Abstract: PD68-11
Sources of Funding: None

Introduction

The role of redo varicocelectomy in infertile males with recurrent or persistent varicocele is controversial in the era of assisted reproductive technology (ART). The aim of the study was to compare sperm parameters, pregnancy and miscarriage rates between the men with recurrent or persistent varicocele who underwent redo microsurgical subinguinal varicocelectomy or had observation only.

Methods

The study included 217 infertile men with recurrent or persistent varicocele. The patients were divided into two groups: 120 men underwent redo microsurgical subinguinal varicocele repair, and 97 had observation only, as the control group. All patients had clinical varicoceles, and recurrences were confirmed with color Doppler ultrasound. Indications for redo varicocelectomy were no improvement in semen parameters and not achieving pregnancy after at least 6 months of initial varicocelectomy. Difference in total motile sperm count (TMSC), serum follicle stimulating hormone (FSH) and total testosterone levels from the beginning to the end of the study, pregnancy (spontaneous or with the use of ART) and miscarriage rates were compared between the two groups.

Results

Baseline mean patient and female partners ages, recurrent varicocele sites, TMSC, serum FSH and total testosterone levels, time to recurrence and follow-up period did not significantly differ between the two groups. The mean TMSC increased from 20.93±2.87 to 45.54±6.28 million in the microsurgical redo varicocelectomy group, and decreased from 16.62±2.75 to 15.6±2.81 million in the control group, revealing significant difference between the two groups (p=0.000). Increase in total testosterone was significantly higher in the microsurgical redo varicocelectomy group (+1.36±0.32 ng/ml) than in the control group (-0.23±0.1 ng/ml) (p=0.000). Of the couples, 63 (52.5%) achieved to pregnancy in the redo microsurgical varicocelectomy group, and 38 (39.2%) had pregnancy in the control group (p<0.05). Spontaneous pregnancy rate was significantly higher in the microsurgical varicocelectomy group (39.7%) than in the control group (15.8%) (p<0.01). Use of ART to achieve pregnancy was significantly lower in the microsurgical varicocelectomy group (60.3%) than in the control group (84.2%) (p<0.01).

Conclusions

Microsurgical subinguinal redo varicocelectomy improves postoperative semen parameters, serum total testosterone level and spontaneous pregnancy rates, compared to the controls. It also decreases need for use and level of ART.

Funding

None