[Effect of bilateral microsurgical subinguinal varicocelectomy on asthenozoospermia and oligozoospermia: A report of 109 cases].

OBJECTIVE: To investigate the effects of bilateral microsurgical subinguinal varicocelectomy (BMSV) in patients with asthenozoospermia or oligozoospermia. METHODS: Totally 147 patients with male infertility received BMSV from January 2018 to May 2019, of whom 109 had complete data recorded. We retrospectively analyzed the clinical data, including the total sperm count per ejeculate, sperm concentration and sperm motility before and after surgery, and the rate of natural conception achieved during the follow-up. RESULTS: BMSV achieved a total effectiveness rate of 79.00% in improving the percentage of progressively motile sperm (a rise of ≥20%) and a marked effectiveness rate of 70.00% (a rise of ≥50%) in the 100 cases of asthenozoospermia as compared with the baseline, with a mean recovery time of (110.13 ± 37.43) days. Besides, a total effectiveness rate of 74.29% (an increase of ≥20%) and a marked effectiveness rate of 71.43% (an increase of ≥50%) were attained in the improvement of sperm concentration in the 35 cases of oligozoospermia, with a mean recovery time of (117.00 ± 48.79 ) days. A natural conception rate of 30.30% was observed during the follow-up. No severe adverse events occurred postoperatively. CONCLUSIONS: BMSV is significantly effective for the treatment of asthenozoospermia and oligozoospermia.

[Treatment of varicocele combined with asthenospermia by microsurgical shunt: 3 cases report].

To investigate the clinic value of microsurgical shunt for the treatment of varicocele combined with asthenspermia, the clinical data and therapeutic method for 3 patients, who conducted the microscope spermatic vein high ligation combined with superficial epigastric vein flow, were retrospectively analyzed. No postoperative complications were found, and the original symptoms and signs were disappeared. All patients were conducted scrotal ultrasound and semen routine after 3 months, and all indexes, including maximum internal diameter of the cord vein (erect position), sperm density, sperm survival rate, sperm deformity rate and sperm forward movement rate, were gradually improved. Consequently, high ligation of spermatic vein combined with vascular bypass surgery under the microscope can block the countercurrent venous blood and establish a new return channel to the testis. Meanwhile, it can also protect the testicular artery and lymph-vessel. It is worth to be spread for the treatment of varicocele combined with asthenospermia.

[High ligation of varicocele improves sperm DNA integrity in patients with asthenospermia].

OBJECTIVE: To assess how high ligation of varicocele improves sperm DNA integrity in patients with asthenospermia. METHODS: The DNA fragmentation index (DFI) and semen analysis were conducted in 30 subjects with normal sperm samples, and the parameters were used as references. Fifty-six patients from the Department of Urology of the Second Affiliated Hospital of Chongqing Medical University from April 2009 to April 2011 all signed the informed consent. Semen was collected 1 week before the high ligation of varicocele and 3 months after the surgery. We compared the change of the integrity of sperm DNA and semen. RESULTS: Three months after the high ligation of varicocele, DFI and semen indexes significantly improved (P<0.05), but no significant difference was found between open surgery and laparoscopic surgery, unilateral varicocele and bilateral varicocele and Grade I, Grade II, Grade III varicocele (P>0.05). Six months later, 27 spouses were pregnant out of the 53 surgical patients (50.9%). DFI of the pregnancy group and the non-pregnancy group was (13.90±9.70)% and (20.10±10.27)%, with significant different (P<0.05). CONCLUSION: Varicocelectomy can improve the sperm DNA integrity in patients with asthenospermia, whose effect is not related to surgical approach, unilateral or bilateral varicocele or varicocele grade.

Effects of varicocelectomy on sperm DNA fragmentation, mitochondrial function, chromatin condensation, and apoptosis.

The aim of this study was to evaluate conventional semen parameters (density, morphology, and progressive motility) and the flow-cytometric parameters of DNA fragmentation, mitochondrial membrane potential, phosphatidylserine externalization, and chromatin compactness in patients with varicocele before and after varicocelectomy. Thirty men (26.5 ± 3.2 years old, range 20-32 years) with oligoasthenoteratozoospermia and grade 3 left varicocele were selected (without other causes of male infertility). Each of them underwent sperm analysis and flow cytometric evaluation before and 4 months after subinguinal microsurgical varicocelectomy (SMV). After varicocelectomy, men had significantly higher sperm density, progressive motility, and normal forms compared with baseline. They also had a significantly lower percentage of spermatozoa with low mitochondrial membrane potential. After SMV, they showed a significantly lower percentage of spermatozoa with phosphatidylserine externalization, an early sign of apoptosis. Significantly decreased percentages of spermatozoa with abnormal chromatin compactness and spermatozoa with DNA fragmentation were found after SMV compared with baseline. Subinguinal microsurgical varicocelectomy improves sperm function in oligoasthenoteratozoospermia secondary to grade 3 left varicocele. Improvements are seen in conventional parameters and biofunctional parameters not routinely evaluated.

Right subclinical varicocele: how to manage in infertile patients with clinical left varicocele?

In this prospective study, we compared the results of bilateral varicocelectomy and left varicocelectomy for treatment of infertile patients with subclinical right and clinical left varicoceles with oligoasthenospermia. Because there was more improvement in semen parameters and pregnancy rate in patients who underwent the bilateral surgery, we concluded that right subclinical varicocele should be surgically treated in conjunction with the left one.

Is varicocelectomy indicated in subfertile men with clinical varicoceles who have asthenospermia or teratospermia and normal sperm density?

OBJECTIVE: Varicocele is the most common treatable cause of male infertility and is associated with progressive decline in testicular function. Varicocelectomy, a commonly performed operation, is indicated in infertile males with varicoceles who have oligospermia, asthenospermia, teratospermia or a combination of these factors. It is not clear if varicocelectomy is indicated if the patients have normal sperm density associated with asthenospermia or teratospermia. METHODS: We reviewed 167 patients with varicocele-associated male infertility over a 7-year period (December 1999-November 2005). Pre- and post-varicocelectomy seminal fluid analyses, assessed using the World Health Organization criteria, were obtained at intervals of 4-6 months. Wilcoxon signed rank tests were used to evaluate for statistical significance and P < or = 0.05 was considered significant. RESULTS: The mean age of the patients and their spouses were 35 and 28 years, respectively. The mean duration of infertility was 3.2 years (range, 1.5-7.5). Oligospermia, teratospermia, asthenospermia, oligospermia, asthenospermia and teratospermia (OAT) syndrome and azoospermia were found preoperatively in 106 (63.5%), 58 (34.7%), 154 (92%), 118 (71%) and 15 (9%) patients, respectively. Overall, significant improvements in semen volume (P < 0.001), sperm density (P < 0.001), sperm motility (P < 0.001) and sperm vitality (P < 0.001) were obtained after varicocelectomy. There was, however, no significant improvement in sperm morphology after varicocelectomy (P = 0.220). When patients with preoperative oligospermia (sperm density, <20 million/mL) were considered separately, varicocelectomy led to significant improvement in all the semen parameters except the sperm morphology (P = 0.183). Conversely, when varicocele patients with a sperm density of > or =20 million/mL (normospermia) associated with asthenospermia and/or teratospermia were considered separately, they did not show significant improvement in any of the semen parameters after varicocelectomy (P > 0.05). In addition, azoospermic patients did not show significant improvement in any of the semen parameters (P > 0.05) CONCLUSION: No significant improvement in semen parameters may be obtained in patients with clinical varicocele and preoperative normospermia. It is possible that only patients with preoperative oligospermia may benefit from varicocelectomy. Larger multi-institutional studies are needed to determine more definitively if asthenospermia or teratospermia in normospermic subfertile males with clinical varicoceles are in fact indications for varicocelectomy.