Nomograms for predicting changes in semen parameters in infertile men after varicocele repair

Capsule:
We formulated nomograms to predict improvements in semen parameters (total motile count, sperm concentration, motility, and morphology) after varicocele repair using multivariable linear regression.

Authors:
Mary K. Samplaski, M.D., Changhong Yu, M.S., Michael W. Kattan, Ph.D., Kirk C. Lo, M.D., Ethan D. Grober, M.D., Armand Zini, M.D., Susan Lau, B.S., Keith Jarvi, M.D.

Volume 102, Issue 1, Pages 68–74

Abstract:

Objective:
To formulate nomograms based on pre-repair characteristics to predict improvements in semen parameters after varicocele repair.

Design:
Model using multivariable linear regression based on prospectively collected database, with performance was quantified by concordance correlation coefficient and Pearson correlation coefficient after internal validation with bootstrapping.

Setting:
A male infertility specialty clinic.

Patient(s):
Men presenting for fertility evaluation from 2003–2012 having varicocele repair.

Intervention(s):
None.

Main Outcome Measure(s):
Semen parameters before and after varicocele repair.

Result(s):
Men undergoing varicocele repair (surgical or embolization) were identified via a prospectively collected database. The relationship of pre-repair semen and clinical characteristics to improvements in semen parameters was modeled using multivariable linear regression, then the model performance was quantified by concordance correlation coefficient and Pearson correlation coefficient after internal validation with bootstrapping. A total of 376 men who had undergone varicocele repair had data available for analysis. After varicocelectomy, the total motile count (TMC) varied depending on the initial left varicocele grade, ejaculate volume, sperm concentration, and motility. The final sperm concentration depended on the initial left varicocele grade, sperm concentration, and motility. The postvaricocelectomy sperm motility varied depending on the patient’s age, left varicocele grade, sperm motility, morphology, and TMC. The final percentage of normal forms depended on the prevaricocelectomy sperm morphology, age, right varicocele grade, normal morphology, and TMC. Nomograms using prevaricocelectomy semen parameters and clinical features were developed to predict postvaricocelectomy TMC, sperm concentration, motility, and morphology. The concordance correlation coefficients were 0.45, 0.47, 0.65, and 0.36, respectively.

Conclusion(s):
Clinical factors provide substantial ability to predict postvaricocele repair semen parameters. These nomograms may be used by clinicians to predict postvaricocele repair semen parameters.

  • Jason Kovac

    In this era of app’s why don’t we just do away with the nomogram as a paper-based tool and spend time converting these into app’s. Downloading the app and using it in the clinic directly would give patients instant feedback and “exact” numbers based on the current literature. This would be very beneficial.

    Perhaps F and S or ASRM could sponsor an educational initiative to develop a software package that would act as a “one-stop-shop” for infertility specialists incorporating nomograms for varicoceles, vasectomy reversals, etc.. in one combined app. How can I “tag” this post with a mention to the editors to consider this… I’d be happy to help !

  • Currently, I usually quote patients a 60% chance for improvement in their semen analysis parameters after varicocele repair. The Toronto group has provided a nomogram for us to give patients more objective data based on their varicocele grade and baseline semen analysis prior to varicocele repair. Although the correlations are not perfect, it gives us additional insight that we previously lacked when counseling patients on their chances of improvement. I look forward to refinements in these nomograms as the Andrology Research Consortium begins collecting data from multiple institutions.

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