The Impact of Microsurgical Repair of Subclinical and Clinical Varicoceles on Total Motile Sperm Count: Is There a Difference? - 24/08/18

Doi : 10.1016/j.urology.2018.06.036

Nannan Thirumavalavan ^a,^⁎ , Jason M. Scovell ^a,^b, Adithya Balasubramanian ^a, Taylor P. Kohn ^a, Byung Ji ^a, Asad Hasan ^a, Alexander W. Pastuszak ^a, Larry I. Lipshultz ^a
^a Scott Department of Urology, Baylor College of Medicine, Houston, TX
^b Translational Biology and Molecular Medicine, Baylor College of Medicine, Houston, TX

^⁎Address correspondence to: Nannan Thirumavalavan, MD, Department of Urology, Baylor College of Medicine, 1 Baylor Plaza, Alkek N730, Houston, TX 77030.1 Baylor Plaza, Alkek N730HoustonTX77030

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Friday 24 August 2018

Abstract

Objective

To determine if subclinical varicocele repair produces similar results to palpable varicocele repair.

Methods

Retrospective review was performed on 190 infertile men who underwent a microsurgical varicocele repair by two surgeons from 2009 to 2017. Improvement in total motile sperm count (TMC) that enables men limited to in vitro fertilization (IVF) or intrauterine insemination (IUI) to undergo IUI or natural conception (upgrade) is clinically meaningful. Using TMC, men were grouped into three pre- and postoperative categories: IVF, (TMC < 5 million), IUI (TMC 5-9 million), or natural pregnancy (TMC > 9 million). Changes in category after varicocele repair were assessed. We compared the proportion of men in each category with clinical varicoceles to those with subclinical varicoceles.

Results

Men with clinical and subclinical varicoceles had improvements in TMC after surgery (change in TMC of 9.3 ± 19.5, 7.7 ± 22.6 million, P < 0.001 for both, respectively). There was no difference in TMC improvement between men with clinical and subclinical varicoceles (P = 0.66). Of men initially limited to IVF, 11% improved to IUI, and 38% to natural pregnancy. Of patients starting in IUI category, 22% transitioned to natural pregnancy category. No difference exists in the proportion of men who “upgraded” between palpable or subclinical varicoceles.

Conclusion

Men with subclinical varicoceles have similar, clinically meaningful improvement in TMC after varicocele repair compared with men with palpable varicoceles.

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Plan

Financial Disclosure: The authors declare that they have no relevant financial interests.
Source of Funding: This work is supported in part by the National Institute of General Medical Sciences of the National Institutes of Health under Award Number T32GM088129, a 2017 Urology Care Foundation Research Scholars Award to AWP,by NIH grants K12 DK0083014, the Multidisciplinary K12 Urologic Research (KURe) Career Development Program awarded to DJL (NT is a K12 Scholar) and R01DK078121 from the National Institute of Kidney and Digestive Diseases to DJL. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.