Embolization of Left Spermatic Vein in Non-obstructive Azoospermic Men with Varicocele: Role of FSH to Predict the Appearance of Ejaculated Spermatozoa After Treatment

Overview

Journal J Endocrinol Invest

Publisher Springer

Specialty Endocrinology

Date 2015 Mar 6

PMID 25740066

Citations 7

Authors

S DAndrea

A V Giordano

S Carducci

L Sacchetti

S Necozione

M Costanzo

A De Gregorio

A Micillo

F Francavilla

S Francavilla

A Barbonetti

Affiliations

Soon will be listed here.

Abstract

Purpose: 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 %.

Conclusion: 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.

Citing Articles

Predictive parameters of the efficacy of varicocele repair: a review.

Crafa A, Cannarella R, Condorelli R, Mongioi L, La Vignera S, Calogero A Asian J Androl. 2024; 26(5):441-450.

PMID: 38783663 PMC: 11449413. DOI: 10.4103/aja202420.

Varicoceles in Men With Non-obstructive Azoospermia: The Dilemma to Operate or Not.

Kaltsas A, Markou E, Zachariou A, Dimitriadis F, Mamoulakis C, Andreadakis S Front Reprod Health. 2022; 4:811487.

PMID: 36303681 PMC: 9580802. DOI: 10.3389/frph.2022.811487.

The impact of male factors and their correct and early diagnosis in the infertile couple's pathway: 2021 perspectives.

Pallotti F, Barbonetti A, Rastrelli G, Santi D, Corona G, Lombardo F J Endocrinol Invest. 2022; 45(10):1807-1822.

PMID: 35349114 PMC: 8961097. DOI: 10.1007/s40618-022-01778-7.

Left spermatic vein reflux after varicocele repair predicts pregnancies and live births in subfertile couples.

DAndrea S, Barbonetti A, Castellini C, Nolletti L, Martorella A, Minaldi E J Endocrinol Invest. 2019; 42(10):1215-1221.

PMID: 30955179 DOI: 10.1007/s40618-019-01042-5.

Should we expand the indications for varicocele treatment?.

Vakalopoulos I, Kampantais S, Lymperi S, Grivas N, Ioannidis A, Mykoniatis I Transl Androl Urol. 2017; 6(5):931-942.

PMID: 29184794 PMC: 5673807. DOI: 10.21037/tau.2017.08.01.

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