Embolization of left spermatic vein in non-obstructive azoospermic men with varicocele: role of FSH to predict the appearance of ejaculated spermatozoa after treatment.
OBJECTIVE
Varicocele repair in non-obstructive azoospermia (NOA) was occasionally associated to ejaculated spermatozoa independently from clinical and laboratory measures. We performed a prospective study in infertile men affected by NOA and left side varicocele to find whether or not the appearance of ejaculated spermatozoa after varicocele repair is predicted by baseline measures.


METHODS
Patients with NOA and grade II, or grade III left side varicocele were submitted to hormone analysis and to scrotal color Doppler ultrasound (CDU). Azoospermia was confirmed in 23 patients aged 25-47 years who were than submitted to varicocele repair through a retrograde internal spermatic vein embolization. Patients were re-evaluated after 6 months.


RESULTS
Six months after varicocele repair 12 patients (52.2 %) were still azoospermic (Group 1) while 11 patients (47.8 %) reported ejaculated spermatozoa (Group 2) [sperm count: 1.3 × 10(6)/mL; 0.5 × 10(6)/mL-1.6 × 10(6)/mL (median 25th-75th centiles)]. Serum baseline FSH was lower in Group 2 compared to Group 1 (p = 0.012), while no differences between groups were revealed for all other clinical and laboratory parameters. ROC analysis indicated that baseline FSH level predicted the appearance of ejaculated spermatozoa after treatment [AUC = 0.811; 95 % Confidence Interval (CI) 0.6-0.9; p = 0.0029]. A cut-off level of FSH <10.06 mIU/mL identified 82.0 % of cases with ejaculated spermatozoa with a specificity of 81.8 % and a sensitivity of 83.3 %.


CONCLUSIONS
Selected patients with NOA may show ejaculated spermatozoa after a non-invasive repair of a left side varicocele, therefore avoiding testicular sperm extraction. Baseline serum FSH was a valuable predictor for ejaculated spermatozoa after treatment.
Department of Life, Health and Environment Sciences, Andrology, University of L'Aquila, Via Vetoio, 67100, L'Aquila, Italy.
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D'Andrea
Interventional Radiology Unit, University Hospital San Salvatore, L'Aquila, Italy.
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Giordano
Interventional Radiology Unit, University Hospital San Salvatore, L'Aquila, Italy.
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Carducci
Interventional Radiology Unit, University Hospital San Salvatore, L'Aquila, Italy.
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Sacchetti
Department of Epidemiology, University of L'Aquila, L'Aquila, Italy.
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Necozione
Department of Life, Health and Environment Sciences, Andrology, University of L'Aquila, Via Vetoio, 67100, L'Aquila, Italy.
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Costanzo
Department of Life, Health and Environment Sciences, Andrology, University of L'Aquila, Via Vetoio, 67100, L'Aquila, Italy.
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De Gregorio
Department of Life, Health and Environment Sciences, Andrology, University of L'Aquila, Via Vetoio, 67100, L'Aquila, Italy.
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Micillo
Department of Life, Health and Environment Sciences, Andrology, University of L'Aquila, Via Vetoio, 67100, L'Aquila, Italy.
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Francavilla
Department of Life, Health and Environment Sciences, Andrology, University of L'Aquila, Via Vetoio, 67100, L'Aquila, Italy. sandro.francavilla@univaq.it.
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Francavilla
Department of Life, Health and Environment Sciences, Andrology, University of L'Aquila, Via Vetoio, 67100, L'Aquila, Italy.
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Barbonetti
D000328:Adult; D053713:Azoospermia / Q000097:blood* / Q000601:surgery*; D004542:Ejaculation; D004621:Embolization, Therapeutic; D005640:Follicle Stimulating Hormone / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013094:Spermatozoa; D016896:Treatment Outcome; D014646:Varicocele / Q000601:surgery*
D005640:Follicle Stimulating Hormone
Azoospermia; FSH; Male infertility; Varicocele