Fertility Potential of Microsurgical Subinguinal Varicocelectomy in Non-obstructive Azoospermia, Virtual Azoospermia and Severe Oligospermia Patients in a Tertiary Care Setup PC01-PC04
Dr. Sunil Patil,
Assistant Professor, Department of Urology, Room No. 219, Lokmanya Tilak Medical College and General Hospital, Sion, Mumbai-400022, Maharashtra, India.
Introduction: The role of varicocelectomy in Non-Obstructive Azoospermia (NOA) and Severe Oligospermia (SO) remains controversial with some studies reporting improvement in these patients.
Aim: To analyse the improvement in semen parameters and pregnancy outcomes after microsurgical varicocelectomy in NOA, SO and Virtual Azoospermia (VA) groups.
Materials and Methods: A single centre six year prospective study, evaluating 25 adults with primary infertility having NOA, VA (<1 million/mL) or SO (1-5 million/mL) with clinical varicocele and normal female partner evaluation was conducted at a tertiary care centre. Microsurgical varicocelectomy along with needle aspiration biopsy of bilateral testes was done in all patients. Follow-up semen analysis was done at six monthsâ€™ postoperatively. The improvement in sperm count and sperm motility postoperatively was compared using Wilcoxon signed rank test and paired t-test respectively.
Results: The mean age of patients were 31 years. There was significant overall improvement in both sperm count and progressive motility. Mean sperm count improved from 1.052 to 8.456 (million/mL) (mean improvement of 8.65 million/mL in VA group, and of 6.25 million/mL in SO group) while mean progressive motility improved from 15.76% to 24.4%. A total of 21 (84%) patients responded on follow-up. The non-respondersâ€™ group had two patients each from VA and SO groups. Pregnancy was achieved in five patients (20%), with spontaneous pregnancy in two and Intrauterine Insemination (IUI) in three patients. All patients with early maturation arrest were non-responders.
Conclusion: Microsurgical subinguinal varicocelectomy can lead to significant increase in semen parameters in severe oligospermic men, which aids spontaneous or assisted pregnancy (IUI) in these couples. Hypospermatogenesis and late maturation arrest are favourable predictors of response after surgery.