Obesity negatively influences the outcome of microscopic varicocelectomy in infertile men

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OBJECTIVE: Compared to men with normal weight, obesity is associated with a higher incidence and grade of varicocele together with lower serum testosterone, diminished semen parameters, and infertility. We sought to determine if obesity influences the outcome of varicocele repair. DESIGN: A retrospective review of infertile men undergoing microscopic varicocelectomy from 2005-2009. MATERIALS AND METHODS: Inclusion criteria included infertility, presence of a clinical varicocele, and postoperative follow-up more than 4 months. Men were excluded if they had a prior varicocele repair, genetic abnormalities, azoospermia, or an obstructive cause of infertility. Obesity was defined as body mass index (BMI)>30. Multiple variables were analyzed with respect to preoperative and postoperative sperm density, motility, and morphology. Univariate and multivariate analysis was used to analyze variables associated with greater than 50% improvement in sperm density. RESULTS: 245 (71 obese) men were included with mean age of 34.4 years and follow-up of 12.5 months. After varicocelectomy, sperm density, motility, and normal morphology significantly improved (p<0.05). Preoperatively, obesity was associated with low testosterone (p<0.01) and increased seminal reactive oxygen species (ROS) (p=0.03). BMI correlated with increased operative time (r=0.4, p<0.01) and operative complications (p=0.04). Compared to obese men, non-obese men displayed a greater improvement in sperm density (11.6x106/mL vs 5.3x106/mL, p<0.01) and normal morphology (5.6% vs -5.4%, p<0.01), but not motility (3.4% vs 0.1%, p=0.09). On multivariate analysis, only initial sperm density and obesity was negatively associated with a 50% improvement in sperm density (p<0.05). CONCLUSION: As previously reported, obesity is associated with low testosterone and increased ROS. After microscopic varicocelectomy, the seminal parameters of obese men show less improvement then non-obese men suggesting that BMI can influence varicocelectomy success.