Induction of spermatogenesis in azoospermic men after varicocelectomy repair: an update.
OBJECTIVE
To assess the treatment outcome after varicocele repair in azoospermic men and to correlate this outcome with the testicular histology patterns.


METHODS
Prospective study.


METHODS
Academic medical centers.


METHODS
Medical records of 27 azoospermic men, who underwent testis biopsy and microsurgical repair of clinical varicocele between July 1999 and May 2004, were reviewed.


METHODS
Twenty-seven azoospermic men underwent testis biopsy and microsurgical repair of clinical varicocele. All patients had at least two semen analyses showing azoospermia taken before the surgery and two semen analyses postoperatively.


METHODS
Semen analysis after varicocelectomy.


RESULTS
Hypospermatogenesis was identified in 9, maturation arrest in 8, and germ cell aplasia in 10 men. Induction of spermatogenesis was achieved in nine men (33.3%). Of these, four had germ cell aplasia, three had maturation arrest, and two had hypospermatogenesis. The improvement in sperm concentration and motility ranged from 1.2 x 10(6)/mL to 8.9 x 10(6)/mL, and from 24% to 75.7%, respectively. Of these nine patients with improvement in semen quality, five relapsed into azoospermia 6 months after the recovery of spermatogenesis (four germ cell aplasia and one maturation arrest). One patient with maturation arrest established pregnancy.


CONCLUSIONS
Azoospermic patients may have an improvement in semen quality after varicocelectomy. Semen samples may be cryopreserved after an initial improvement after varicocelectomy.
Pasqualotto
Fábio Firmbach
FF
Divisão de Clínica Urológica, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil. Fabio@conception-rs.combr
Sobreiro
Bernardo Passos
BP
Hallak
Jorge
J
Pasqualotto
Eleonora Bedin
EB
Lucon
Antônio Marmo
AM
D000328:Adult; D001284:Atrophy; D016922:Cellular Senescence; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D006801:Humans; D008297:Male; D009845:Oligospermia / Q000097:blood / Q000209:etiology / Q000473:pathology / Q000503:physiopathology*; D011184:Postoperative Period; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies; D012008:Recurrence; D013076:Sperm Count; D013081:Sperm Motility; D013091:Spermatogenesis; D013094:Spermatozoa / Q000648:ultrastructure; D013737:Testis / Q000473:pathology; D014646:Varicocele / Q000150:complications / Q000601:surgery*
D005640:Follicle Stimulating Hormone