title: Clinical outcome of microsurgical varicocelectomy in infertile men with severe oligozoospermia.
abstract: OBJECTIVE
  To evaluate the outcome of microsurgical varicocelectomy in infertile men with severe oligozoospermia and to identify the predictive parameters associated with the efficacy of microsurgical varicocelectomy in this cohort of patients.
  
  
  METHODS
  This study included 102 consecutive severe oligozoospermic patients who underwent microsurgical varicocelectomy between 2000 and 2013. The significance of several parameters as predictors of response to microsurgical varicocelectomy was evaluated using univariate and multivariate analyses. Responders were defined as those who fulfilled the following criteria: (1) sperm motility rate improved after surgery and (2) sperm concentration increased from <1 × 10(6)/mL to ≥ 5 × 10(6)/mL or from 1-5 × 10(6)/mL to ≥ 10 × 10(6)/mL.
  
  
  RESULTS
  After the mean postoperative observation period of 8.2 months, the mean sperm concentration increased from 2.4 to 11.6 million/mL (P <.001), and the mean sperm motility improved from 32.8% to 42.2% (P = .0024). There were no significant differences in the levels of hormonal parameters between the preoperative and postoperative measurements. Of the 102 patients, 42 (41.1%) were determined to be responders, and the wives of 17 (16.7%) conceived naturally. Univariate analysis identified preoperative sperm concentration (≥ 2.0 vs <2.0 million/mL) and laterality of varicocele (bilateral vs unilateral) as significant predictors of response to varicocelectomy. Only preoperative sperm concentration appeared to be independently related to the efficacy of varicocelectomy in men with severe oligozoospermia on multivariate analysis.
  
  
  CONCLUSIONS
  Varicocelectomy may improve the sperm quality and fertility potential in men with severe oligozoospermia, particularly for those with relatively high sperm concentration.
authors.affiliation: Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan. Electronic address: nenatsu@med.kobe-u.ac.jp.
authors.forename: Noritoshi
authors.initials: N
authors.lastname: Enatsu
authors.affiliation: Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Yamaguchi
authors.affiliation: Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Chiba
authors.affiliation: Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Miyake
authors.affiliation: Division of Urology, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Fujisawa
mesh_terms: D000328:Adult; D006801:Humans; D007248:Infertility, Male / Q000209:etiology / Q000601:surgery; D008297:Male; D008866:Microsurgery; D009845:Oligospermia / Q000209:etiology* / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D013521:Urologic Surgical Procedures, Male / Q000379:methods; D014646:Varicocele / Q000150:complications* / Q000601:surgery*; D055815:Young Adult