Effect of varicocele repair on sperm retrieval rate and testicular histopathological patterns in men with nonobstructive azoospermia

Abstract

Varicocele adversely affects semen parameters. However, the effect of varicocele repair on the sperm retrieval rate and testicular histopathological patterns in men with nonobstructive azoospermia has not been widely reported. We retrospectively assessed the sperm retrieval rates and testicular histopathological patterns in men with nonobstructive azoospermia who were referred to the Urology Clinic in Dr. Cipto Mangunkusumo Hospital (Jakarta, Indonesia) and Bunda General Hospital (Jakarta, Indonesia) between January 2009 and December 2019. We compared patients who had undergone a surgical sperm retrieval procedure for assisted reproductive technology no earlier than three months after varicocele repair and those who had not undergone varicocele repair. The study included 104 patients (age range: 26–54 years), 42 of whom had undergone varicocele repair before the sperm retrieval procedure and 62 who had not. Motile spermatozoa were found in 29 (69.1%) and 17 (27.4%) patients who had undergone varicocele repair before the sperm retrieval procedure and those who had not undergone the repair, respectively (relative risk: 2.51; 95% confidence interval: 1.60–3.96; P < 0.001). A predicted probabilities graph showed consistently higher sperm retrieval rates for patients with varicocele repair, regardless of their follicle-stimulating hormone levels. Patients who underwent varicocele repair showed higher testicular histopathological patterns ( P = 0.001). In conclusion, men with nonobstructive azoospermia and clinical varicocele who underwent varicocele repair before the sperm retrieval procedure had higher sperm retrieval rates compared to those who did not undergo varicocele repair.

Varicoceles in Men With Non-obstructive Azoospermia: The Dilemma to Operate or Not

“…There was consistently more postoperative spermatogenesis in hypospermatogenesis patients compared with SCO patients, who had very low rates of appearance of spermatozoa in the ejaculates. In a similar fashion, Ustuner et al ( 60 ) found a certain degree of amelioration in the histological results of certain patients after varicocele repair surgery. In patients with a high probability of post-varicocele repair complications, performing TESE or microdissection-Testicular Sperm Extraction (micro-TESE) prior to varicocelectomymay be suggested.…”

“…It should be emphasized that the studies published in PubMed basis concerning the outcome of varicocelectomy in NOA-males are highly variable. Looking through Table 1 , it is obvious that the outcome in the percentage of males with motile spermatozoa in the ejaculates ranges from 5% ( 59 ) to 69% ( 60 ).…”

Consensus and Diversity in the Management of Varicocele for Male Infertility: Results of a Global Practice Survey and Comparison With Guidelines and Recommendations

“…While this correlates with a common sense approach that these parameters indicate significant testicular damage and hence improvement after VR is less likely, there is little evidence in the literature to support such a belief. A study by Birowo et al [49] found improvement in sperm retrieval rates after VR in men with NOA across all levels of FSH, while another study showed a reduction in FSH after VR with a correlation between reduction in FSH and an increase in semen parameters [50]. Similarly, while studies have shown an increase in testicular volume after VR in both adolescents [51] and adults [52,53], there is no data is supporting the exclusion of VR in men with small testes and OAT.…”

Varicocele, wat moet je ermee? Een overzicht van evidence based informatie en controverse als basis voor een goed gesprek

“…Daarnaast stelden diverse andrologieonderzoeksgroepen zich de vraag of de opbrengst van TESE zou verbeteren als de varicocele drie tot zes maanden voorafgaand aan de TESE gecorrigeerd zou worden. De sperm retrieval rate (SRR) bij 42 mannen die voorafgaand aan de TESE een varicocelecorrectie ondergingen was 69%, versus een SRR van 27% bij 62 mannen bij wie de varicocele ongemoeid werd gelaten [24].…”