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VARICOCELE REPAIR IMPROVES SEMEN PARAMETERS IN AZOOSPERMIC MEN WITH SPERMATOGENIC FAILURE

1999; Lippincott Williams & Wilkins; Volume: 162; Issue: 3 Part 1 Linguagem: Inglês

10.1097/00005392-199909010-00031

1527-3792

EDWARD D. KIM, BENJAMIN B. LEIBMAN, Dimitri M. Grinblat, LARRY I. LIPSHULTZ,

Male Reproductive Health Studies

No AccessJournal of UrologyClinical Urology: Original Articles1 Sep 1999VARICOCELE REPAIR IMPROVES SEMEN PARAMETERS IN AZOOSPERMIC MEN WITH SPERMATOGENIC FAILURE EDWARD D. KIM, BENJAMIN B. LEIBMAN, DIMITRI M. GRINBLAT, and LARRY I. LIPSHULTZ EDWARD D. KIMEDWARD D. KIM , BENJAMIN B. LEIBMANBENJAMIN B. LEIBMAN , DIMITRI M. GRINBLATDIMITRI M. GRINBLAT , and LARRY I. LIPSHULTZLARRY I. LIPSHULTZ View All Author Informationhttps://doi.org/10.1097/00005392-199909010-00031AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We analyzed the efficacy of varicocele repair in improving semen parameters in azoospermic men with spermatogenic failure. Materials and Methods: After routine clinical evaluation with confirmatory pellet analysis testicular biopsy and varicocele repair were simultaneously performed in 28 azoospermic men with a primary diagnosis of unilateral or bilateral varicocele and spermatogenic failure. Semen analyses were obtained starting 4 months after varicocelectomy. Results: Repair was bilateral repair in 20 men and unilateral in 8. Of the 28 men 12 (43%) had sperm in the ejaculate with a mean postoperative sperm count plus or minus standard deviation of 1.2 +/− 3.6 × 106/ml. and an average followup of 24 months. Mean sperm motility was 19 +/− 24% (range 0 to 80). Testicular biopsy was predictive of outcome. Only 9 men with severe hypospermatogenesis and 5 with maturation arrest spermatid stage had improvement in sperm density. No improvement was seen in 3 men with the Sertoli-cell-only pattern or 3 with maturation arrest spermatocyte stage. No pregnancies by natural intercourse resulted. One couple used fresh ejaculate for intracytoplasmic sperm injection and 1 underwent testicular sperm extraction with intracytoplasmic sperm injection. Both pregnancies resulted in live births. No other predictive factors were identified. Conclusions: Varicocele repair can result in sperm in the ejaculate of azoospermic men when severe hypospermatogenesis or maturation arrest spermatid stage is present. Select men with spermatogenic failure and varicoceles may be candidates for varicocele repair, rather than resorting to testis biopsy for sperm extraction in preparation for intracytoplasmic sperm injection. However, the couple should be counseled that assisted reproductive technologies will most likely be required to initiate pregnancy. References 1 : Seminal cytology in the presence of varicocele. Fertil. Steril.1965; 16: 735. Google Scholar 2 : The varicocele and semen characteristics. J. Urol.1979; 121: 435. Link, Google Scholar 3 : Varicocele: a progressive or static lesion?. Urology1993; 42: 541. Google Scholar 4 : Loss of fertility in men with varicocele. Fertil. Steril.1993; 59: 613. Crossref, Medline, Google Scholar 5 : The varicocele controversies. I. Etiology and pathophysiology. AUA Update Series XIV1995; 106. Lesson 13. Google Scholar 6 : Treatment of varicocele and male infertility. Arch. Androl.1993; 30: 157. Google Scholar 7 : Treatment outcome after varicocelectomy. A critical analysis. Urol. Clin. N. Amer.1994; 21: 517. Google Scholar 8 : Predictive parameters of successful varicocele repair. J. Urol.1986; 136: 609. Link, Google Scholar 9 : Controlled trial of high spermatic vein ligation for varicocele in infertile men. Fertil. Steril.1995; 63: 120. Google Scholar 10 : Varicocele in infertility: Incidence and results of surgical therapy. J. Urol.1974; 112: 222. Link, Google Scholar 11 : Induction of spermatogenesis and achievement of pregnancy after microsurgical varicocelectomy in men with azoospermia and severe oligoasthenospermia. Fertil. Steril.1998; 70: 71. Crossref, Medline, Google Scholar 12 : Results of ligation of internal spermatic vein in the treatment of infertility in azoospermic patients. Fertil. Steril.1976; 271: 110. Google Scholar 13 : Results of the surgical treatment of varicocelectomy in patients with azoospermia. Minerva. Chir.1987; 426: 489. Google Scholar 14 : Varicocelectomy in patients with azoospermia. Arch. Androl.1979; 3: 51. Google Scholar 15 : Pregnancies after intracytoplasmic injection of single spermatozoon into an oocyte. Lancet1992; 340: 17. Crossref, Medline, Google Scholar 16 : Fertilization and pregnancy rates after intracytoplasmic sperm injection using ejaculate semen and surgically retrieved sperm. Fertil. Steril.1997; 681: 108. Google Scholar 17 : Comparison of the fertilization rate after intracytoplasmic sperm injection (ICSI) using ejaculated sperms, epididymal sperms and testicular sperms. J. Med. Assoc. Thai1998; 81: 565. Google Scholar 18 : In vitro fertilization treatment for severe male factor: a comparative study of intracytoplasmic sperm injection with testicular sperm extraction and with spermatozoa from ejaculate. J. Assist. Reprod. Genet.1998; 15: 386. Google Scholar 19 : Pregnancies achieved with testicular and ejaculated spermatozoa in combination with intracytoplasmic sperm injection in men with totally or initially immotile spermatozoa in the ejaculate. Hum. Reprod.1996; 11: 1343. Google Scholar 20 : Testicular biopsy in male infertility evaluation. In: . St. Louis: Mosby-Year Book1997: 219. Google Scholar 21 : WHO Laboratory Manual for the Examination of Human Semen and Sperm-Cervical Mucus Interaction. In: . New York: Cambridge1992: 3. section 2. Google Scholar 22 : Semen pellet analysis: a technique to detect the presence of sperm in men considered azoospermic by routine semen analysis. J. Urol.1998; 159: 1548. Link, Google Scholar 23 : Correlation between testicular histology and outcome after intracytoplasmic sperm injection using testicular spermatozoa. Hum. Reprod.1996; 111: 127. Google Scholar 24 : Testicular sperm extraction with intracytoplasmic sperm injection for nonobstructive azoospermia. Urology1997; 49: 435. Google Scholar 25 : Extended sperm preparation: an alternative to testicular sperm extraction in non-obstructive azoospermia. Hum. Reprod.1997; 12: 1222. Google Scholar From the Scott Department of Urology, Baylor College of Medicine, Houston, Texas(Kim) Financial interest and/or other relationship with Pfizer, TAP and VIVUS.© 1999 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byShiraishi K, Oka S and Matsuyama H (2016) Predictive Factors for Sperm Recovery after Varicocelectomy in Men with Nonobstructive AzoospermiaJournal of Urology, VOL. 197, NO. 2, (485-490), Online publication date: 1-Feb-2017.Niederberger C (2014) Re: Clinical Outcome of Microsurgical Varicocelectomy in Infertile Men with Severe OligozoospermiaJournal of Urology, VOL. 193, NO. 1, (255-255), Online publication date: 1-Jan-2015.Abdel-Meguid T (2011) Predictors of Sperm Recovery and Azoospermia Relapse in Men With Nonobstructive Azoospermia After Varicocele RepairJournal of Urology, VOL. 187, NO. 1, (222-226), Online publication date: 1-Jan-2012.Weedin J, Bennett R, Fenig D, Lamb D and Lipshultz L (2011) Early Versus Late Maturation Arrest: Reproductive Outcomes of Testicular FailureJournal of Urology, VOL. 186, NO. 2, (621-626), Online publication date: 1-Aug-2011.Weedin J, Khera M and Lipshultz L (2010) Varicocele Repair in Patients With Nonobstructive Azoospermia: A Meta-AnalysisJournal of Urology, VOL. 183, NO. 6, (2309-2315), Online publication date: 1-Jun-2010.Inci K, Hascicek M, Kara O, Dikmen A, Gürgan T and Ergen A (2009) Sperm Retrieval and Intracytoplasmic Sperm Injection in Men With Nonobstructive Azoospermia, and Treated and Untreated VaricoceleJournal of Urology, VOL. 182, NO. 4, (1500-1505), Online publication date: 1-Oct-2009.Al-Said S, Al-Naimi A, Al-Ansari A, Younis N, Shamsodini A, A-sadiq K and Shokeir A (2008) Varicocelectomy for Male Infertility: A Comparative Study of Open, Laparoscopic and Microsurgical ApproachesJournal of Urology, VOL. 180, NO. 1, (266-270), Online publication date: 1-Jul-2008.Hussein A (2018) The Role of Color Doppler Ultrasound in Prediction of the Outcome of Microsurgical Subinguinal VaricocelectomyJournal of Urology, VOL. 176, NO. 5, (2141-2145), Online publication date: 1-Nov-2006.JAROW J, SHARLIP I, BELKER A, LIPSHULTZ L, SIGMAN M, THOMAS A, SCHLEGEL P, HOWARDS S, NEHRA A, DAMEWOOD M, OVERSTREET J and SADOVSKY R (2018) Best Practice Policies for Male InfertilityJournal of Urology, VOL. 167, NO. 5, (2138-2144), Online publication date: 1-May-2002.Çayan S, Erdemir F, Özbey I, Turek P, Kadioğlu A and Tellaloğlu S (2018) Can Varicocelectomy Significantly Change The Way Couples Use Assisted Reproductive Technologies?Journal of Urology, VOL. 167, NO. 4, (1749-1752), Online publication date: 1-Apr-2002.Schlegel P (2018) Editorial commentJournal of Urology, VOL. 167, NO. 2 Part 2, (1186-1186), Online publication date: 1-Feb-2002. Volume 162 Issue 3 Part 1 September 1999 Page: 737-740 Advertisement Copyright & Permissions© 1999 by American Urological Association, Inc.Metrics Author Information EDWARD D. KIM More articles by this author BENJAMIN B. LEIBMAN More articles by this author DIMITRI M. GRINBLAT More articles by this author LARRY I. LIPSHULTZ More articles by this author Expand All Advertisement PDF downloadLoading ...