PD24-02 IS VARICOCELECTOMY BENEFICIAL IN MEN PREVIOUSLY DEEMED SUBFERTILE BUT WITH NORMAL SEMEN PARAMETERS BASED ON THE NEW GUIDELINES? A RETROSPECTIVE STUDY

Abstract

You have accessJournal of UrologyInfertility: Therapy1 Apr 2014PD24-02 IS VARICOCELECTOMY BENEFICIAL IN MEN PREVIOUSLY DEEMED SUBFERTILE BUT WITH NORMAL SEMEN PARAMETERS BASED ON THE NEW GUIDELINES? A RETROSPECTIVE STUDY Patrick Mcgarry, Khalid Alrabeeah, Keith Jarvi, and Armand Zini Patrick McgarryPatrick Mcgarry More articles by this author , Khalid AlrabeeahKhalid Alrabeeah More articles by this author , Keith JarviKeith Jarvi More articles by this author , and Armand ZiniArmand Zini More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1993AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In 2010, the World Health Organization (WHO) released new reference values for semen parameters that are significantly lower than previously reported editions. Given this change in lower limits, some men that were considered abnormal (with semen parameters below the reference values) are now be considered normal. The aim of this study is to determine whether surgical treatment of clinical varicocele for infertility based on previous WHO reference values had benefit and whether using the new reference values will result in missed treatable causes of infertility. METHODS We conducted a retrospective review of infertile men with clinical varicocele and abnormal semen parameters by WHO 1999 standards. Patients that were abnormal by WHO 1999 standards but normal by WHO 2010 standards were identified. Of these patients, those undergoing surgery for varicocele and those opting to not undergo surgery were compared for changes in conventional semen parameters and ability to achieve spontaneous pregnancy. RESULTS A total of 445 infertile men presented with clinical varicocele and abnormal semen parameters by 1999 standards. Of these, 13% (56/445) would be now considered normal by WHO 2010 standards. 57% (32/56) of the patients now considered normal by WHO 2010 standards elected to undergo microsurgical varicocelectomy and 43% (24/55) elected not to undergo surgery. In the surgery group, postoperative sperm concentration increased significantly compared to before surgical repair (50 +/- 35 x 106/ml vs. 32 +/- 23 x 106/ml, p=0.003). However, there was no significant change in sperm parameters between the two semen samples (taken at 3-month interval) in the non-surgery group. The spontaneous pregnancy rate was higher in the surgery compared to the non-surgery group (52% vs. 38%, respectively) but the difference was not statistically significant. CONCLUSIONS The data indicate that varicocelectomy may be beneficial in the subset of men with clinical varicocele and semen parameters deemed abnormal by WHO 1999 standards but now considered normal based on the new WHO semen reference values. As such, applying the new WHO semen reference values into clinical practice may result in missed opportunities to correct potentially treatable causes of male infertility. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e731 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Patrick Mcgarry More articles by this author Khalid Alrabeeah More articles by this author Keith Jarvi More articles by this author Armand Zini More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...