OBJECTIVE: To investigate the impact of subinguinal microsurgical varicocelectomy on semen parameters and pregnancy outcomes in couples with male factor subfertility.
DESIGN: Case series.
SETTING: Male Infertility Clinic in an academic institution in Hong Kong.
PATIENTS: The clinical records of 42 consecutive subfertile male patients who had subinguinal microsurgical varicocelectomy (from January 2000 to December 2009) were retrospectively reviewed. All the patients had a known history of subfertility and abnormalities in one or more semen parameters. Female subfertility factors were not addressed. Only grade 2 or higher clinically palpable varicoceles were operated on.
MAIN OUTCOME MEASURES: Preoperative and postoperative semen analyses based on the World Health Organization criteria; the outcome measures included changes in semen parameters and whether a pregnancy ensued.
RESULTS: The mean age of patients and their spouses were 38 and 33 years, respectively. The mean duration of infertility was 4 years; 37 patients had primary infertility and five had secondary infertility. The mean (+/- standard deviation) sperm concentration improved from 12 +/- 19 million/mL to 23 +/- 29 million/mL following varicocelectomy (P< 0.001), the mean sperm motility improved from 26% +/- 16% to 32% +/- 18% (P< 0.001), and the mean normal morphology increased from 5% +/- 7% to 6% +/- 6% (P< 0.001). Postoperatively, 23 (55%) of the patients achieved pregnancy, 11 (26%) being spontaneous, 1 (2%) by intrauterine insemination, and 11 (26%) by in-vitro fertilisation. Among 20 patients with severe preoperative oligospermia (< 5 million/mL), statistically significant improvements occurred in postoperative mean sperm concentration, motility and morphology (all P< 0.001), and five (25%) of them achieved a spontaneous pregnancy. There was one intra-operative injury to the testicular artery with immediate repair and no testicular atrophy. Five (12%) of the patients had recurrences. No preoperative factors appeared predictive of a pregnancy ensuing.
CONCLUSIONS: In couples with male infertility due to varicoceles, subinguinal microsurgical varicocelectomy was shown to improve sperm concentrations, motility and morphology, and the likelihood of a pregnancy. Spontaneous pregnancy was achieved in 25% of the couples in which the man had severe oligospermia.
Written by:
Leung L, Ho KL, Tam PC, Yiu MK. Are you the author?
Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
Reference: Hong Kong Med J. 2013 May 6. Epub ahead of print.
doi: 10.12809/hkmj133884
PubMed Abstract
PMID: 23650197
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