title: Subsequent impaired fertility (with or without sperm worsening) in men who had fathered children after a left varicocelectomy: A novel population?
abstract: OBJECTIVE
  The objective of this paper was to assess whether the beneficial effects of a varicocelectomy on fertility are transitory or definitive after a first fathering.
  
  
  METHODS
  This was a retrospective study which involved seven andrological centers. The files of 2223 patients who underwent subinguinal ligation of a high grade left varicocele for (oligo)±(astheno)±(terato)-spermia and infertility between January 1(st), 2002 and January 1(st) 2013 were reviewed. Inclusion criteria for the patients were the following: Sperm count improvement and fathering a child after an uneventful left varicocelectomy; 745 patients were considered. Patients who had undergone three assessments for (in-) fertility: Before surgery, before the first fathering and after the first fathering were included in the study. Each assessment included: Clinical history, physical examination, two sperm analyses, bilateral scrotal Duplex scans, blood hormonal levels [follicle stimulating hormone (FSH), luteinising hormone (LH), testosterone (T) and prolactin (PRL)].
  
  
  RESULTS
  Forty patients were finally studied; they all had an improved sperm count and had fathered once after surgery. Fifteen had fathered twice and still had their sperm count increased after the second fathering. Twenty-five patients could not father twice; 13 patients had their sperm count decreased after the first fathering and 12 did not. A decrease in testicular volume and an increase in FSH paralleled the worsening of sperm concentration, motility and morphology after fathering. No other differences could be observed between the groups.
  
  
  CONCLUSIONS
  Our data indicated that the beneficial effects of a varicocelectomy might be transitory in some cases.
authors: Department of Andrology, Gynepro-Medical Group, Via Tranquillo Cremona 8, 40137 Bologna, Italy.
authors: Giorgio
authors: G
authors: Cavallini
authors: Department of Andrology, Centro Italiano Fertilita e Sessualita, Via Della Fortezza 6, 50129 Firenze, Italy.
authors: Giovanni
authors: G
authors: Beretta
authors: Department of Andrology, Andros-Italia, Outpatient Clinic of Perugia, Via Somaglia 10, 29121 Piacenza, Italy.
authors: Giulio
authors: G
authors: Biagiotti
authors: Department of Urology, Clinica San Marco, Via XXI Aprile 7, 04100 Latina, Italy.
authors: Roberto
authors: R
authors: Mallus
authors: Department of Andrology, Centro Medico Cirm, Outpatient Clinic of Piacenza, Via Somaglia 10, 29121 Piacenza, Italy.
authors: Carlo
authors: C
authors: Maretti
authors: Department of Andrology, Andrological Section, Hesperia Hospital, Via Arquà 80/1, 41125 Modena, Italy.
authors: Edoardo
authors: E
authors: Pescatori
authors: Department of Andrology, Complex Operative Unit of Urology, Regina Apostolorum Hospital, 00041 Albano Laziale, Rome, Italy.
authors: Gianni
authors: G
authors: Paulis
keywords: Male infertility; sperm analysis; varicocele; varicocele correction
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