MP35-17 SPERM ULTRASTRUCTURAL DEFECTS IN MEN WITH SEVERE ASTHENOSPERMIA IS NOT A POOR PROGNOSTICATOR FOR VARICOCELECTOMY OUTCOMES (2017)

You have accessJournal of UrologyInfertility: Epidemiology & Evaluation II1 Apr 2017MP35-17 SPERM ULTRASTRUCTURAL DEFECTS IN MEN WITH SEVERE ASTHENOSPERMIA IS NOT A POOR PROGNOSTICATOR FOR VARICOCELECTOMY OUTCOMES Sarah Ferrara, Keith Jarvi, and Jared Bieniek Sarah FerraraSarah Ferrara More articles by this author , Keith JarviKeith Jarvi More articles by this author , and Jared BieniekJared Bieniek More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1107AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Varicocele repair has been shown to improve semen parameters in men struggling with infertility, although the impact may be less clear in some subgroups, such as those with severe asthenospermia. Electron microscopy (EM) of sperm in men with severe asthenospermia and preserved viability has identified a higher frequency of subcellular ultrastructural defects (USDs) not identifiable with traditional microscopy. The impact of USDs on varicocelectomy results has not been explored, thus this study was designed to determine if the presence of EM-identified sperm defects predicts post-varicocele repair outcomes. METHODS Data from our tertiary male infertility referral center is prospectively collected in a review board-approved database. Semen specimens with severe asthenospermia (<10%) and preserved sperm viability (>50%) at our center are referred for EM testing. We retrospectively reviewed all men with sperm EM testing between 2003-2013 who underwent either surgical varicocelectomy or embolization. Pre- and post-repair semen analyses within one year of repair were collected and analyzed. Statistical analyses were performed using Student's t test for continuous data with p<0.05 reported as significant. RESULTS During our study time period, 54 men had sperm EM testing and underwent varicocele repair. Four patients had inadequate specimens for EM and were excluded. The mean age of the remaining 50 men was 36.1 years. Fold changes in pre- and post-repair sperm concentration, motility, and total motile count (TMC) were 1.50, 2.46, and 3.67, respectively. EM abnormalities were identified in 15/50 (30%) while no abnormalities were noted in 35 (70%). There were no significant differences between sperm concentration, motility, TMC, or morphology when comparing those with normal vs abnormal EM, 1 vs 2+ EM abnormality subtypes, or <50% vs 50+% sperm affected by USDs. Among men with <50% sperm affected by a USD, there was a 1.16 fold change in ejaculate volume as opposed to 0.64 change seen in men with 50+% sperm affected (p=0.03). CONCLUSIONS Post-varicocele repair outcomes in men with sperm EM abnormalities appear to be non-inferior to those without identified abnormalities. Certainly, it will be more challenging for these men with severe asthenospermia to approach normal parameters, but this small series demonstrates that the presence of EM abnormalities should not preclude a discussion about varicocelectomy. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e464-e465 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Sarah Ferrara More articles by this author Keith Jarvi More articles by this author Jared Bieniek More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...