Login to Access Video or Poster Abstract: MP89-01
Sources of Funding: None

Introduction

Varicoceles are the most common identifiable cause of male factor subfertility. The impact of varicocelectomy on pregnancy outcome has been debated. We sought to evaluate the time frame for changes in semen parameters following varicocelectomy and examine the impact on natural conception.

Methods

We performed a retrospective chart review on all patients who presented to our Reproductive Medicine Center for male factor subfertility and abnormal semen analysis (SA) parameters. Inclusion criteria were limited to men with clinically palpable varicoceles, who had at least one abnormal semen parameter on pre-operative SA, and had post-operative SA data available at both 3 and 6 months. Patients with at least 50% increase in total progressively motile sperm per ejaculate on their post-operative SA were classified as having improved semen parameters after varicocelectomy. Pregnancy outcomes were gathered retrospectively, and successful pregnancy was defined as live birth after intrauterine insemination or spontaneous pregnancy.

Results

A total of 126 patients who underwent sub-inguinal varicocelectomy between 2006 and 2015 were included in this study. Following varicocelectomy, 72 patients (57%) had improvement in semen parameters. Spontaneous pregnancy or pregnancy from intrauterine insemination was more likely to occur in patients who had improved SA parameters (31% vs 10% p = 0.004). Of the patients that improved, 50 patients (69%) did so by 3 months. Another 22 patients (31%) saw eventual improvement in SA parameters by 6 months post-operative. There was no statistically significant difference in pregnancy outcomes between early improvement and delayed improvement in SA parameters ( 26% vs 41% respectively, p = 0.21).

Conclusions

Varicocelectomy resulted in a significant improvement in semen parameters in half of our patients. Of these, the majority who improved did so by 3 months post procedure; however, ~30% of patients without improvement at 3 months subsequently improved at 6 months. Pregnancy rates were statistically higher in patients who had >50% increase in total progressive motile sperm, regardless of the time it took to see this improvement. This data may be useful in counseling couples post varicocelectomy as to the time course for improvement and pregnancy outcomes.

Funding

None