EFFECT OF MICROSURGICAL VARICOCELECTOMY ON NONOBSTRUCTIVE AZOOSPERMIA (NOA) AND SEVERELY OLIGOZOOSPERMIA

Abstract

Varicoceles are the most frequent physical abnormality found in infertile men and surgical ligation of spermatic vein is generally accepted as the treatment of choice for this condition. The aim of this study is to assess the treatment outcome and the benefits after microsurgical varicocelectomy in men with nonobstructive azoospermia (NOA) and severely oligozoospermia. Retrospective clinical analysis. The records were retrospectively evaluated for 41 patients with NOA and 259 severely oligozoospermic patients who underwent microsurgical inguinal varicocele ligation. The age was 34.34.3 (meanSD) years. Two hundred sixty-nine (90%) underwent a unilateral left-sided procedure (33 of 41 with NOA, 236 of 259 with severe oligospermia), and 31 (10%) underwent a bilateral procedure. Severely oligozoospermia was defined as <5x106/ml in all analyses submitted. Our indication of varicocelectomy for NOA patients was more than 12 ml of testicular volume preoperatively and the palpable varicocele. We obtained institutional review board approval as well as individual patient signed consents. Chi-square test was used to compare continuous variables between the groups. In all cases, statistical significance was set at P <0.05. ± After ligation, induction of spermatogenesis was achieved in six men (14.6%). We could not find the predictive factor retrospectively (e.g. hormone levels or testicular volume). The sperm concentration increased from 2.71.4 to 12.16.5 million/mL (P<0.001) with severely oligozoospermic patients. The sperm motility did not change significantly. Twenty seven (10.4%) of the 259 oligospermia men have contributed to unassisted pregnancies. Among 259 patients with severely oligozoospermia, improvement of sperm concentration was seen in 152 patients (responders, 59%). Between responders and non-responders with severely oligozoospermia, no significant differences were seen in FSH level (9.25.5 and 10.44.9 IU/L, respectively), LH level (4.72.2 and 5.13.5 IU/L, respectively), testosterone level (4.32.2 and 4.52.4 ng/mL, respectively), left testicular volume (15.63.3 and 16.13.4 mL, respectively), the percentage of varicocele grade III (52 and 54 %, respectively), and the volume of semen (2.80.7 and 2.91.2 mL, respectively). Microsurgical varicocelectomy resulted in the induction or enhancement of spermatogenesis for several men with NOA or severely oligozoospermia. It is reasonable to be considered an option in selective patients with NOA before testicular sperm extraction and severely oligozoospermia.