Spontaneous pregnancy outcome after surgical repair of clinically palpable varicocele in young men with abnormal semen analysis

Objective: The beneficial effect of varicocele repair in male infertility remains unresolved. The aim of this study was to identify the benefit from varicocele treatment based on pregnancy rate rather than improvement of semen quality.Subjects and Methods: This study included 141 infertile men with varicocele detected by clinical examination and confirmed by venous reflux on continuous wave Doppler ultrasonography (US). Measurement of Body Mass Index (BMI) and hormonal assays were performed in all patients. A total of 233 sub-inguinal varicocele repairs were done. Couples were followed up with semen analysis and pregnancy detection for 6, 12 and 18 months. Statistical analysis was performed using the chi-square, t-test and Mann-Whitney test where appropriate (p <0.05 accepted as statistically significant).Results: The spontaneous pregnancy rate was significantly greater in men with low or normal BMI. There were statistically significant differences between postoperative mean sperm count (64.7±6.8 and 10.5±1.8 million/ml) and progressive motility (38.3±2.4 and 17.7±1.8%) for spontaneous pregnancy and non-pregnancy, respectively. There were also significant changes from pre- to postoperative mean sperm concentration (21.5±2.1 and 64.7±3.8 million/ml), progressive motility (12.9±1.8 and 31.7±1.4%) and normal morphology (54±1.3 and 81.3±4.6%) in the spontaneous pregnancy cohort. Comparing pre- and postoperative serum hormone levels, FSH and prolactin decreased significantly in spontaneous pregnancy (6.57±0.65 to 4.6±0.53 IU/L and 166.2±11.8 to 149.3±10.4 pmol/L, respectively) and increased in non-pregnancy (9.05±0.71 IU/L and 187.8±13.3 pmol/L, respectively).Conclusion: Spontaneous pregnancy after sub-inguinal varicocelectomy is significantly affected by BMI, sperm concentration, progressive motility and morphology. The decrease of FSH may predict the spontaneous pregnancy outcome

Carnitine supplement: Does it worth trial to improve semen quality among infertile Sudanese men?

Carnitine supplement proves to upgrade the quality of semen by increasing sperm count and motility. In this study we have determined the level of L - carnitine in the seminal plasma of men with normal and abnormal seminal analysis. L - carnitine levels among the normal group was significantly higher than the abnormal group. We recommend trials of carnitine supplements to evaluate its usefulness in correcting some infertility cases. Subjects and methods: A total of 52 men; recruited from fertility centers in Khartoum ;were included in this study. Colorimetric carnitine determination kits were used for estimation of L - carnitine in seminal plasma. Results: Collectively; men with normal values of semen analysis had significantly higher mean seminal plasma carnitine levels compared to abnormal values (p = 0.028). Oligospermic men had significantly lower levels of carnitine compared to normal (p = 0.046). Conclusion: Seminal plasma carnitine level seems to correlate with seminal quality and its deficiency may be a reason for infertility among some Sudanese men