(135) CHARACTERIZATION OF SEMEN PARAMETER IMPROVEMENTS FOLLOWING VARICOCELECTOMY
Authors: Song J , Applewhite J , Fleming B , Boyne A , Burchfiel E , Orozco-Rendon D , Lipshultz L , Khera M 
Published: December 2024

Introduction

Infertility is a prevalent problem in the United States with male factor etiology in up to 50% of these cases. Varicoceles are present in up to 35% of men with primary infertility. However, surgical correction with varicocelectomy yields varying improvements in semen parameters.

Objective

To characterize semen parameter improvements following varicocelectomy.

Methods

An ongoing retrospective chart review of men who underwent varicocelectomy from 2009-2024 at our high-volume men’s health center was undertaken. Adult men with no prior varicocelectomy at an outside institution were included. Baseline scrotal ultrasounds measured maximum pampiniform vein diameters. Semen analyses were collected at baseline and months 1, 3, 6, and 12 after varicocelectomy. Spearman’s rank correlation and paired t-test were utilized to assess for statistical significance.

Results

A total of 338 adult men who underwent varicocelectomy were included. The average age at presentation was 34.7 (SD 6.9) years. 288 (85.2%) men were referred to our center for infertility evaluation following normal fertility evaluation of their partners. Patients underwent varicocelectomy median 2.3 (IQR 1.4-5.5) months after initial presentation. Maximum resting vein diameter was measured at median 3.7 (IQR 3.4-4.4) mm. Measurements of baseline total and free testosterone and estrogen were not associated with semen parameters. Increased LH and FSH levels significantly decreased baseline density, total sperm, and total motility (p &lt; 0.02 for all). Increased baseline FSH was associated with decreased final density, total sperm, and total motility (Spearman -0.21, -0.19, -0.22, respectively, p &lt; 0.02 for all). Surgical approach and number of veins ligated were not significantly correlated with semen parameters. Significant improvements in semen parameters were noted to one year after varicocelectomy. 42 (12.4%) of men presented with azoospermia. In this cohort, only 8 (26.7%) of the 30 men with followup had sperm present in subsequent semen analyses.

Conclusions

Our findings demonstrate that varicocelectomy significantly improved semen parameters, most notably within 3 and 6 months following surgery. Preoperative hormonal labs may be used to guide patients on the likelihood of semen parameter improvements following surgery.

Disclosure

Yes, this is sponsored by industry/sponsor: AUA/UCF Medical Student Research Fellowship.

Clarification: Industry funding only - investigator initiated and executed study.

Any of the authors act as a consultant, employee or shareholder of an industry for: M.K. acts as a consultant for AbbVie, Marius, Tolmar, Endo, Petros, Boston Scientific, Coloplast. M.K. is an investor of Sprout. L.L. acts as a consultant for AbbVie, Aytu BioScience, Contraline, Lipocine. L.L. acts as an advisor for Inherent Bioscences. L.L. acts as consultant/speaker for Endo Pharmaceuticals. L.L. acts as a speaker for American Medical Systems/Boston Scientific.