Login to Access Video or Poster Abstract: MP35-17
Sources of Funding: None.

Introduction

Varicocele repair has been shown to improve semen parameters in men struggling with infertility, although the impact may be less clear in some subgroups, such as those with severe asthenospermia. Electron microscopy (EM) of sperm in men with severe asthenospermia and preserved viability has identified a higher frequency of subcellular ultrastructural defects (USDs) not identifiable with traditional microscopy. The impact of USDs on varicocelectomy results has not been explored, thus this study was designed to determine if the presence of EM-identified sperm defects predicts post-varicocele repair outcomes.

Methods

Data from our tertiary male infertility referral center is prospectively collected in a review board-approved database. Semen specimens with severe asthenospermia (<10%) and preserved sperm viability (>50%) at our center are referred for EM testing. We retrospectively reviewed all men with sperm EM testing between 2003-2013 who underwent either surgical varicocelectomy or embolization. Pre- and post-repair semen analyses within one year of repair were collected and analyzed. Statistical analyses were performed using Student's t test for continuous data with p<0.05 reported as significant.

Results

During our study time period, 54 men had sperm EM testing and underwent varicocele repair. Four patients had inadequate specimens for EM and were excluded. The mean age of the remaining 50 men was 36.1 years. Fold changes in pre- and post-repair sperm concentration, motility, and total motile count (TMC) were 1.50, 2.46, and 3.67, respectively. EM abnormalities were identified in 15/50 (30%) while no abnormalities were noted in 35 (70%). There were no significant differences between sperm concentration, motility, TMC, or morphology when comparing those with normal vs abnormal EM, 1 vs 2+ EM abnormality subtypes, or <50% vs 50+% sperm affected by USDs. Among men with <50% sperm affected by a USD, there was a 1.16 fold change in ejaculate volume as opposed to 0.64 change seen in men with 50+% sperm affected (p=0.03).

Conclusions

Post-varicocele repair outcomes in men with sperm EM abnormalities appear to be non-inferior to those without identified abnormalities. Certainly, it will be more challenging for these men with severe asthenospermia to approach normal parameters, but this small series demonstrates that the presence of EM abnormalities should not preclude a discussion about varicocelectomy.

Funding

None.