Impact Of Varicocelectomy Research Articles

Investigating the Anogenital Distance as a Predictive Factor for Improvement in Semen Analysis Parameters After Varicocele Surgery

Background: A varicocele is an unusual enlargement and twisting of veins within the pampiniform plexus, contributing to male infertility. Varicoceles are prevalent in approximately 11 to 15 percent of adult males and can impact testicular function. Varicocelectomy is recommended for non-azoospermic infertile men with abnormal seminal parameters, although uncertainties exist regarding the specific parameters indicating the need for surgery. This study investigates the potential relationship between anogenital distance (AGD) and semen analysis factors before and after varicocelectomy. Methods: The study enrolled 35 males with primary varicocele, excluding those with certain conditions. AGD measurements were taken before surgery, and patients subsequently underwent varicocelectomy. Comprehensive assessments and laboratory examinations were conducted preoperatively, and follow-up semen analyses were performed six months postoperatively. Results: Preoperative and postoperative semen analyses revealed no significant differences in sperm parameters. Statistical analyses indicated no significant correlation between AGD and sperm concentration before or after surgery. Despite these findings, the study contributes valuable information to the ongoing debate on the impact of varicocelectomy on male fertility. Conclusions: This study, while highlighting the limitations and uncertainties, suggests that AGD may not be a significant predictive factor for improvements in semen analysis after varicocelectomy. The nuanced nature of varicocele-associated male infertility underscores the ongoing need for comprehensive research to clarify the true effects of varicocelectomy. Individual patient factors and careful evaluation of available evidence remain crucial in managing varicocele-associated male infertility.

Impact of varicocelectomy on sperm parameters and hormone levels in infertile patients with sickle cell disease

Purpose: This study analyzes the semen parameters and gonadal hormone levels in infertile patients with sickle cell disease (SCD) and palpable varicoceles who underwent varicocelectomy for impaired semen parameters. Patients and methods: Improvements in the semen parameters—serum levels of total testosterone, follicle-stimulating hormone (FSH), and inhibin B—and testicular volume (TV) in 18 infertile patients with SCD were evaluated before and at 6 months after varicocelectomy. Results: Before varicocelectomy, all sperm parameters were affected, with high rates of low sperm concentration (83.3%), poor motility (88.9%), and abnormal morphology (77.8%). All sperm parameters were altered in 61.1%. On follow-up at 55.5 months after varicocelectomy, improvement in all the semen parameters was successful and complete in 22.2% but was not significant in 77.8%. The median follow-up period for sperm recovery was relatively long at 60.3 months. Total testosterone, FSH, and inhibin B were not significantly different before and after treatment (P > 0.05). However, testosterone, FSH, and TV significantly correlated with the semen parameters (P < 0.05). Moreover, a significant positive correlation was found between TV and inhibin B (P < 0.05), and the improvement in the semen parameters was significantly correlated with primary hypogonadism (P < 0.05). Conclusion: In adult men with SCD, varicocelectomy had a positive impact on the impaired seminal parameters and may be an option before sperm cryopreservation to improve future male fertility. Furthermore, primary testicular failure may be a feature of reversible spermatogenesis recovery in these patients.

The impact of varicocelectomy on sperm DNA fragmentation and pregnancy rate in subfertile men with normal semen parameters: A pilot study

The impact of varicocelectomy on sperm DNA fragmentation and pregnancy rate in subfertile men with normal semen parameters: A pilot study

The impact of varicocelectomy on sperm DNA fragmentation and pregnancy rate in subfertile men with normal semen parameters: A pilot study

ABSTRACT Objective: To evaluate the outcome of microscopic subinguinal varicocelectomy on sperm DNA fragmentation (SDF) and pregnancy rate in men with normal semen parameters. Patients and methods: A pilot study that included male patients with a minimum of a 1-year history of male subfertility, normal semen parameters, a high percentage of SDF, and clinically palpable varicoceles. Microscopic subinguinal varicocelectomy was carried out for 45 patients (study group), while 40 patients had no intervention (control group). Semen analysis and SDF were measured before and at 6 months after the varicocelectomy. The pregnancy rate was assessed at the 6- and 12-month follow-ups. Results: Between July 2014 and January 2019, 85 subfertile men were included in the study and completed 12 months of follow-up. The two groups were comparable in terms of their age, body mass index, infertility duration, infertility type, varicoceles laterality, and varicoceles grade (P values = 0.84, 0.34. 0.35, 1, 0.39, and 0.46, respectively). At 6 months after varicocelectomy, the mean SDF was reduced in both groups, and this reduction was statistically higher in the varicocelectomy group (P < 0.001). After 1-year, spontaneous pregnancy was achieved in 62% of the patients in the varicocelectomy group compared to 30% in the control group (P = 0.009). Conclusion: Varicocelectomy has a positive impact on SDF and spontaneous pregnancy in infertile men with clinically palpable varicoceles and normal semen parameters. Abbreviations: BMI: body mass index; DFI: DNA fragmentation Index; SDF: sperm DNA fragmentation

Outcome of varicocelectomy on different degrees of total motile sperm count: A systematic review and meta-analysis

ABSTRACTIt is crucial to identify the subfertile men with varicocele who will benefit the most from varicocelectomy, and the factors which help in predicting the response to varicocelectomy. We aimed to evaluate the impact of varicocelectomy on total motile sperm count (TMSC) and spontaneous pregnancy (SP) rates. A comprehensive literature search was performed using Medline/PubMed and Google Scholar up to December 26, 2018, with no restriction on language and year of publication. Published articles reporting different degrees of TMSC before and after varicocelectomy in infertile men with varicocele (palpable and/or clinical) were extracted. In addition, SP rates as a function of TMSC after varicocelectomy were reviewed. Potential biases were analyzed to rule out skewing factors. Mean TMSC was graded as: <2 million – profound, 2–5 million – severe, 5–10 million – moderate, and >10 million – mild. Data were analyzed using Stata11. Among the total 96 articles identified through electronic and manual searches of references, nine articles fulfilling the inclusion criteria were included. All degrees of TMSC resulted in a significant postoperative improvement, with only small differences, among the profound [10.20 million (95% confidence interval [CI]: 9.11–11.30, p < 0.0001)], severe [15.77 million (95% CI: 10.65–20.89, p < 0.0001)], and moderate groups [19.18 million (95% CI: 10.40–27.96, p < 0.0001)]. However, the mild group demonstrated a highly significant improvement [49.68 million (95% CI: 38.74–60.62, p < 0.0001)]. After varicocelectomy, the SP rate was highest in the TMSC >20 million group (55.4%), followed by TMSC 5–20 million group (45.4%), and TMSC <5 million group (26.3%). In comparison, the TMSC <1.5 million group demonstrated the lowest SP rate (16.0%). Moderate evidence suggests that varicocelectomy results in a significantly improved TMSC. The improvement in TMSC and SP rates is higher in patients who present a mild or moderate decreased TMSC.Abbreviations: TMSC: total motile sperm count; SP: spontaneous pregnancy; ART: assisted reproductive technology; IVF: in-vitro fertilization; IUI: intrauterine insemination; WMD: weighted mean difference; CI: confidence interval

Effects of Varicocelectomy on Abnormal Semen Parameters in Patients with Clinically Palpable Varicocele

Prevalence of varicocele is approximately 15.1% of the general population. Studies showed that surgical correction of clinically palpable varicocele could improve the semen parameters. However, there is scarce of study to demonstrate post-operative outcome of varicocelectomy among the patients with abnormal semen parameter. Therefore, this study tried to compare the microscopic changes in sperm concentration, sperm motility, and sperm morphology before and after varicocelectomy. This quasi-experimental study was done in Urology Department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from November 2014 to April 2016. Forty five patients with clinically palpable varicocele were finally includedin the study. Semen parameters of these patients were assessed by following the World Health Organization′s 5th manual of semen parameter, 2010. Subinguinal varicocelectomy was performed in every case. Follow up was done three months and six months after surgery. Data were analysed with statistical software SPSS 20 and level of significance was assessed by paired t-test.Almost 60.0% of patients were from 25 to 35 years age group. Of them, 87.1% patients were presented with left-sided varicocele, and 80% were grade III. All the patients showed oligospermia on semen analysis, whereas the number of abnormal sperm motility and abnormal morphology was 39, and 09, respectively. After surgical correction of varicocele, mean improvement of sperm concentration, motility and morphology found in 35 patients (77.7%), 31 patients (79.4%) and six patients (66.6%) respectively. The improvement was statistically significant (p&lt;0.05). This study showed that surgical treatment could lead to the betterment of semen parameters in patients with clinically palpable varicocele, which will guide in deciding the management of varicocele patients presented with abnormal semen parameter. However, to recommend varicocelectomy as a most useful procedure in treating infertility cases; further longitudinal studies are recommended to establish the impact of varicocelectomy on

MP89-01 TIME TO IMPROVEMENT IN SEMEN ANALYSIS PARAMETERS AFTER VARICOCELECTOMY

You have accessJournal of UrologyInfertility: Therapy I1 Apr 2017MP89-01 TIME TO IMPROVEMENT IN SEMEN ANALYSIS PARAMETERS AFTER VARICOCELECTOMY Melissa St.Aubin, Dane Johnson, Kate Cohen, and Jay Sandlow Melissa St.AubinMelissa St.Aubin More articles by this author , Dane JohnsonDane Johnson More articles by this author , Kate CohenKate Cohen More articles by this author , and Jay SandlowJay Sandlow More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2799AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Varicoceles are the most common identifiable cause of male factor subfertility. The impact of varicocelectomy on pregnancy outcome has been debated. We sought to evaluate the time frame for changes in semen parameters following varicocelectomy and examine the impact on natural conception. METHODS We performed a retrospective chart review on all patients who presented to our Reproductive Medicine Center for male factor subfertility and abnormal semen analysis (SA) parameters. Inclusion criteria were limited to men with clinically palpable varicoceles, who had at least one abnormal semen parameter on pre-operative SA, and had post-operative SA data available at both 3 and 6 months. Patients with at least 50% increase in total progressively motile sperm per ejaculate on their post-operative SA were classified as having improved semen parameters after varicocelectomy. Pregnancy outcomes were gathered retrospectively, and successful pregnancy was defined as live birth after intrauterine insemination or spontaneous pregnancy. RESULTS A total of 126 patients who underwent sub-inguinal varicocelectomy between 2006 and 2015 were included in this study. Following varicocelectomy, 72 patients (57%) had improvement in semen parameters. Spontaneous pregnancy or pregnancy from intrauterine insemination was more likely to occur in patients who had improved SA parameters (31% vs 10% p = 0.004). Of the patients that improved, 50 patients (69%) did so by 3 months. Another 22 patients (31%) saw eventual improvement in SA parameters by 6 months post-operative. There was no statistically significant difference in pregnancy outcomes between early improvement and delayed improvement in SA parameters ( 26% vs 41% respectively, p = 0.21). CONCLUSIONS Varicocelectomy resulted in a significant improvement in semen parameters in half of our patients. Of these, the majority who improved did so by 3 months post procedure; however, ~30% of patients without improvement at 3 months subsequently improved at 6 months. Pregnancy rates were statistically higher in patients who had >50% increase in total progressive motile sperm, regardless of the time it took to see this improvement. This data may be useful in counseling couples post varicocelectomy as to the time course for improvement and pregnancy outcomes. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1202 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Melissa St.Aubin More articles by this author Dane Johnson More articles by this author Kate Cohen More articles by this author Jay Sandlow More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Impact of varicocelectomy on premature ejaculation in varicocele patients

In a prospective manner, we studied the effect of varicocelectomy on premature ejaculation and testicular hormonal function in patients with varicocele. Microsurgical subinguinal varicocelectomy was carried out in 73 patients with clinical varicocele associated with premature ejaculation (group 1) and compared with 56 patients without operative intervention (group 2; control). The primary efficacy variable was the mean change in the Premature Ejaculation Diagnostic Tool. The changes in International Index of Erectile Function questionnaire, total serum testosterone and testicular size were also assessed. In group 1, the Premature Ejaculation Diagnostic Tool decreased significantly after varicocelectomy, from 15.56 to 11.37 (P<0.001), indicating improvement of premature ejaculation. Thirty patients (41.1%) showed improvement of premature ejaculation compared to 5.3% in the control group (P<0.001). In group I, but not in group II, testosterone levels and International Index of Erectile Function values increased significantly when compared with pre-operative values (P<0.001 and 0.040 respectively). Testicular size increased after varicocelectomy, but this increase was nonsignificant till the end of study (P=0.054). We concluded that varicocelectomy is clearly related to improvement of premature ejaculation and testicular hormonal function in varicocele patients.

Varicocele repair for low testosterone

Several recent clinical studies have added to the existing literature on the impact of varicocelectomy on serum testosterone levels. These studies were not included in the most recent previous review of this topic and strengthen considerably the evidence base supporting the claim that varicocele repair can reliably restore below-normal testosterone levels. Three studies were published in 2011 on the effect of varicocele repair on testosterone levels. These studies were all adequately powered to detect statistically significant changes in testosterone preprocedure and postprocedure, and all demonstrated significant increases in testosterone levels in patients who had low preprocedure testosterone levels. Varicocele repair can restore testosterone to the eugonadal range in hypogonadal patients with either unilateral or bilateral varicocele.

Alternate indications for varicocele repair: non-obstructive azoospermia, pain, androgen deficiency and progressive testicular dysfunction

Varicocele repair is indicated for infertile men with clinical varicoceles. Some men with scrotal pain, low testosterone, non-obstructive azoospermia, and who are at risk for testicular dysfunction may also benefit from varicocelectomy.