 2013. Demographic, clinical, and laboratory data were recorded.
The aim of the study was to determine preoperative clinical and laboratory predictors of success of microscopic subinguinal varicocelectomy as defined by a 50% improvement in sperm concentration.
“By collecting patient data, including preoperative and postoperative semen analyses, demographic, clinical, and labarotory data on 182 patients, we were able to perform multivariate analysis of multiple patient variables to identify any factors that were predictive for >50% improvement in total motile sperm following varicocelectomy,” Dr. Johnson indicated.
Patients had to have at least two semen analyses preoperatively and at last one semen analysis postoperatively to be eligible. Multivariate logistic regression analysis was used to identify independent predictors for success.
Mean patient age was 32.9 years and their mean duration of infertility was 24.5 months. About three-fourths (76.3%) of men had type I infertility and 23.7% had type II. Varicocele location was unilateral in 24.7% and bilateral in 75.3%.
Varicocele grade was mostly grade 2 (68.4%), with grade 1 varicocele present in 17.3% and grade 3 in 14.3%.
• Mean sperm concentration improved significantly from 12.9 x 106/mL to 18.6 x 106 mL (p<.0001).
• Mean motility improved significantly from 35.5% to 41.8% (p<.0001).
• Total progressive motile sperm improved significantly from 12.1 x 106 to 19.4 x 106 (p<.0001).
Pregnancy data were available for 118 patients. Of these patients, 40 (34%) achieved pregnancy via natural conception and 34 (28%) via assisted reproductive technology, for an overall pregnancy rate of 63%.
“The only factor proven to be predictive for success was severity of the varicocele: Patients with grade 3 varicoceles were more likely to experience success compared to patients with grade 1 or 2 varicoceles [odds ratio 2.999, p=.0095],” said Dr. Johnson.
Patient age, length of infertility, body mass index, smoking history, and hormone levels did not influence the likelihood for success.
“These data support the opinion that the severity of a patient’s varicocele is the most important factor for determining which patients are most likely to benefit from varicocelectomy,” Dr. Johnson said.
“Our findings can be of use for counseling patients, and help shape their expectations for treatment,” he said. “While patients with grade 3 varicoceles were most likely to experience improvement in semen parameters following surgery, 50% of patients with grade 2 varicoceles also experienced >50% improvement in their total motile sperm count. Thus, patients with palpable varicoceles and abnormal semen parameters should be offered varicocelectomy.”