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

Abstract

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.

Smoking and obesity negatively affect the favourable outcome of varicocelectomy in sub‐fertile men

“…Despite the detrimental effects of varicocele on male fertility, varicocele repair effect on fertility remains debatable (Yetkin & Ozturk, 2018). However, most of the studies reported that varicocele repair resulted in improvement in semen parameters (Gomaa et al., 2018; Palmisano et al., 2019). Palmisano et al.…”

“…Previous studies have addressed the mechanism of testosterone/oestradiol (T/E) balance in regulation of testicular and erectile functions (El‐Sakka, 2013; Yamamoto et al., 1995). Sub‐inguinal varicocelectomy has resulted in significant improvement of semen variables and androgen pattern in infertile patients (Gomaa et al., 2018; Palmisano et al., 2019).…”

Prediction of reproductive function recovery after microsurgical varicocelectomy in men from infertile couples: Clinical and laboratory predictors

“…(2014) and Palmisano et al. (2019) show a significant predictive role of this factor. According to Bozhedomov et al.…”

“…Our results show that the male age should also be considered a significant factor. The previous studies yielded conflicting results: some researchers considered the male age to be a reliable predictor of improved fertility after varicocelectomy (Kimura et al., 2017; Palmisano et al., 2019; Samplaski et al., 2014), while others argued that this factor did not significantly affect varicocelectomy outcomes (Almekaty et al., 2019; Çayan et al., 2017; Zhang et al., 2017). It follows from our data that male age is a significant factor of fertility recovery after varicocelectomy; however, it may be not independent, but only a co‐factor, the influence of which is manifested depending on the initial semen parameters.…”

“…However, varicocelectomy leads to an improvement in semen parameters only in 60%–70% of cases and real fertility in 40%–60% of cases (Almekaty et al., 2019; Bozhedomov et al., 2014). Recently, a number of studies analysed the causes for the effectiveness and the ineffectiveness of varicocelectomy in male infertility treatment (Madhusoodanan et al., 2020; Palmisano et al., 2019; Zhang et al., 2017), but the available data are controversial. Therefore, in this study we searched for potential clinical and laboratory predictors of real fertility recovery after varicocelectomy in men with clinical varicocele and studied the possibility of predicting the fertility outcomes of varicocele repair.…”