Prognostic factors for a favorable outcome after varicocele repair in adolescents and adults

Abstract

The effect of varicocele repair on male fertility remains controversial. It would be helpful to determined which men would benefit most from varicocele repair, and target repair efforts at those individuals. A detailed review of the literature on prognostic factors for varicocele repair was performed using the PubMed NLM database. We found that the best predictor of postvaricocelectomy semen parameters is the preoperative semen parameters. The greatest improvements in semen parameters were found in men with larger varicoceles. While there is controversy, higher testosterone, younger age and larger testis size, in some studies predict for improvements in semen parameters postvaricocelectomy. A nomogram has been developed to predict the postvaricocelectomy semen parameters based on the preoperative semen parameters, varicocele grade and the age of the man (www.fertilitytreatmentresults.com). Limited data consistently demonstrates the greatest improvements in DNA fragmentation rates in men with higher baseline DNA fragmentation rates. With respect to reproductive outcomes, higher baseline sperm density consistently predicts for natural pregnancy or assisted reproductive technology (ART) pregnancy rates. In addition, varicocele repair does seem to reduce the need for more invasive modalities of ART. In conclusion, we can now start to use specific parameters such as baseline semen quality, varicocele grade and patient age to predict post-repair semen quality and fertility potential following varicocelectomy.

Early varicocelectomy by percutaneous scleroembolization improves seminiferous tubules spermatozoa release in the adolescent phase of testicular growth

“…Current guidelines do not recommend US as a first‐line diagnostic procedure in patients with varicocele and recommend a timely surgical correction of adolescent varicocele for persistent differences in testicular size (Jungwirth et al, ; Samplaski & Jarvi, ).…”

Afterword to varicocele and male infertility: current concepts and future perspectives

“…Samplaski and Jarvi reviewed the prognostic factors for a favorable outcome after varicocele repair in adolescents and adults. 10 Higher testosterone levels, lower age, and larger testis were the factors associated with improvements in semen postvaricocelectomy. The authors also showed that the greatest reductions in sperm DNA fragmentation rates occurred in men with higher baseline levels of SDF, and added that varicocele repair might reduce the need for more invasive modalities of ART.…”

Preoperative follicle-stimulating hormone: A factor associated with semen parameter improvement after microscopic subinguinal varicocelectomy

“…8 Increasing varicocele grade has been the most studied male prognostic factor of response to varicocelectomy, 17 however, new evidence suggests that other factors, including baseline sperm density and reproductive hormones, may have a prognostic utility for varicocelectomy response. 18 Furthermore, infertile men with varicoceles may also have concomitant causes of infertility and varicocele repair alone may be insufficient to achieve fertility in these men. In a study of 1,213 men with infertility, 35.6% had idiopathic infertility with no clearly identifiable cause.…”