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

Male infertility secondary to varicocele : a study of the management of 45 patients

Varicocele is a common condition worldwide. The aim of this five-year prospective study is to examine the effect of varicocelectomy on the fertility profile of affected men in a male infertility clinic in Benin City, Edo State. A total of 45 men aged 16-65 years were diagnosed with varicocele during the period. Forty one (91.1%) had infertility while 4 (8.9%) were unmarried boys with third degree varicocele. Thirty seven (82.2%) consented to varicocelectomy; thirty three had infertility. Varicocelectomy was done through an open subinguinal approach. Restored testicular volume and semen quality were achieved within the first 12 months in all but one. Among the 33 men who had infertility, the spouses of 23 (69.7%) achieved pregnancy during the period of follow-up after varicocelectomy while the spouses of 10 (30.3%) had not. No major complication was recorded after operation. It is recommended that in subtropical Africa where there are no facilities for microscopic varicocelectomy and embolization, open varicocelectomy should be used. It is safe, effective and has much to offer. (Afr Reprod Health 2008; 12[1]:54-59)

Varicocelectomy: what benefits to the infertile Ghanaian male?

Fifty Ghanaian males of infertile marriages found on clinical examination to have varicoceles underwent varicocelectomy. Their mean age was 34.2 years (range 24 to 47 years). The varicocele was left-sided in 36 patients (72 per cent); bilateral in 13 (26 per cent) and right-sided in 1 (2 per cent). The mean of 3 preoperative semen analysis showed 9 patients (18 per cent) had azoospermia while 26 (52 per cent) had counts of 5 million/ml or less. The rest had counts between 6 and 20 million/ml. Normal sperm motolity (50 per cent or more motile sperms) and morphology (50 per cent or more with normal morphology) were seen in 36 per cent and 22 per cent of cases respectively. Following varicocelectomy 26 (52 per cent) obtained an overall improvement in semen quality. Of these 15 (30 per cent) had mean sperm counts above 20 million/ml. None of the patients with azoospermia obtained any benefit. A conception rate of 18 per cent (9/50) was obtained