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Prognostic Factors for a Favorable Outcome After Varicocele Repair in Adults with Infertility

  • Adit Shah
  • Mary K. SamplaskiEmail author
Chapter

Abstract

The effect of varicocele repair on male fertility remains controversial. Not all men with varicoceles will experience subfertility. While most men with abnormal semen parameters will experience some degree of improvement after a varicocele repair, not all men undergoing varicocele repair will have an improvement in their fertility after varicocele repair. We performed a systematic review of the literature, looking at factors that may predict for an improvement in reproductive outcomes after varicocele repair. This would be useful to target efforts directed at these patient populations. The literature supports that men with higher-grade varicoceles will have larger improvements in their semen parameters. In addition, a higher baseline sperm concentration or total motile sperm count (TMC) is predictive of a larger post-repair TMC and also seems to correlate with pregnancy outcomes. With respect to reproductive outcomes, higher baseline sperm concentration does seem to predict for natural pregnancy or assisted reproductive technology (ART) pregnancy rates after varicocele repair. In addition, varicocele repair does seem to reduce the need for more invasive modalities of ART. In accordance with the American Urological Association (AUA) and American Society for Reproductive Medicine (ASRM) guidelines, repair of subclinical varicoceles does not seem to prognostically improve outcomes. Varicocele repair does seem to restore sperm to the ejaculate in 20–40% of men with nonobstructive azoospermia, but the factors predicting for this are still being determined. The prognostic role of hormones, patient age, body mass index, pre-repair imaging characteristics, DNA fragmentation, and histology is still being determined. The prognostic value of genetics will likely play an increasing role in the future in predicting which males will respond favorably to varicocele repair; however, data looking specifically at its prognostic role in patients undergoing varicocelectomy is still lacking at this time.

Keywords

Varicocele Varicocelectomy Varicocele repair Prognostic factors Sperm Total motile count Pregnancy 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Institute of UrologyUniversity of Southern CaliforniaLos AngelesUSA

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