The role of varicocele sclerotherapy in men with severe oligo-astheno-teratozoospermia

Abstract

The aim of this study was to verify the role of antegrade scrotal sclerotherapy for the treatment of varicoceles in infertile men with severe oligo-astheno-teratozoospermia (OAT). The 59 patients with severe OAT in this study underwent antegrade scrotal sclerotherapy for the treatment of varicoceles. The outcome was assessed in terms of improvement in semen parameters and spontaneous conception rate. Semen parameters and reproductive hormones were evaluated before antegrade sclerotherapy (AS) and 6 months after AS. After an average follow-up time of 34.863.2 months, significant improvement was noted in the mean sperm concentration, motility and morphology in 36 patients (61%). Spontaneous pregnancy occurred in nine couples (15%). Six months after treatment, inhibin B levels were significantly higher (P,0.04), whereas follicle-stimulating hormone (FSH) levels were significantly lower (P,0.001) than before treatment. Antegrade internal spermatic vein sclerotherapy can significantly improve seminal parameters and hormonal parameters in men with severe OAT and may even result in spontaneous pregnancy in couples who would otherwise be candidates for intracytoplasmic sperm injection (ICSI). 1 Several studies have confirmed an association between varicocele and testicular dysfunction, reflected by abnormal semen and the loss of testicular volume.

Beneficial effects of varicocele embolization on semen parameters

“…Inhibin B is an important factor in testicular hormonal function. In men with severe oligoasthenoteratozoospermia, treatment of varicocele was associated with a significant increase in inhibin B levels and a significant decrease in FSH levels [ 8 ]. Some researchers have noted a significant improvement in serum inhibin B level after varicocelectomy and have concluded that combining this endocrine marker with a spermogram could be an effective guide to the effect of varicocelectomy on spermatogenesis [ 12 , 30 ].…”

“…Despite heterogeneity in patient characteristics, diagnostic criteria, treatment methods and treatment outcomes, most researchers have found that varicocele repair is associated with a significant improvement in the sperm concentration (in 15 out of 22 studies) and progressive motility (in 12 out of 17 studies) [ 4 ]. Varicocele repair's effect on sperm morphology is less clear [ 6 – 8 ] and it has been suggested that significant morphological changes in germ cells can only be observed over long follow-up periods [ 7 ]. Menkveld et al [ 9 ] showed that the measurement or evaluation of sperm morphology remains therefore a very important tool in the diagnosis of a male’s fertility potential and in the clinical decision making for the treatment of patients with infertility problems.…”

The predictive value of the platelet volume parameters in evaluation of varicocelectomy outcome in infertile patients

“…Moreover, several published reports confirmed the positive impact of varicocelectomy on improvement of seminal parameters (Feber & Kass, 2008; Ghanem, Safan, Ghanem, & Dohle, 2011; Nevoux, Mitchell, Chevallier, Rigot, & Marcelli, 2011). However, to our knowledge, few reports have investigated the effects of platelet volume parameters on infertility outcome in varicocele (Mahdavi‐Zafarghandi et al, 2014; Polat et al, 2015; Polat, Gulpimar, Sarica, & Benlioglu, 2017; Pyoa & Cho, 2016).…”

“…Although outcome of varicocele correction has been linked to the significant improvements of semen parameters in 60%–80% of men after varicocelectomy (Feber & Kass, 2008; Ghanem et al, 2011; Nevoux et al, 2011), a little is known about the value of preoperative and postoperative haematological markers for follow‐up varicocele cases.…”

“…The PLT and PVI (MPV, PDW and PCT) were measured using an automated blood cell analyser. Also, serum FSH, total testosterone levels and semen analysis were evaluated by using the procedure described by Mitchell et al (2011) and Ghanem et al (2011) .…”