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Urology. 2018 Oct;120:109-113. doi: 10.1016/j.urology.2018.06.036. Epub 2018 Jul 5.

The Impact of Microsurgical Repair of Subclinical and Clinical Varicoceles on Total Motile Sperm Count: Is There a Difference?

Author information

1
Scott Department of Urology, Baylor College of Medicine, Houston, TX. Electronic address: nannan@bu.edu.
2
Scott Department of Urology, Baylor College of Medicine, Houston, TX; Translational Biology and Molecular Medicine, Baylor College of Medicine, Houston, TX.
3
Scott Department of Urology, Baylor College of Medicine, Houston, TX.

Abstract

OBJECTIVE:

To determine if subclinical varicocele repair produces similar results to palpable varicocele repair.

METHODS:

Retrospective review was performed on 190 infertile men who underwent a microsurgical varicocele repair by two surgeons from 2009 to 2017. Improvement in total motile sperm count (TMC) that enables men limited to in vitro fertilization (IVF) or intrauterine insemination (IUI) to undergo IUI or natural conception (upgrade) is clinically meaningful. Using TMC, men were grouped into three pre- and postoperative categories: IVF, (TMC < 5 million), IUI (TMC 5-9 million), or natural pregnancy (TMC > 9 million). Changes in category after varicocele repair were assessed. We compared the proportion of men in each category with clinical varicoceles to those with subclinical varicoceles.

RESULTS:

Men with clinical and subclinical varicoceles had improvements in TMC after surgery (change in TMC of 9.3 ± 19.5, 7.7 ± 22.6 million, P < 0.001 for both, respectively). There was no difference in TMC improvement between men with clinical and subclinical varicoceles (P = 0.66). Of men initially limited to IVF, 11% improved to IUI, and 38% to natural pregnancy. Of patients starting in IUI category, 22% transitioned to natural pregnancy category. No difference exists in the proportion of men who "upgraded" between palpable or subclinical varicoceles.

CONCLUSION:

Men with subclinical varicoceles have similar, clinically meaningful improvement in TMC after varicocele repair compared with men with palpable varicoceles.

PMID:
29981299
PMCID:
PMC6221979
DOI:
10.1016/j.urology.2018.06.036
[Indexed for MEDLINE]
Free PMC Article

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