Left spermatic vein reflux after varicocele repair predicts pregnancies and live births in subfertile couples
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Varicocele repair (VR) is proposed to improve fertility in subfertile couples with a poor semen quality. We explored whether the disappearance of a left continuous spermatic venous reflux (SVR) at scrotal colour-Doppler ultrasound (CDUS), an objective evidence for a VR, is predictive for improved fertility outcome in subfertile couples.
VR was performed by left internal spermatic vein sclero-embolisation in 88 males seeking a consultation for subfertility. Semen analysis and scrotal CDUS were evaluated before and 6 months after VR. Serum levels of FSH and total testosterone (TT) were obtained at baseline. Telephone interview was used to obtain information about fertility outcome. Significant predictors of pregnancy and live births, selected by univariate analyses, were included into multiple logistic regression models to assess independent associations.
At the adjusted model, independent significant predictors of pregnancy after VR were a disappeared SVR at CDUS (OR = 5.5, 97.5% CI 2.01–15.4; p = 0.0009) and an improved sperm total motile count (TMC) (OR = 5.5, 97.5% CI 1.4–27.9; p = 0.02). Even live births were independently associated with both disappeared left SVR at CDUS (OR = 4.3, 97.5% CI = 1.6–11.8; p = 0.003) and improved TMC after VR (OR = 4.8, 97.5% CI 1.3–24.2; p = 0.02).
The still controversial effect of varicocele repair on fertility in subfertile couples may reside on the undefined objective methods to document a successful VR and its effect on couple fertility. The disappearance of a continuous left SVR at CDUS after VR was the objective best predictor for subsequent improved fertility in subfertile couples.
KeywordsVaricocele Fertility Pregnancy Live birth Ultrasound Semen analysis
SD acquisition of data, drafting the article, analysis and interpretation of data. AM acquisition of data, drafting the article, analysis and interpretation of data. AB, LN, CC acquisition, analysis and interpretation of data. AVG, SG, EM, AM, SN statistical analysis and interpretation of data. FF critical revision for important intellectual content. SF conception and design, analysis and interpretation of data, critical revision for important intellectual content, final approval of the version to be published.
This work was supported by Ministero dell’Università e della Ricerca Scientifica, Italy.
Compliance with ethical standards
Conflict of interest
The authors have no potential conflicts of interest to disclosure.
The local ethics committee approved the study protocol.
Informed consent was obtained from all individuals included in the study.
- 6.Ghanaie MM, Asgari SA, Dadrass N, Allahkhah A, Iran-Pour E, Safarinejad MR (2012) Effects of varicocele repair on spontaneous first trimester miscarriage: a randomized clinical trial. Urol J 9(2):505–513Google Scholar
- 16.Cina A, Minnetti M, Pirronti T, Vittoria Spampinato M, Canadè A et al (2006) Sonographic quantitative evaluation of scrotal veins in healthy subjects: normative values and implications for the diagnosis of varicocele. Eur Urol 50:345–350. https://doi.org/10.1016/j.eururo.2006.02.055 CrossRefGoogle Scholar
- 18.D’Andrea S, Micillo A, Barbonetti A, Giordano AV, Carducci S et al (2017) Determination of spermatic vein reflux after varicocele repair helps to define the efficacy of treatment in improving sperm parameters of subfertile men. J Endocrinol Invest 40(10):1145–1153. https://doi.org/10.1007/s40618-017-0695-x CrossRefGoogle Scholar
- 19.von Elm E, Altman DG, Egger M, Pocock SJ, Peter C, Gøtzsche P, Vandenbroucke J (2007) guidelines for reporting observational studies strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 335(October):19–22. https://doi.org/10.1136/bmj.39335.541782.AD Google Scholar
- 20.Pezzella A, Barbonetti A, Micillo A, D’Andrea S, Necozione S, Gandini L, Lenzi A, Francavilla F, Francavilla S (2013) Ultrasonographic determination of caput epididymis diameter is strongly predictive of obstruction in the genital tract in azoospermic men with normal serum FSH. Andrology 1(1):133–138CrossRefGoogle Scholar
- 21.Pezzella A, Barbonetti A, D’Andrea S, Necozione S, Micillo A, Di Gregorio A et al (2014) Ultrasonographic caput epididymis diameter is reduced in non-obstructive azoospermia compared with normozoospermia but is not predictive for successful sperm retrieval after TESE. Hum Reprod 29(7):1368–1374. https://doi.org/10.1093/humrep/deu092 CrossRefGoogle Scholar
- 22.D’Andrea S, Giordano AV, Carducci S, Sacchetti L, Necozione S, Costanzo M et al (2015) Embolization of left spermatic vein in non-obstructive azoospermic men with varicocele: role of FSH to predict the appearance of ejaculated spermatozoa after treatment. J Endocrinol Invest 38(7):785–790. https://doi.org/10.1007/s40618-015-0259-x CrossRefGoogle Scholar
- 24.Hamilton JAM, Cissen M, Brandes M, Smeenk JMJ, De Bruin JP, Kremer JAM et al (2015) Total motile sperm count: a better indicator for the severity of male factor infertility than the WHO sperm classification system. Hum Reprod 30(5):1110–1121. https://doi.org/10.1093/humrep/dev058 CrossRefGoogle Scholar
- 34.Sansone A, Fegatelli DA, Pozza C, Fattorini G, Lauretta R, Minnetti M, Romanelli F, Lucatelli P, Corona M, Bezzi M, Lombardo F, Lenzi A, Gianfrilli D (2018) Effects of percutaneous varicocele repair on testicular volume: results from a 12-month follow-up. Asian J Androl. https://doi.org/10.4103/aja.aja_102_18 Google Scholar
- 35.Condorelli RA, Calogero AE, Mongioi’ L, Vicari E, Russo GI, Lanzafame F, La Vignera S (2016) Varicocele and concomitant dilation of the periprostatic venous plexus: effects on semen viscosity sperm parameters. J Endocrinol Invest 39(5):543–547. https://doi.org/10.1007/s40618-015-0401-9 CrossRefGoogle Scholar