Abstract: PD68-12
Sources of Funding: None

Introduction

Varicocele occurs in 35% and 75% of primary and secondary infertility. Azoospermia and SO occurs in 4.3% and 13.3% patients with varicocele._x000D_ Primary objective was to analyse improvement in semen parameters after varicocelectomy in NOA, VA, SO groups. _x000D_ Secondary objective was to analyse the pregnancy outcomes after varicocelectomy. _x000D_

Methods

Single centre study over 6 years of 25 adult patients of primary infertility with NOA, SO (< 5 million/ml), VA (< 1 milion/ml) with clinical varicocele and testicular size >10cc, semen volume >1.5 ml, pH >7.2 and normal FSH, testosterone levels and normal female evaluation. Patients were operated by loupe guided microsurgical subinguinal artery, lymphatic sparing varicocelectomy followed by needle aspiration biopsy (NAB) of bilateral testes. Semen analysis was done at 3, 6 months. Response was evaluated by improvement in sperm counts, progressive motility and pregnancy outcome.

Results

Mean age and mean duration of infertility were 30.64 years, 4.36 years. 18 patients had grade 2 varicocele, 4 had grade 1, 3 had grade 3 with mean grade of 1.96. Average testicular size was 19.16 cc. Mean counts improved from 1.052 to 8.456 (million/ml) (p<0.0001). Mean progressive motility improved from 15.76% to 24.4% (p<0.001). Twenty-one (84%) patients responded and four patients (16%) did not respond. Between two groups age, duration and grade were not significantly different. Amongst NOA, VA, SO groups; age, duration, grade, testicular size were not significantly different. 5 patients had pregnancy (2 spontaneous, 3 IUI). Mean time was 15 months (spontaneous), 4.5 months (IUI). They had significant improvement in motility (p 0.003). Grade was significantly different in pregnant (2.4) and non-pregnant (1.85) groups (p 0.048). On NAB 4 had hypospermatogenesis, 1 had late MA. In follow up no-one had recurrence, 1 patient had unilateral hydrocele. Limitations were small sample size and non-randomisation. _x000D_ _x000D_

Conclusions

Significant improvement in sperm counts and motility occurred after varicocelectomy in general (NOA, VA, SO). Age >33 years, duration >7.75 years, abnormal testicular histology were risk factors for non-responsiveness. Hypospermatogenesis was relatively better and early MA was worst for pregnancy outcome.

Funding

None