European male aging study gonadal state related to the outcomes of microsurgical varicocele repair

Abstract

ABSTRACT Introduction and Objective In European Male Aging Study (EMAS), hypogonadism is classified in four groups as normal or eugonadal [total testosterone (TT) ≥10.5nmol/L and luteinizing hormone (LH) ≤9.4IU/L; N/E group], secondary hypogonadism (TT<10.5nmol/L and LH ≤9.4IU/L; S/H group), primary hypogonadism (TT<10.5nmol/L and LH>9.4IU/L; P/H group), compensated hypogonadism (TT≥10.5nmol/L and LH>9.4IU/L;C/H group). Symptoms and co-morbidities were different among groups. In the present study, incidence of EMAS hypogonadism and the relationship between gonadal state and treatment outcomes of microsurgical varicocele repair. Patients and Methods Enrolled were 88 patients who underwent microsurgical varicocele repair with pretreatment measurement of sex hormones. We retrospectively analyzed incidence of EMAS hypogonadism, presurgical difference in semen quality according to gonadal state, and change in semen parameters after microsurgical varicocele repair. Student T test was used to compare two groups. This study was proved by institutional review board of Chiba University (#2557). Results Seventy-five patients were classified as eugonadal (N/E group, 84.3%), and 13 (15.7%) were hypogonadal [8 in S/H group (9%), 0 in P/H group (0%), and 5 in C/H group (5.7%)]. Mean testicular volume was significantly higher in N/E group than in hypogonadal (S/H, P/H and C/H) groups (mean volume of the right testis 17mL vs. 12mL, p=0.0283; mean volume of the left testis, 16mL vs. 11mL, p=0.0281). Out of 54 patients with male infertility, 44 were in N/E group and 8 (15.4%) were hypogonadal and total sperm count was significantly higher in N/E group than in hypogonadal patients (10.1 × 106 vs.1.3 × 106, p=0.0033). Post-surgical semen analyses were performed after 6.4 months in average. Sperm count, sperm motility and total sperm count were significantly higher in N/E group than in hypogonadal patients (in average, 33.4 × 106/mL vs. 2.8 × 106/mL, p<0.001; 41.4% vs. 22.3%, p=0.003; 116.8 × 106 vs. 7.7 × 106, p<0.001, respectively). Change rate before and after surgery was significantly better in N/E group than in hypogonadal patients (sperm count, 8.1 times increase vs. 2.5 times increase in average, p=0.0242; total sperm count, 10.7 times increase vs. 2.5 times increase in average, p=0.0159). Conclusion Hypogonadism should be evaluated using not only testosterone level but also LH level. EMAS hypogonadal state were related to semen parameters and outcomes of microsurgical varicocelectomy. Disclosure Work supported by industry: no.