title: Male infertility in Kuwait. Etiologic and therapeutic aspects.
abstract: OBJECTIVE
  To evaluate the pathological patterns associated with male infertility in Kuwait and to characterize treatment outcome after varicocele repair using percutaneous varicocele embolization.
  
  
  METHODS
  We carried out a prospective study of 64 infertile men in Kuwait between 2001 and 2005. All patients included had proven non-obstructive azoospermia or oligospermia (sperm count <20 million/ml). All patients underwent ultrasonographic evaluation of the scrotum. Fine needle aspiration of the testes was performed on all azoospermic patients.
  
  
  RESULTS
  A total of 24 (38%) patients were azoospermic while 40 (62%) were oligospermic. Sertoli- cell-only pattern was the most common cytopathology associated with primary testicular failure. Among the oligospermic patients, 50% had small to moderate varicocele. Spermatic vein embolization resulted in a significant rise in the mean sperm count from 10.6 +/- 3.8 million/ml to 30.2 +/- 6.8 million/ml (p<0.05) in 5 treated oligospermic patients, followed by spontaneous pregnancy in 2 couples. No effect was seen on azoospermic patients.
  
  
  CONCLUSIONS
  From an etiological point of view, we believe that the high incidence of Sertoli cell-only-syndrome among nationals and residents of a country that underwent a major environmental insult strengthens the chances of an environmental role in the development of this syndrome. From a management point of view, in cultures where in vitro fertilization is either still not widely acceptable or is unaffordable, oligospermia with clinical or subclinical varicocele deserves a trial of a low risk, out patient procedure, namely, spermatic vein embolization that could improve fertility.
authors.affiliation: Department of Medicine-Endocrinology, Faculty of Medicine, Kuwait University. Lailaqadan@hotmail.com
authors.forename: Laila R
authors.initials: LR
authors.lastname: Qadan
authors.forename: Adel A
authors.initials: AA
authors.lastname: Ahmed
authors.forename: Kusum A
authors.initials: KA
authors.lastname: Kapila
authors.forename: Nahida A
authors.initials: NA
authors.lastname: Hassan
authors.forename: Jan A
authors.initials: JA
authors.lastname: Kodaj
authors.forename: Shahed K
authors.initials: SK
authors.lastname: Pathan
mesh_terms: D000328:Adult; D006801:Humans; D007248:Infertility, Male / Q000209:etiology* / Q000628:therapy*; D007730:Kuwait; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies