Varicocele causes progressive and time dependent impairment of spermatogenesis.

Abstract

Objective: We compared the results of semen analysis before and after surgery in young men with newly diagnosed varicocele and adult men with varicocele and infertility to test the hypothesis of progressive and time dependent impairment of spermatogenesis associated with varicocele. Design: This was cross-sectional study. Materials/Methods: Semen analysis and ultrasound results were obtained in 112 young men (average age—17.6 years) with newly diagnosed varicocele found on varicocele screening physical exam. The 7.5 MHz, 10 cm long linear probe was used to measure testicular size, and pampiniform plexus vein diameter. Semen analysis were obtained from a different group of 100 adult men (average age—30.5 years) with varicocele diagnosed during evaluation for infertility. The semen analysis was repeated 6–12 months after surgical repair of varicocele. The 1992 revision of WHO manual of semen analysis served as reference for semen analysis. Multivariate regression was used to analyze the hypothesis of time-dependent testicular atrophy based on cross-sectional and paired measurements of testicular volume. Results: Left testicular atrophy (decrease in volume) and hence impaired spermatogenesis was time and grade dependent (p <0.0001). The average age was 17.6 years in young males group (YM) and 30.5 in adult group. Semen analysis revealed statistically significant (SS) lower density (27 mil/cc v. 50 mil/cc) and motility (39% v. 54%) in adult group as compared to YM with varicocele. There was no difference in percentage of abnormal morphological forms between groups. Varicocele repair in YM group resulted in catch-up growth of testicular volume and an increase in sperm motility (54% preop to 64% postop), no SS difference was found in density and distribution of abnormal morphological forms before and after surgery in YM group. In the adult men group there was a similar pattern of improvement of semen analysis result. No difference was found in sperm density, but there was SS improvement in sperm motility (37% preop and 45% postop) an sperm morphology (36% preop and 47% postop). The improvement in semen analysis result was better in younger males. Conclusions: Based on the cross-sectional and longitudinal analysis of testicular volume we showed that varicocele causes a progressive and time dependent testicular function impairment. In men with varicocele, sperm motility, density and morphology deteriorates with time. We thus conclude that varicocele cause progressive and time dependent impairment of spermatogenesis. Repair of varicocele in young men at the time of presentation may prevent future fertility problems.