(073) EVALUATING THE IMPACT OF HORMONE LEVELS PRIOR TO VARICOLECTOMY ON FERITLITY SUCCESS IN MEN WITH INFERTILITY
Authors: Duan M , Orozco Rendon D , Saffati G , Hinojosa-Gonzalez D , Kronstedt S , Khera M 
Published: December 2024

Abstract

Introduction
Varicocele is a common cause of male infertility, estimated to be present in around 40% of men with primary infertility and up to 80% of men with secondary infertility. The condition can result in global testicular dysfunction and affects spermatogenesis, DNA fragmentation, and hypogonadism. Varicocele repair has been established as an effective method to address male infertility and increase rates of pregnancy and live births. Several predictors of clinical success have been explored, including semen parameters and hormonal levels. There are no studies that examine the predictive value of the full panel of hormones implicated in the multifactorial issue of infertility.

Objective
This study aimed to evaluate pre-procedure hormone levels as a possible predictor of varicocelectomy efficacy in achieving fertility.

Methods
A retrospective chart review was conducted on patients who presented for male infertility care at a single urban center. Patients were selected by searching the EHR for ICD code 606.9. Only patients diagnosed with varicocele during their first visit and received a varicocelectomy were included in this study. Demographic and clinical characteristics were extracted, including age, race, and relevant past medical history (hypertension, diabetes mellitus, and hyperlipidemia). Hormone panels for male factor infertility conducted at the first visit included testosterone (T), free testosterone (FT), estradiol (E), prolactin (PRL), luteinizing hormone (LH), and follicular stimulating hormone (FSH). Patients not tested for any hormones were excluded from the study. Two-way non-parametric statistical testing was performed to determine statistical significance.

Results
The study included 97 patients with 39 (40.2%) achieving fertility and 58 (59.8%) failing to achieve fertility after a varicocelectomy. None of the hormones tested on the first visit were statistically significant in the context of achieving fertility. Table 1 summarizes the average hormone levels for patients achieving and not achieving fertility. Those who identified with a race or ethnicity other than the provided options (White, Black or African American, Hispanic, Asian Indian, Other Asian, Native Hawaiian) more often achieved fertility after their procedures (IRR = 8.92, P = 0.021). The average age of men who achieved fertility was significantly lower than the ones who did not, with 41.1 (SD 5.31) and 43.6 (SD 3.01), respectively (P = 0.015). Hypertension, diabetes mellitus, and hyperlipidemia failed to show a significant predictive relationship with post-op fertility. Included patients were predominantly white (62.89%).

Conclusions
Among patients presenting with male infertility and a new diagnosis of varicocele, the hormones T, FT, E, PRL, LH, and FSH are not predictive of the efficacy of a varicocelectomy in achieving fertility. Therefore, hormone levels prior to surgery should neither positively nor negatively influence expectations of future fertility. Patients who achieved fertility after varicocelectomy were younger than those who did not- unsurprising given the association of age with decreasing sperm quality and sexual function.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Disclosures: Consultant for AbbVie, Marius, Tolmar, Endo, Petros, Boston Scientific, Coloplast, Halozyme Investor: Sprout.