P-043 Does BMI affect the outcome of microsurgical varicocelectomy in Infertile men?
Authors: Arafa M , Majzoub A , Khalafalla K , AlSaid S , Elbardisi H 
Published: June 2022

Abstract

Study question
Does Body Mass Index (BMI) affect the semen parameter outcome after microsurgical varicocelectomy in infertile men?

Summary answer
BMI significantly affects the quality of semen parameters of infertile men with varicocele. However, it does not influence the outcome of varicocele repair.

What is known already
Varicocele is the most common correctable cause for male infertility. It has been proven that varicocele affects different semen parameters which can be corrected by varicocelectomy, thus restoring male fertility potential. Obesity is another well-known risk factor for male infertility. Both varicocele and obesity can affect semen parameters through similar pathophysiological mechanisms including hyperthermia and increased seminal oxidative stress. Although, varicocele was found to be negatively correlated with BMI, the effect of BMI on varicocele management was not investigated.

Study design, size, duration
This retrospective study of 1170 patients presenting with male factor infertility to a tertiary medical center over a period of 8 years. The inclusion criteria were patients who underwent microsurgical varicocelectomy for infertility. Patients with a genetic abnormality, history of chemotherapy or radiotherapy or leukocytospermia were excluded.

Participants/materials, setting, methods
813 patients were recruited and grouped according to BMI international score into Group A (n = 251patients, BMI &lt; 25kg/m2), Group B (n = 289patients, BMI 25-29.9kg/m2), Group C (n = 183patients, BMI 30-34.9kg/m2 ) and Group D (n = 90patients, BMI&gt;34.9kg/m2) Semen analysis, sperm DNA fragmentation(SDF), hormonal profile were collected pre-and 3 months post-operatively. Chi-squared test, Spearman correlations and Mann-Whitney test were used for statistical analysis of the study data. p-value &lt;0.05 was considered significant.

Main results and the role of chance
The patients’ mean age was 35.87±8.17 years. High-grade varicocele (II and III) was significantly more prevalent in the lower BMI groups (group A and B, p &lt; 0.001). BMI showed significant negative correlation with sperm concentration (r=-196, p &lt; 0.0001), total motility (r=-117, p = 0.001) and progressive motility (r=-107, p = 0.002). The basal pre-operative investigations showed significant difference between the obesity groups as regards sperm concentration (p &lt; 0.001), total motility (p = 0.003) and progressive motility (p = 0.037). The more obese groups (Groups C and D) showed the poorest semen parameters. Postoperatively, all groups showed significant improvement in sperm concentration (A:p=0.03, B:0.01, C:&lt;0.001, D:0.01). Total and progressive motility were only significant in Groups A (p = 0.06, &lt;0.0001 respectively), B (p &lt; 0.0001, 0.03 respectively) and C (p &lt; 0.0001, &lt;0.0001 repectively) while in Group D, total motility was improved clinically but did reach statistical significance (p = 0.07) and progressive motility didn’t show improvement. Morphology was significantly improved in only Group B (p = 0.02). There was no significant difference between the 4 groups as regards the median improvement of semen parameters postoperatively except for morphology which improved significantly more in the less obese patients (p = 0.002).

Limitations, reasons for caution
The main limitation is the retrospective design of the study.

Wider implications of the findings
In infertile patients with varicocele, obesity is an additional factor that leads to worse semen parameters, thus weight reduction may help in these cases.
Clinicians should not be discouraged to go for varicocelectomy in obese patients based on the improvement in semen parameters post-varicocelectomy in all obesity groups.

Trial registration number
Not applicable