Abstract
Surgical treatment or varicocele embolization (VE) with sclerosing or mechanical embolic agents have been shown to improve the semen parameters of infertile men. The aim of this study was to evaluate the impact of VE using N-butyl cyanoacrylate (NBCA) glue on semen parameters in infertile men. From January 2014 to June 2018, infertile adult patients with stage 3 varicocele and an initial semen analysis showing at least one abnormal semen parameter, and who were successfully embolized with NBCA Glubran®2 glue, were retrospectively recruited. The availability of a second semen analysis after VE was mandatory for patient inclusion. The primary endpoint was the change in total sperm number (TSN) after VE. The other parameters of interest were progressive and total sperm motilities (Smot) at 1 h (H1), sperm vitality (SV) and morphology (SMor). One hundred and two patients were included. Eight patients presented null TSN before and after VE. Among the remaining 94 patients, a significant improvement in the median TSN after VE was shown (31.79 × 106/ejaculate [IQR: 11.10–127.40 × 106/ejaculate] versus 62.24 × 106/ejaculate [IQR: 17.90–201.60 × 106/ejaculate], p = 0.0295). Significant improvement in TSN was found for the 60 oligo- or azoospermic patients (p = 0.0007), whereas no significant change was found for the 42 patients with normal initial TSN (p = 0.49). Other parameters, such as progressive and total SMot, SV and SMor, also significantly improved after VE (p = 0.0003, 0.0013, 0.0356 and 0.007, respectively). The use of NBCA glue as an embolic agent for VE in infertile men with stage 3 varicocele significantly improves the semen parameters.
Highlights
Varicocele is caused by a reflux of blood in the internal spermatic vein and is defined by abnormal tortuosity and dilatation of the veins in the pampiniform plexus
The left side is affected in 80–90% of cases whereas varicocele is present on the right side in only 5–10% of cases, the condition being bilateral in 1–15% [3]
Twenty-eight patients answered and gave the following reasons: eleven patients stated that the exam was not prescribed, seven had wife pregnancy/childbirth shortly after varicocele embolization (VE) and did not find useful to do the exam, two underwent the second semen analysis in another city, four forgot to do this exam, three stopped medically assisted procreation follow-up, and one refused this exam
Summary
Varicocele is caused by a reflux of blood in the internal spermatic vein and is defined by abnormal tortuosity and dilatation of the veins in the pampiniform plexus. Biomedicines 2021, 9, 1423 to the failure of ipsilateral testicular growth and development, symptoms of pain and discomfort and reduced fertility [1]. Varicocele is found in 40% of men with an abnormal semen analysis [2]. Congenital and/or acquired valve dysfunction responsible for reflux in the internal spermatic vein are the most common causes [3]. The left side is affected in 80–90% of cases whereas varicocele is present on the right side in only 5–10% of cases, the condition being bilateral in 1–15% [3]
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