Prognostic factors for successful varicocelectomy to treat varicocele-associated male infertility

Huang, Hsin‐Chieh; Huang, Shih‐Tsung; Chen, Yu; Hsu, Yu‐Chao; Chang, Po-Chih; Hsieh, Ming‐Li

doi:10.1071/rd12368

Cited by 8 publications

(9 citation statements)

References 21 publications

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“…found that preoperative sperm density had a favorable association with the likelihood of successful (as determined by improvements in semen analysis at 3, 6 and 12 months postoperatively) varicocelectomy, and that a preoperative sperm density of 12 × 10 6 ml −1 or greater was able to predict successful varicocelectomy with a sensitivity of 77.6% and specificity of 77.4%. 7 To our review, there have been no studies demonstrating a negative correlation between pre- and post-repair sperm density.…”

Section: Prevaricocelectomy Factors Predicting Postrepair Semen Parammentioning

confidence: 89%

“…found on multivariate logistic regression that age, with an odds ratio of 0.56 (95% confidence interval: 0.41–0.76), had a significant unfavorable association with the likelihood of improvement in semen analysis parameters after varicocelectomy. 7 Conversely, a study of men with nonobstructive azoospermia found that patient age at the time of repair was not associated with the odds of recovery of sperm in the ejaculate following the varicocelectomy. 21 Likewise, several other studies have not demonstrated a relationship between age and seminal outcomes following varicocele repair.…”

Section: Prevaricocelectomy Factors Predicting Postrepair Semen Parammentioning

confidence: 99%

“…In this study, the mean age was 34 years (range 23–42) and mean sperm density was 18.2 × 10 6 ml −1 ; On linear multivariate logistic regression, age (OR: 0.56, P < 0.001) and preoperative sperm density (OR: 1.22, P = 0.001) were significantly associated with the likelihood of successful varicocelectomy. 7 …”

Section: Introductionmentioning

confidence: 99%

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

Samplaski

Jarvi

2016

Asian J Androl

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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.

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Section: Prevaricocelectomy Factors Predicting Postrepair Semen Parammentioning

confidence: 89%

Section: Prevaricocelectomy Factors Predicting Postrepair Semen Parammentioning

confidence: 99%

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

Samplaski

Jarvi

2016

Asian J Androl

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“…In addition, the data indicated that low preoperative standard semen parameters were predictive of better outcomes than high baseline parameters after varicocoele correction. Multiple studies have confirmed the authors’ data (Marks et al ., ; Matkov et al ., ; Huang et al ., ; Samplaski et al ., ). In fact, the larger and the greater the influence of the mechanisms affecting spermatogenesis and fertility potential, the worse the sperm parameters were (Samplaski et al ., ; Marmar, ).…”

Section: Discussionmentioning

confidence: 99%

The clinical usefulness of a novel grading system for varicocoeles using duplex Doppler ultrasound examination based on postsurgical modifications of seminal parameters

2018

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Background: The existing classifications of varicocoeles have poor predictive value regarding the effects of surgery on sperm count. Objective: To develop a new grading system for varicocoeles, useful as an indication for surgery. Materials and methods: This is a three-center prospective study which examined 173 men having clinically detectable left varicocoeles and oligo AE astheno AE terato-spermia. The patients underwent medical history collection, objective examination, duplex Doppler ultrasound scrotal examination, hormonal profiles, two semen analyses before surgery, and two semen analyses after surgery. Sperm concentration, motility, and morphology (standard semen parameters) were evaluated 6 months after surgery in function of the following preoperative variables: patient age, follicle-stimulating hormone, clinical grade of varicocoele, right and left testicular volume, extension of venous reflux, and semen parameters. The venous reflux was graded in two centers using duplex Doppler ultrasound: reflux visible only with Valsalva and continuous reflux. Spearman's rank semiquantitative analysis was used. All patients had their varicocoeles corrected according to the Colpi technique. Results: The variables capable of determining an improvement in semen parameters after varicocoele correction were in order of decreasing importance: venous reflux extent assessed by scrotal duplex Doppler ultrasound examination, varicocoele clinical grade, basal semen parameters, and follicle-stimulating hormone. Male age did not influence postoperative semen quality. Only patients with continuous reflux had their standard semen parameters improved after surgery. Discussion: Venous reflux extent is the most critical variable capable of predicting semen improvement after varicocoelectomy. Conclusions: A correct duplex Doppler assessment of venous reflux is mandatory for predicting postoperative improvement of the sperm count.

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“…15 Huang et al found that preoperative sperm density had a favorable association with the likelihood of successful varicocelectomy, and that a preoperative sperm density of 12 × 106 /ml or greater was able to predict successful varicocelectomy with a sensitivity of 77.6% and specificity of 77.4%. 17 Authors compared pre-operative and post-operative semen parameters with respect to age of patients. Mean sperm counts/ml (million/ml) improved from 43, 52.96 and 44.05 (pre-operatively) to 65.5, 68.42 and 73.72 (post-operatively) among age groups <20 years, 21-30 years and 31-40 years respectively as shown in table III.…”

Section: Discussionmentioning

confidence: 99%

Effect of varicocelectomy on seminogram in patients with clinical varicocele

et al. 2018

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INTRODUCTIONVaricocele has first been described as early as first century B.C.1 Celsus wrote "when the disease has spread over the testicle and its cord, the testicle sinks a little lower and becomes smaller than its fellow, in as much as its nutrition has become defective". The earliest description of varicocele in the modern literature was in 1885 by Barwell.1 Varicocele is a very common finding in young men. It is an abnormal enlargement and tortuosity of the pampiniform plexus of veins in the spermatic cord.2 The prevalence of varicocele is approximately 15% in general population, 25%-40% among men with primary infertility and 45% to 81% among men with secondary infertilty.2 Isolated left-sided lesions are seen in 78% to 93% of varicocele patients, ABSTRACTBackground: Despite various studies published in the recent years, efficacy of varicocelectomy and its influence on semen parameters, particularly sperm count, motility and morphology has not yet been determined. Conflicting results obtained in different studies, accounts for sparked interest in varicocele management and its effects on seminal parameters. Therefore, present study was designed in an attempt to evaluate the effect of varicocelectomy on the semen parameters by analyzing reports that included men with varicoceles who had both preoperative and postoperative semen examination done. Methods: The present prospective study enrolled fifty patients. Varicocele was graded by Dubin grading system by palpation in standing and during Valsalva maneuver under adequate exposure and illumination. Macro and microscopic assessment of semen samples was carried out according to WHO guidelines. The surgical approach used for varicocelectomy was inguinal (Modified Ivanissevich procedure). Results: Significant improvement in semen parameters viz sperm counts/ml, sperm counts/ejaculate and sperm motility were observed after varicocelectomy. We noted no effect of patient's age on the degree of improvement in semen parameters post operatively. Preoperatively, men with Grade III varicoceles had lower sperm counts and sperm motility, but significant improvement was observed post-operatively compared to men with Grades I and II varicoceles. Conclusions: Our study supports the fact that, varicocele exerts a deleterious effect upon sperm motility, concentration and repair of varicocele leads to improvement in these seminal parameters. The repair of larger varicocele seems to be a predictor for better post-repair semen parameters. Varicocele is a treatable cause of male infertility (primary and secondary), so patients undergoing varicocelectomy should have a pre-operative and postoperative semen examination done routinely.

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Prognostic factors for successful varicocelectomy to treat varicocele-associated male infertility

Cited by 8 publications

References 21 publications

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

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

The clinical usefulness of a novel grading system for varicocoeles using duplex Doppler ultrasound examination based on postsurgical modifications of seminal parameters

Effect of varicocelectomy on seminogram in patients with clinical varicocele

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