Embolization of left spermatic vein in non-obstructive azoospermic men with varicocele: role of FSH to predict the appearance of ejaculated spermatozoa after treatment

D’Andrea, Settimio; Giordano, A. V.; Carducci, Sergio; Sacchetti, L; Necozione, Stefano; Costanzo, Mario; Gregorio, A de; Micillo, A.; Francavilla, Felice; Francavilla, Sandro; Barbonetti, Arcangelo

doi:10.1007/s40618-015-0259-x

Cited by 18 publications

(5 citation statements)

References 38 publications

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“…The current study observed that testicular volume was not predictive of post‐varicocelectomy sperm recovery in the ejaculate, in agreement with others (Abdel‐Meguid, ; Aboutaleb et al, ; Cakan & Altug, ; D'Andrea et al, ; Esteves & Glina, ; Ishikawa, Kondo, Yamaguchi, Sakamoto, & Fujisawa, ; Pasqualotto et al, ; Youssef et al, ). Similarly, we found no significant association between any of the reproductive hormones (FSH, LH, testosterone, oestradiol) and sperm recovery in the ejaculate post‐varicocelectomy, in agreement with most studies in the review.…”

Section: Discussionsupporting

confidence: 92%

“…However, another seven studies had a higher sperm recovery rate (range 43%–56%; Esteves & Glina, ; Gat, Bachar, Everaert, Levinger, & Gornish, ; Haydardedeoglu et al, ; Kim et al, ; Matthews et al, ; Poulakis, Ferakis, Vries, Witzsch, & Becht, ; Zampieri et al, ). The higher sperm recovery rate of these seven studies could probably be due to (a) their small sample sizes (mean 24 patients) compared with the remaining studies (mean 39 patients) and (b) the possibility that these seven studies had more favourable testicular histopathologies leading to higher sperm recovery rate, as most of them did not report the histopathology (D'Andrea et al, ; Gat et al, ; Matthews et al, ; Poulakis et al, ; Zampieri et al, ).…”

Section: Discussionmentioning

confidence: 97%

“…Similarly, we found no significant association between any of the reproductive hormones (FSH, LH, testosterone, oestradiol) and sperm recovery in the ejaculate post‐varicocelectomy, in agreement with most studies in the review. Only one study (D'Andrea et al, ), using a small sample (23 NOA patients), found that FSH was predictive of post‐varicocelectomy sperm recovery in the ejaculate and identified a FSH cut‐off of <10.06 mIU/ml in 82% of successful patients (specificity 81.8%, sensitivity 83.3%).…”

Section: Discussionmentioning

confidence: 99%

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Does varicocelectomy improve semen in men with azoospermia and clinically palpable varicocele?

et al. 2019

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The effectiveness of varicocelectomy in nonobstructive azoospermia is controversial. The current study assessed the efficacy of microsurgical subinguinal varicocelectomy in nonobstructive azoospermic men with palpable varicocele and to evaluate predictive parameters of outcome. We reviewed the records of 723 patients who had microsurgical varicocelectomy and diagnostic testicular biopsy between 2012 and 2016 at a tertiary medical centre. Data pertaining to the physical, laboratory (semen analysis and hormonal profile) and histopathology features were examined, exploring the predictors of improvement in semen analysis post‐varicocelectomy. In total, 42 patients with mean age 35.71 ± 6.35 years were included. After a mean varicocelectomy follow‐up of 6.7 months, motile spermatozoa in the ejaculate could be observed in 11 patients (26.2). Out of all the factors examined, only testicular histopathology significantly predicted post‐varicocelectomy outcome, where 8/11 patients exhibited hypospermatogenesis, and 3/11 Sertoli cell‐only regained spermatozoa in semen. Microsurgical varicocelectomy in nonobstructive azoospermic men with clinically palpable varicocele can result in sperm appearance in the ejaculate with the highest success expected in hypospermatogenesis.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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Does varicocelectomy improve semen in men with azoospermia and clinically palpable varicocele?

et al. 2019

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“…Eleven retrospective and seven prospective studies were included in this systematic review and accounted for 468 treated patients who had complete azoospermia and were subjected to either surgical varicocele repair or percutaneous embolization. 6 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 In 13 of the included studies, patients were subjected to varicocele repair using either inguinal or subinguinal microsurgical methods. 6 14 15 16 17 19 22 23 24 25 26 27 30 In one 29 and three studies, 18 20 28 respectively, inguinal macroscopic varicocelectomy and anterograde or retrograde percutaneous embolization were the treatment methods.…”

Section: Resultsmentioning

confidence: 99%

Outcome of varicocele repair in men with nonobstructive azoospermia: systematic review and meta-analysis

Esteves¹,

Miyaoka²,

Roque³

et al. 2016

Asian J Androl

132

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The objective of this systemic review was to evaluate the benefit of repairing clinical varicocele in infertile men with nonobstructive azoospermia (NOA). The surgically obtained sperm retrieval rate (SRR) and pregnancy rates following assisted reproductive technology (ART) with the use of retrieved testicular sperm were the primary outcomes. The secondary outcomes included the presence of viable sperm in postoperative ejaculate to avoid the testicular sperm retrieval and pregnancy rates (both assisted and unassisted) using postoperative ejaculated sperm. An electronic search to collect the data was performed using the MEDLINE and EMBASE databases until April 2015. Eighteen studies were included in this systematic review and accounted for 468 patients who were diagnosed with NOA and varicocele. These patients were subjected to either surgical varicocele repair or percutaneous embolization. Three controlled studies evaluating sperm retrieval outcomes indicated that in patients who underwent varicocelectomy, SRR increased compared to those without varicocele repair (OR: 2.65; 95% CI: 1.69–4.14; P < 0.001). Although pregnancy rates with the use of testicular sperm favored the varicocelectomy group, results were not statistically significant (clinical pregnancy rate OR: 2.07; 95% CI: 0.92–4.65; P = 0.08; live birth rate OR: 2.19; 95% CI: 0.99–4.83; P = 0.05). The remaining fifteen studies reported postoperative semen analysis results. In 43.9% of the patients (range: 20.8%–55.0%), sperm were found in postoperative ejaculates. Pregnancy rates for unassisted and assisted (after IVF/ICSI) were 13.6% and 18.9% in the group of men with sperm in postoperative ejaculates, respectively. Our findings indicate that varicocelectomy in patients with NOA and clinical varicocele is associated with improved SRR. In addition, approximately 44% of the treated men will have enough sperm in the ejaculate to avoid sperm retrieval. Limited data on pregnancy outcomes with both postoperative ejaculated sperm and harvested testicular sperm preclude any firm conclusion with regard to the possible increased fertility potential in treated individuals. In conclusion, the results of our study indicate that infertile men with NOA and clinical varicocele benefit from varicocelectomy. Given the low/moderate quality of evidence available, it is advisable that doctors discuss with their patients with NOA the risks and benefits of varicocele repair.

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“…Gray-scale sonograms allow the accurate assessment of testicular volume and texture, the evaluation of epididymis size and texture and the detection of enlargements in the pampiniform venous plexus [ 11 , 12 ]. When combined with colour Doppler spectrum analysis, US also provides a quantitative measure of spermatic venous reflux in patients with clinical varicocele [ 24 , 25 ] and can identify subclinical varicocele or assist in the follow-up of varicocele repair [ 26 ]. Of note, infertile oligozoospermic men exhibit an increased risk of testicular germ cell tumour (TGCT) compared with fertile control subjects [ 27 ] and, in infertile men, the presence of testicular microlithiasis is associated to an about 18-fold higher prevalence of testicular cancer [ 28 ], thus further supporting the recommendation to perform scrotal US in all infertile men with OAT [ 14 ].…”

Section: Diagnostic Work Up Of Men From the Infertile Couplementioning

confidence: 99%

The impact of male factors and their correct and early diagnosis in the infertile couple's pathway: 2021 perspectives

Pallotti

Barbonetti

Rastrelli

et al. 2022

J Endocrinol Invest

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Purpose The current clinical practice in reproductive medicine should pose the couple at the centre of the diagnostic–therapeutic management of infertility and requires intense collaboration between the andrologist, the gynaecologist and the embryologist. The andrologist, in particular, to adequately support the infertile couple, must undertake important biological, psychological, economical and ethical task. Thus, this paper aims to provide a comprehensive overview of the multifaceted role of the andrologist in the study of male factor infertility. Methods A comprehensive Medline, Embase and Cochrane search was performed including publications between 1969 and 2021. Results Available evidence indicates that a careful medical history and physical examination, followed by semen analysis, always represent the basic starting points of the diagnostic work up in male partner of an infertile couple. Regarding treatment, gonadotropins are an effective treatment in case of hypogonadotropic hypogonadism and FSH may be used in men with idiopathic infertility, while evidence supporting other hormonal and nonhormonal treatments is either limited or conflicting. In the future, pharmacogenomics of FSHR and FSHB as well as innovative compounds may be considered to develop new therapeutic strategies in the management of infertility. Conclusion To provide a high-level of care, the andrologist must face several critical diagnostical and therapeutical steps. Even though ART may be the final and decisive stage of this decisional network, neglecting to treat the male partner may ultimately increase the risks of negative outcome, as well as costs and psychological burden for the couple itself.

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Embolization of left spermatic vein in non-obstructive azoospermic men with varicocele: role of FSH to predict the appearance of ejaculated spermatozoa after treatment

Abstract: Selected patients with NOA may show ejaculated spermatozoa after a non-invasive repair of a left side varicocele, therefore avoiding testicular sperm extraction. Baseline serum FSH was a valuable predictor for ejaculated spermatozoa after treatment.

Cited by 18 publications

References 38 publications

Does varicocelectomy improve semen in men with azoospermia and clinically palpable varicocele?

Does varicocelectomy improve semen in men with azoospermia and clinically palpable varicocele?

Outcome of varicocele repair in men with nonobstructive azoospermia: systematic review and meta-analysis

The impact of male factors and their correct and early diagnosis in the infertile couple's pathway: 2021 perspectives

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