Spontaneous pregnancy rates in Chinese men undergoing microsurgical subinguinal varicocelectomy and possible preoperative factors affecting the outcomes

Capsule:
Microsurgical varicocelectomy could improve semen quality and spontaneous pregnancy rates in patients with varicoceles. Patients with high initial sperm concentration may benefit from varicocelectomy.

Authors:
Jing Peng, M.D., Zhichao Zhang, M.D., Wanshou Cui, M.D., Yiming Yuan, M.D., Weidong Song, M.D., Bing Gao, M.D., Zhongcheng Xin, M.D., Sainan Zhu, M.D.

Volume 103, Issue 3, Pages 635-639

Abstract:

Objective:
To investigate pregnancy rates after microsurgical varicocelectomy in Chinese infertile men with clinical varicoceles and to identify preoperative factors affecting the outcomes.

Design:
Retrospective data analysis.

Setting:
University infertility clinic.

Patient(s):
One hundred seventy-six consecutive Chinese men with infertility and clinical varicoceles who underwent varicocelectomy from January 2010 to December 2011. Semen data were available for 145 patients, and pregnancy data were available for 66.

Intervention(s):
Varicocelectomy was performed on all patients.

Main Outcome Measure(s):
Spontaneous pregnancy rates and improvement in semen parameters after varicocelectomy.

Result(s):
We followed 145 men (82.4%) for a median of 21 months (range 12–36 months) after varicocelectomy. For 109 patients (75.2%), both sperm concentration and forward motility improved. Overall, 45.5% (66/145) of female partners achieved spontaneous pregnancy at a mean follow-up of 11.7 ± 6.2 months. On univariate analysis, preoperative high sperm concentration (≥20 million/mL) and high sperm motility (≥25%) were positively associated with spontaneous pregnancy. On multivariate analysis, only preoperative sperm concentration was an independent predictor.

Conclusion(s):
Microsurgical varicocelectomy could improve semen quality and spontaneous pregnancy rates. Only preoperative sperm concentration was an independent predictor of spontaneous pregnancy. Patients with high initial sperm concentration may benefit from varicocelectomy for spontaneous pregnancy.

  • jimdupree4

    Despite it’s lack of a control group, the authors should be commended for adding this manuscript to our body of knowledge on the role of microsurgical varicocelectomy as a treatment for male-factor infertility. It’s worth noting that in the second year of regular, unprotected intercourse, about 15% of couple achieve a spontaneous pregnancy, so the authors rate of 24% is higher than historical controls.

    We are referred a fair amount of patients because of low strict morphology findings on semen analyses. Could the authors comment on the strict morphology results in their population before and after surgery and if the pre-operative strict morphology value was associated with pregnancy after surgery?

  • msamplaski

    The role of varicocelectomy in fertility remains controversial. The major limitation of most of the prior publications on varicocelectomy is that they do not address pregnancy outcomes (which is what most couples are truly interested in). This article addresses this issue. While it is intuitive that men with the highest baseline sperm parameters would have the highest pregnancy rate, this is the first article to demonstrate this. I would be interested to know the DEGREE of improvement, which is not mentioned in the abstract. In addition, any change in DNA fragmentation levels would be interesting to know.

    • Agree with Dr. Samplaski.
      There are so many other variables that we don’t know about outside of the semen analysis that may be positively impacted with a varicocele repair: DNA fragmentation, ROS levels, proteomic changes, etc.

      The improvements in this study are above the ~60% SA changes that are seen in the literature. It would be nice to know at which point of the Q3 month followup which the maximal changes were noted in concentration, motility, morphology, etc.

      In addition, it would be nice to know if there was an empiric medical therapy, vitamins, or antioxidants used for any of the patients in this population.

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