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Microsurgical varicocele repair induces spermatogenesis among men with non obstructive azoospermia: a 25 year experience

R. Flannigan, P.V. Bach, M. Goldstein
P-536 Wednesday, November 1, 2017
DOI: http://dx.doi.org/10.1016/j.fertnstert.2017.07.918

The objective of this study was to determine the proportion of non-obstructive azoospermic (NOA) men that develop sperm in their ejaculate following varicocele repair (VR) and pregnancy outcomes.

Retrospective review of all NOA men that have undergone VR at a single institution by a single surgeon (MG).

Materials and Methods
A review of all men with NOA that have undergone a microsurgical varicocele repair of palpable varicoceles by a single surgeon was performed. Semen analysis, and pregnancy rates were evaluated following repair. Student T-test, and chi square were used for between group univariate analyses using Microsoft Excel & Graph Pad Software. Statistical significance was set to a p value of 0.05.

133 men with NOA underwent a microsurgical VR between 1992 and 2017. 44/129 had unilateral, and 85/129 had bilateral VR. Overall, 59/133 (44%) of men had sperm return to the ejaculate following VR. Of men who had sperm return to the ejaculate, the mean concentration was 9.1 million sperm per ml (Table 1). FSH values were lower among NOA men who had post-VR sperm in their ejaculate (Table 1). Greater preoperative testosterone and semen volume trended toward significance among men with post VR sperm in their ejaculates (Table 1). Pregnancy rates using ejaculated sperm for IVF/ICSI among men with sperm in their ejaculates post VR was 20/45 (44%).

Among patients with NOA and palpable varicoceles, VR resulted in 44% of men with sperm in their ejaculates. These findings suggest that repair of varicoceles may obviate the need for surgical sperm retrieval in at least ½ of men with NOA.


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