Abstract
Background. Male etiology is responsible for nearly half of cases of infertility. Frequency of azoospermia in infertile men reaches 30 %; varicocele is diagnosed in almost 40 % of the patients. Varicocele- associated infertility has traditionally been considered an indication for surgical treatment. At the same time, the main method of sperm retrieval in azoospermia is testicular biopsy (testicular sperm extraction, TESE). Objective: to assess the efficacy of surgical treatment in patients with non-obstructive azoospermia (NOA) and varicocele. Materials and methods . The study included 327 patients with NOA and varicocele aged between 22 and 48 years treated in the Department of Andrology and Urology at the V. I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology in 2012– 2016. Study participants were divided into two comparable groups. Patients in the first group underwent microsurgical varicocelectomy (Marmara procedure) on the first stage and testicular biopsy (micro-TESE) on the second stage. Patients in the second group underwent micro-TESE with no surgical correction of varicocele prior to it. Results. In the first group, the appearance of spermatozoa in ejaculate was observed in 84 (44.4 %) patients 6 month post microsurgical varicocelectomy. Upon micro-TESE, spermatozoa suitable for use in assisted reproductive technologies were obtained in 60 (56.7 %) men. Treatment was effective in 144 (76.2 %) patients from the first group. In the second group, spermatozoa were retrieved in 66 (47.8 %) men upon micro-TESE. Conclusion . Microsurgical varicocelectomy increases treatment efficacy in males with NOA and varicocele. In the absence of severe degeneration of the seminiferous epithelium, 72.6 % of patients had the opportunity of becoming a genetic parent, avoiding in some cases testicular biopsy.
Highlights
Male etiology is responsible for nearly half of cases of infertility
Во 2-й группе сперматозоиды при микро-TESE были обнаружены у 66 (47,6 %) больных
Frequency of azoospermia in infertile men reaches 30 %; varicocele is diagnosed in almost 40 % of the patients
Summary
Г. Гасанов1 1Отделение андрологии и урологии ФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии им. Кулакова» Минздрава России; Россия, 117198 Москва, ул. В исследование были включены 327 больных с НОА и варикоцеле в возрасте от 22 до 48 лет, проходивших лечение в 2012–2016 гг. В отделении андрологии и урологии ФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии им. Во 2-й группе микро-TESE выполняли без предварительной хирургической коррекции варикоцеле. Во 2-й группе сперматозоиды при микро-TESE были обнаружены у 66 (47,6 %) больных. Микрохирургическая варикоцелэктомия увеличивает эффективность лечения мужчин с НОА и варикоцеле. Ключевые слова: бесплодие, азооспермия, необструктивная азооспермия, биопсия, варикоцеле, микрохирургическая экстракция сперматозоидов из яичка. I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia; 4, Oparina St., Moscow 117198, Russia; 2Department of Obstetrics, Gynecology, Perinatology, and Reproductology, I. Sechenov First Moscow State Medical University, Ministry of Health of Russia; 8/2 Trubetskaya St., Моscow 119991, Russia
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