Age is a significant predictor of early and late improvement in semen parameters after microsurgical varicocele repair

Kimura, Masaki; Nagao, Kōichi; Tai, Toshihiro; Kobayashi, Hideyuki; Nakajima, Koichi

doi:10.1111/and.12620

Cited by 18 publications

(12 citation statements)

References 20 publications

(18 reference statements)

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“…[ 27 ] A study showed that younger age was associated with better improvements in total motile sperm counts after microsurgical varicocele repair compared with older men. [ 20 ] In the present study, age was independently associated with semen volume, motility, and total sperm count. Discrepancies among the present study and previous ones [ 25 – 27 ] could be due to a number of factors, including population, genetics, stress, and diet.…”

Section: Discussionsupporting

confidence: 50%

“…[ 16 ] Supporting the association between varicoceles and infertility, surgical repair of varicoceles has been shown to increase sperm concentration and to improve sperm motility. [ 20 – 24 ] A recent meta-analysis showed that varicocele repair improves sperm parameters, probably by reducing sperm oxidative stress and DNA damage. [ 9 ] All types of repair improve these parameters, but microsurgical repair seems to produce the best outcomes.…”

Section: Discussionmentioning

confidence: 99%

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Varicoceles affect semen quality of infertile men in Southern China

Zhang

et al. 2017

Medicine

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The association of varicoceles with infertility is well established, but the exact effect of varicoceles on semen quality among patients with infertility is still poorly known. The study aimed to examine the prevalence of varicoceles among Chinese men with infertility and to examine the factors associated with semen quality.This was a cross-sectional study of 5447 male patients treated for infertility at the Affiliated Hospital of Guangdong Medical University from October 2012 to December 2015. The patients were divided on the basis of the presence of varicoceles. Examinations of the amount of semen and sperm morphology were performed according to seminal parameter detection methods recommended by the World Health Organization.Patients with varicoceles (n = 1429/5447, 26.2%) were slightly younger (P = .046), and had smaller testis (P = .019), higher frequency of abnormal epididymis (P < .001), slightly shorter infertility duration (P = .046), and lower frequency of smokers (P = .012). There was no difference in the distribution of occupations (P = .777). Using multiple linear regression analysis, varicoceles were shown to be independently associated with semen volume [B = −0.153, 95% confidence interval (95% CI): −0.245 to −0.062, P = .001], sperm concentration (B = 9.633, 95% CI: 7.152–12.114, P < .001), proportion of sperms with normal morphology (B = 0.951, 95% CI: 0.623–1.278, P < .001), motility (B = 3.835, 95% CI: 2.675, 4.995, P < .001), total sperm count (B = 22.481, 95% CI: 13.333–31.629, P < .001), and forward movement sperm count (B = 15.553, 95% CI: 9.777–21.329, P < .001). Varicoceles were present in 26% of Chinese male patients with infertility.Varicoceles were independently associated with sperm volume, sperm concentration, proportion of sperms with normal morphology, motility, total sperm count, and forward movement sperm count.

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Section: Discussionsupporting

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Varicoceles affect semen quality of infertile men in Southern China

Zhang

et al. 2017

Medicine

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“…19 Of interest, Kimura and colleagues revealed that patients younger than 37 years old experienced greater early (3 months) and late (⩾6 months) improvements in semen parameters after microsurgical varicocele repair, however, they did not exclude the possibility of semen parameter improvement in older men, and concluded that microsurgical varicocele repair could also be beneficial for older men. 20 The main problem concerning investigations on how much age can influence seminal parameters and their possible improvement after a treatment lies in the fact that the patient's age at the time of varicocele diagnosis is not related to the onset of the disease but is related to the patient's desire for children, this may represent a huge bias with no solution. In this context, what is of clinical importance is the effective improvement of the seminal parameters of these patients following surgery.…”

Section: Discussionmentioning

confidence: 99%

“…However, current evidence indicates that the degree of improvement in semen parameters 3 months after varicocelectomy remains the same, or stable, 12 months after surgery. [20][21][22][23][24][25][26][27][28][29][30][31][32] In addition, no comparison with other varicocelectomy techniques was performed, with microsurgical varicocele repair being the gold standard in varicocele treatment. 7 Another limitation of the current study is its retrospective design for which we did not have data collection with standardized protocols regarding the hormonal profiles of the patients, therefore, making any speculation impossible.…”

Section: Discussionmentioning

confidence: 99%

Clinical factors affecting semen improvement after microsurgical subinguinal varicocelectomy: Which subfertile patients benefit from surgery?

Palmisano¹,

Moreno-Mendoza²,

Ievoli³

et al. 2019

European Urology Supplements

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Background: The exact mechanism of varicocele-related infertility is still elusive, therefore, the current challenges for its management lie in determining which patients stand to benefit most from surgical correction. The authors aimed to assess the clinical factors affecting semen improvement after left microsurgical subinguinal varicocelectomy (MSV) in relation to patient age, ultrasound varicocele grading (USVG), and presence of a right subclinical varicocele (RSV). Methods: From 2010 to 2017 a total of 228 infertile patients underwent left MSV for clinical varicocele. Descriptive statistics were used to describe the cohort and verify the surgical benefit in terms of semen improvement, in addition, subsets of patients were selected according to clinical covariates. Logistic regression modeling was applied to evaluate the presence of RSV, operative time, age, and USVG as explanatory variables. Results: Sperm concentration (SC), progressive sperm motility (PSM), and normal sperm morphology (NSM) increased significantly after surgery (p = 0.002; p = 0.011; p = 0.024; respectively). Mean SC improved after MSV in ⩾35 year-old patients and the grade 3 USVG group (p = 0.01; p = 0.02; respectively). Logistic regression modeling showed a that the probability of SC improvement was 76% lower in subjects presenting RSV (p = 0.011). In addition, patients with a grade 3 USVG presented a three-times greater probability of SC improvement compared with patients with a lower USVG (p = 0.035). In addition, older patients showed a greater probability of SC improvement after MSV (p = 0.041). Conclusions: MSV is an effective varicocele-related infertility treatment that should also be offered to older patients. In addition, patients with a higher USVG benefit from surgery. In infertile men with an RSV in association with a left clinical disease, a bilateral varicocele repair should be considered.

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“…In contrast, Kimura et al. (2017) noted that younger age (<37 years) was associated with early and late post‐operative improvement in TMSC. Conversely, Palmisano et al.…”

Section: Discussionmentioning

confidence: 91%

Can preoperative gonadotropin and testosterone levels predict the success of varicocelectomy?

Erdoğan

Durmuş

2020

Andrologia

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We examined the effects of preoperative hormonal values on varicocelectomy success. A total of 136 patients who underwent varicocelectomy for infertility in our clinic were analysed retrospectively. Improvement in semen quality was defined as >50% increase in post‐operative total motile sperm count (TMSC) in those with preoperative TMSC >5 million and at least 100% increase in those with <5 million. The patients were divided into two groups as benefiting from the treatment (Group A) and no benefits (Group B). The best cut‐off value for follicle‐stimulating hormone (FSH) and the luteinising hormone/testosterone ratio (LTR) that can predict varicocelectomy success were 7.01 and 0.016 with an area under the curve of 0.844 and 0.856 respectively. The highest sensitivities and specificities of FSH and LTR were 0.845 and 0.788 and 0.821 and 0.846 respectively. Binary logistic regression analysis showed FSH (odds ratio [OR]: 3.7; p < .001) and LTR (OR: 5.2; p < .001) as independent predictive factors in predicting varicocelectomy success. Our study demonstrated that low FSH (7.01 IU/L) and LTR (<.016) can be a useful preoperative predictive tool to help identify men who benefit most from varicocelectomy in infertile patients with varicocele.

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Age is a significant predictor of early and late improvement in semen parameters after microsurgical varicocele repair

Cited by 18 publications

References 20 publications

Varicoceles affect semen quality of infertile men in Southern China

Varicoceles affect semen quality of infertile men in Southern China

Clinical factors affecting semen improvement after microsurgical subinguinal varicocelectomy: Which subfertile patients benefit from surgery?

Can preoperative gonadotropin and testosterone levels predict the success of varicocelectomy?

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