Prognostic factors for successful varicocelectomy to treat varicocele-associated male infertility
Hsin-Chieh Huang A , Shih-Tsung Huang A , Yu Chen A , Yu-Chao Hsu A , Po-Chih Chang A and Ming-Li Hsieh A B
+ Author Affiliations
- Author Affiliations
A Department of Urology, Chang Gung Memorial Hospital at Linkou, 5# Fusing Street, Gueishan Township, Taoyuan County 333, Taiwan (R.O.C.).
B Corresponding author. Email: h0810@cgmh.org.tw
Reproduction, Fertility and Development 26(3) 485-490 https://doi.org/10.1071/RD12368
Submitted: 12 November 2012 Accepted: 11 March 2013 Published: 15 April 2013
Abstract
The present study identified prognostic factors for successful varicocelectomy for the treatment of varicocele-induced male infertility. All varicoceles were diagnosed and graded by physical examination and ultrasound. Pre- and postoperative analysis of semen specimens measured sperm density, morphology and motility. ‘Responder’ and ‘non-responder’ status was determined by semen analyses at 3, 6 and 12 months postoperatively. Varicocele Grades 1, 2 and 3 were found in 16, 36 and 28 patients, respectively; 49 patients (61.3%) were responders based on improved seminograms. Significant postoperative increases were noted in sperm density (from 18.20 ± 14.76 × 106 to 32.36 ± 24.81 × 106 mL–1; P < 0.001), sperm morphology (from 57.21 ± 17.35% to 62.66 ± 15.18%; P = 0.006) and percentage motility (from 29.89 ± 14.71% to 50.92 ± 19.30%; P < 0.001). Multivariate logistic regression indicated that age (odds ratio (OR) 0.56; P < 0.001) and preoperative sperm density (OR 1.22; P = 0.001) had significant unfavourable and favourable associations, respectively, with the likelihood of successful varicocelectomy. Furthermore, a preoperative sperm density of 12 × 106 mL–1 as a cut-off point was able to predict successful varicocelectomy with a sensitivity of 77.6% and specificity of 77.4% (area under the curve = 0.85; P < 0.001; 95% confidence interval 0.76–0.92). Age and preoperative sperm density are prognostic factors for successful varicocelectomy. The results of the present study may allow clinicians to predict surgical improvement in fertility in patients with varicocele.
Additional keywords: fertility, semen analysis, sperm density, sperm morphology, sperm motility.
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