Repeat semen analyses not always necessary

San Diego-Findings of a retrospective study investigating variability of semen parameters after repeat testing in adolescents with varicocele indicate that a second semen analysis is warranted only when the sperm concentration is initially abnormal.

“Semen analysis is the most representative test of fertility potential in men, but the optimal number of analyses needed for evaluation of potentially impaired fertility in adolescents remains controversial. Therefore, we conducted this study to help clinicians better gauge if and when a single semen analysis is sufficient,” said first author Samir Derisavifard, MD, urology resident at the Cohen Children’s Medical Center of New York, New Hyde Park.

“Since sperm concentration on repeat testing was predicted by the findings of a first semen analysis, we recommend repeating the study only in patients with an abnormal result in the first test in order to tease apart those individuals whose sperm concentration is truly low,” said Dr. Derisavifard, who worked on the study with Lane Palmer, MD, and colleagues.

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The single-practice study included 66 Tanner 5 adolescent males seen between January 2009 and September 2015. Eligible participants had undergone scrotal ultrasound and at least two semen analyses performed within a 2-month interval. The patients in the study had a mean age of 17.3 years with a range between 13 and 21 years.

Comparison of findings from the first and second semen analyses showed statistically significant changes in mean percentage sperm motility (50.6% vs. 54.8%) and semen volume (2.2 mL vs. 2.6 mL), but not in sperm concentration (51.5 x10⁶/mL vs. 50.4 x10⁶/mL) or morphology (10.5% vs. 10.1%).

Based on World Health Organization 4^th edition reference standards, the sperm concentration was normal (≥20x10⁶/mL) at the first evaluation in 41 patients and remained normal on repeat testing in all but a single patient. Ten (40%) of the 25 patients whose sperm concentration was abnormal in the first analysis had an abnormal sperm count with repeat testing.

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Sperm concentration, testicle volume linked

Analyses of data on testicular volume showed a statistically significant association between sperm concentration and total testicular volume. Sperm concentration did not correlate with volume of the right or left testis or size discrepancy between testes.

“These findings suggest that testicular volume may be used as a surrogate measure for sperm concentration when semen parameters are not available,” Dr. Derisavifard said.

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In the future, the authors are planning to see if the number of semen analyses performed has an effect on whether a patient undergoes surgery and if there is any correlation with fertility status.

“The limitations of our study pertain to inadequate follow-up in assessing associations between sperm concentration and clinical practice patterns, rates of clinical pregnancy, and outcomes of surgical intervention. Ultimately, concern about fertility potential is what drives further evaluation of the adolescent with varicocele and the decision to perform surgery,” Dr. Derisavifard said.

Findings from the study were presented at the 2016 AUA annual meeting in San Diego.

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