Preoperative follicle-stimulating hormone: A factor associated with semen parameter improvement after microscopic subinguinal varicocelectomy

Abstract

Introduction: Currently, there exists no serum biomarker to predict patients likely to benefit from varicocelectomy. The purpose of this study was to assess the association between baseline follicle-stimulating hormone (FSH) and semen parameter changes after subinguinal microscopic varicocelectomy.
 Methods: We retrospectively reviewed all men who underwent microscopic subinguinal varicocelectomy between August 2015 and October 2018. Pre- and postoperative semen analyses were stratified per total motile sperm count (TMSC): TMSC <5, 5–9, and >9 million (based on TMSC required for in vitro fertilization, intrauterine insemination (IUI), and natural conception, respectively). Then, variables were analyzed to determine the correlation with postoperative TMSC values and upgrade in TMSC category.
 Results: Among the 66 men analyzed, 55 (83.3%) and 11 (16.7%) had a preoperative TMSC of <5 million and 5–9 million, respectively. A total of 33 (50%) patients upgraded in TMSC category, 26 of them achieving levels corresponding to natural conception and seven achieving those of IUI. Additionally, a significant correlation was observed between postoperative TMSC and preoperative TMSC (r=0.528; p<0.001), and preoperative FSH (r=-0.314; p=0.010). A lower preoperative FSH (odds ratio [OR] 0.82; 95% confidence interval [CI] 0.68–0.98; p=0.028) and a higher preoperative TMSC (OR 1.37; 95% CI 1.06–1.76; p=0.015) were associated with upgrade in TMSC category.
 Conclusions: Lower preoperative FSH and higher TMSC are associated with improvement in TMSC category after varicocelectomy, although small sample size limited the study. FSH can be useful to identify men who are most likely to benefit from varicocele repair.

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

“…In a study with 66 patients, Madhusoodanan et al. (2019) reported that preoperative FSH could be a predictive factor of post‐operative TMSC; a lower FSH significantly correlated with post‐operative TMSC and was associated with a TMSC category upgrade. Our data show that preoperative FSH levels in infertile patients with varicocele are useful in identifying those who can benefit most from microsurgical varicocelectomy.…”

Determination of the time for improvement in semen parameters after varicocelectomy

“…In patients with varicoceles, pre-operative FSH levels may serve as a marker for spermatogenesis, with elevated levels suggesting a higher degree of dysfunction with a lower likelihood of improvement after varicocelectomy. In several studies, it has been shown that lower pre-operative FSH levels are associated with better post-operative semen parameters (Chen & Chen, 2011;Kondo et al, 2009;Madhusoodanan et al, 2020). However, the relationship between FSH levels and the time for improvement in semen parameters after varicocelectomy has not yet been extensively studied.…”

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

“…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.…”