title: Pregnancy after varicocelectomy: impact of postoperative motility and DFI.
abstract: OBJECTIVE
  To examine clinical and laboratory variables to determine which, if any, predict improved semen parameters and pregnancy after varicocelectomy.
  
  
  METHODS
  Surgical logs were reviewed for men who underwent varicocele ligation for a fertility concern. Clinical, demographic, and laboratory data was obtained through medical chart review and paired with postoperative reproductive outcomes obtained through chart review and survey.
  
  
  RESULTS
  Eighty-three subjects met inclusion criteria of which 63 and 24 completed both preoperative and postoperative basic and advanced semen testing, respectively. There was a statistically significant improvement in semen concentration, total motile count, sperm DNA fragmentation index (DFI), and total normal sperm count (TNSC) after varicocelectomy. Motility improved significantly in patients with preoperative asthenospermia. Concentration and motility demonstrated mean increases of 5.2 M/mL and 18%, respectively. DFI decreased from a preoperative mean of 40.8% to a postoperative mean of 24.5%. Fifty-one percent of couples were able to conceive using natural conception, intrauterine insemination, or in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). Pregnancy, regardless of the method used to conceive, was associated with a higher postoperative motility. The mean postoperative DFI in couples who reported a spontaneous pregnancy was 34%, which was statistically higher than the mean DFI of 17.5% in couples who reported a pregnancy with IVF/ICSI (P = .04).
  
  
  CONCLUSIONS
  Varicocele ligation improves multiple semen parameters. An increase in motility was the only variable associated with postoperative pregnancy irrespective of the method by which pregnancy was obtained. Mean DFI in couples able to achieve spontaneous pregnancy was above 30% and statistically higher than couples who reported pregnancy via IVF/ICSI.
authors: Department of Urology, Center for Male Fertility, Glickman Urological and Kidney Institute, The Cleveland Clinic, Cleveland, OH 44195, USA. bakerk8@ccf.org
authors: Karen
authors: K
authors: Baker
authors: John
authors: J
authors: McGill
authors: Rakesh
authors: R
authors: Sharma
authors: Ashok
authors: A
authors: Agarwal
authors: Edmund
authors: E
authors: Sabanegh
mesh_terms: D000328:Adult; D053938:DNA Fragmentation; D005260:Female; D006801:Humans; D007248:Infertility, Male / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D012189:Retrospective Studies; D055101:Semen Analysis; D013081:Sperm Motility; D014646:Varicocele / Q000150:complications / Q000601:surgery*; D055815:Young Adult