Preoperative semen analysis as a predictor of seminal improvement following varicocelectomy.
OBJECTIVE
To determine the predictive role of preoperative semen analysis on both seminal improvement and pregnancy rates following varicocelectomy.


METHODS
Retrospective data analysis.


METHODS
Two academic medical center infertility clinics.


METHODS
One hundred ten consecutive patients who underwent varicocelectomies. Seminal improvement data were available for 84 patients, and pregnancy data were available for 58 patients.


METHODS
Stratification of patients based on preoperative total motile sperm count (TM). Varicocelectomy was performed on all patients.


METHODS
TMs, pregnancy rates, and conception techniques following varicocelectomy of each preoperative group.


RESULTS
Men with mild to moderate oligoasthenospermia (TM >5 million) had significantly better seminal improvement following varicocelectomy. While preoperative stratification showed no difference in pregnancy rates (when assisted reproductive techniques were included), men who achieved a postoperative TM >20 million were more likely to achieve conception by less invasive techniques (natural and intrauterine insemination vs. in vitro fertilization [IVF]).


CONCLUSIONS
Varicocelectomy may be the most cost-effective initial intervention in males with TM >5 million. Patients with TM <5 million and concomitant female factor infertility may be better initial candidates for IVF.
Matkov
T G
TG
Department of Urology, Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612, USA.
Zenni
M
M
Sandlow
J
J
Levine
L A
LA
D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D011247:Pregnancy; D012189:Retrospective Studies; D012661:Semen / Q000166:cytology*; D013076:Sperm Count; D014646:Varicocele / Q000175:diagnosis / Q000601:surgery*