title: Is varicocelectomy beneficial in men previously deemed subfertile but with normal semen parameters based on the new guidelines? A retrospective study.
abstract: OBJECTIVE
  To determine whether using the 2010 World Health Organization (WHO) semen parameter reference values to select varicocelectomy candidates may exclude infertile men who can potentially benefit from this treatment. With the application of the 2010 WHO semen parameter thresholds, some men previously considered to have abnormal semen parameters would now be considered normozoospermic.
  
  
  METHODS
  We conducted a retrospective review of infertile men with varicocele and identified those with abnormal semen parameters according to WHO 1992 or 1999 standards but normozoospermic by WHO 2010 standards. We compared outcomes (semen parameters and spontaneous pregnancy) of couples undergoing varicocelectomy with those choosing observation.
  
  
  RESULTS
  We identified 445 infertile men with varicocele and abnormal semen parameters by WHO 1992 or 1999 standards. Fifty-six of 445 men (13%) were normozoospermic by WHO 2010. Thirty-two of 56 (57%) of these normozoospermic men elected to have varicocelectomy, and 24 of 56 men (43%) choosing observation. In these normozoospermic men (by WHO 2010), varicocelectomy was associated with a significant increase in sperm concentration (50 ± 35 × 10(6)/mL [postsurgery] vs. 32 ± 23 × 10(6)/mL [presurgery]; P = .003). Although not statistically significant, the clinical pregnancy rate was higher in the varicocelectomy group compared with the observation group (52% vs. 38%; P = .37).
  
  
  CONCLUSIONS
  Varicocelectomy may be beneficial in those men with clinical varicocele and abnormal semen parameters by WHO 1992 or 1999 standards but now normozoospermic by WHO 2010 standards. Applying the 2010 WHO semen parameter reference values into practice may result in missed opportunities to correct treatable causes of male infertility.
authors.affiliation: Division of Urology, Department of Surgery, McGill University, Montreal, Quebec, Canada.
authors.forename: Patrick
authors.initials: P
authors.lastname: McGarry
authors.affiliation: Division of Urology, Department of Surgery, McGill University, Montreal, Quebec, Canada.
authors.forename: Khalid
authors.initials: K
authors.lastname: Alrabeeah
authors.affiliation: Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Keith
authors.initials: K
authors.lastname: Jarvi
authors.affiliation: Division of Urology, Department of Surgery, McGill University, Montreal, Quebec, Canada. Electronic address: ziniarmand@yahoo.com.
authors.forename: Armand
authors.initials: A
authors.lastname: Zini
mesh_terms: D000328:Adult; D006801:Humans; D007248:Infertility, Male / Q000209:etiology / Q000601:surgery*; D008297:Male; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012661:Semen; D013521:Urologic Surgical Procedures, Male; D014646:Varicocele / Q000150:complications / Q000601:surgery*