Impact of a second semen analysis on a treatment decision making in the infertile men with varicocele: minimalist approach

Abstract

Clinically diagnosed varicocele and abnormal semen parameters are required indications for the varicocelectomy in the infertile male. Numerous studies revealed large within-subject variation in sperm concentration, motiltiy and morphology in the infertile and healthy men. Multiple semen analyses (SA) are necessary to estimate true individual homeostatic setting point of each sperm parameters. Since practical value of such approach is limited, a minimum of 2 SA have been recommended and widely accepted in clinical practice. We evaluated the impact of 2nd SA on a treatment decision in the infertile men with varicocele and abnormal first SA. Retrospective study. The study included 160 infertile men with varicocele and abnormal first SA who had 2nd SA performed in the same Andrology lab about 3–8 weeks apart. SA was considered abnormal according to WHO criteria for sperm concentrtation, motility, morphology. Men with azoospermia, low semen volume, leukocytospermia, febrile illness within 3 months and habitual heat exposure were excluded from the study. SA of 112 patients were evaluated. Despite fluctuation in abslolute values of sperm concentration, motility, morphology between two SA, these parameters remained mainly unchanged - normal or abnormal-in the 2nd SA.The rare turns of a single parameter from normal to abnormal and vice versa were higher for motility and concentration and lower for morphology (Table 1). Overall, 2nd SA was abnormal in 111 out of 112 men (99.1%) with abnormal first SA. Table 1Changes in semen parameters in 2nd SAConcentrationMotilityMorphologyDecrease (absolute value)44 (39%)46 (41%)50 (45%)Increase (absolute value)68 (61%)66 (59%)62 (55%)Unchanged (normal or abnormal)95 (85%)94 (84%)109 (97%)Changed (to abnormal or to normal)17 (15%)18 (16%)3 (3%) Open table in a new tab In most patients with varicocele and abnormal first SA the 2nd SA is also abnormal and does not change decision for varicocelectomy. Therefore, single first abnormal SA is a sufficient to consider surgery if test performed in the Andrology lab under strict guidelines for semen collection, handling and analysis. Second SA is indicated in certain clinical situation e.g. azoospermia, low semen volume, leukocytospermia, recent febrile illness, habitual heat exposure. Clinical evaluation is recommended prior to frequently ordered “screening” SA. This approach may decrease cost and expedite treatment of infertile men with varicocele.