Login to Access Video or Poster Abstract: MP35-18
Sources of Funding: none

Introduction

The time needed for optimal improvement of semen parameters after varicocelectomy remains controversial. Our goal was to determine the ultimate follow up period required post ligation as a cutoff after which urologists could decide to advance in their management plan of a male infertility case.

Methods

30 patients underwent subinguinal varicocelectomy for male factor infertility and were followed for 9 months. All patients were subjected to a full clinical evaluation including semen analyses, hormonal profile for those with oligozoospermia, and scrotal doppler ultrasonography. Postoperative follow up was at 3 month intervals. Semen parameters and pregnancy rates at each visit (pretreatment, 3 months, 6 months and finally 9 months post treatment) were compared.

Results

After 3 months patients showed significant improvements in sperm motility (mean [m]=13.3% +/-9.3 vs. m=23.83 +/-14.95) [p =0.0001]. A significant reduction in the percentage of abnormal forms from 20-90% (m=53.5 +/-17.5) to 10-70% (m=38.5 +/-16.56) was also detected [p=0.0001]. However, counts failed to show similar significant improvements. Forty percent of the subjects (12/30) were able to impregnate their wives during the 1st 3 months post ligation. After 6 months, further significant increases continued to show in sperm motility reaching 0-70% (m=27.58% +/-14.9) [p=0.0199]. However abnormal forms (42.2% +/-14.5) and sperm concentrations (16.9 million +/-10.7) did not show similar significant improvement [p=0.221 and 0.9395 respectively]. By the 6th month of follow up 18/30 couples had achieved natural conception (60%). Among the nonpregnant couples who remained for follow up at 9 months posttreatment, no significant changes were identified in all semen parameters.

Conclusions

The optimal effect of varicocelectomy may take more than 3 months to be reached with a maximum of 6 months after which no further improvement may be expected. In other words, a 3-month follow up period may be insufficient before alternative therapies for male infertility cases treated by varicocele ligation could be decided. Hence, a wait time of at least 2 spermatogenic cycles (6 months) may be suggested before shifting to further management.

Funding

none