Abstract
Purpose
Varicocele repair in non-obstructive azoospermia (NOA) was occasionally associated to ejaculated spermatozoa independently from clinical and laboratory measures. We performed a prospective study in infertile men affected by NOA and left side varicocele to find whether or not the appearance of ejaculated spermatozoa after varicocele repair is predicted by baseline measures.
Methods
Patients with NOA and grade II, or grade III left side varicocele were submitted to hormone analysis and to scrotal color Doppler ultrasound (CDU). Azoospermia was confirmed in 23 patients aged 25–47 years who were than submitted to varicocele repair through a retrograde internal spermatic vein embolization. Patients were re-evaluated after 6 months.
Results
Six months after varicocele repair 12 patients (52.2 %) were still azoospermic (Group 1) while 11 patients (47.8 %) reported ejaculated spermatozoa (Group 2) [sperm count: 1.3 × 106/mL; 0.5 × 106/mL—1.6 × 106/mL (median 25th–75th centiles)]. Serum baseline FSH was lower in Group 2 compared to Group 1 (p = 0.012), while no differences between groups were revealed for all other clinical and laboratory parameters. ROC analysis indicated that baseline FSH level predicted the appearance of ejaculated spermatozoa after treatment [AUC = 0.811; 95 % Confidence Interval (CI) 0.6–0.9; p = 0.0029]. A cut-off level of FSH <10.06 mIU/mL identified 82.0 % of cases with ejaculated spermatozoa with a specificity of 81.8 % and a sensitivity of 83.3 %.
Conclusion
Selected patients with NOA may show ejaculated spermatozoa after a non-invasive repair of a left side varicocele, therefore avoiding testicular sperm extraction. Baseline serum FSH was a valuable predictor for ejaculated spermatozoa after treatment.
Similar content being viewed by others
References
Czaplicki M, Bablok L, Janczewski Z (1979) Varicocelectomy in patients with azoospermia. Arch Androl 3:51–55
Gorelick JI, Goldstein M (1993) Loss of fertility in men with varicocele. Fertil Steril 59:613–616
Redmon JB, Carey P, Pryor JL (2002) Varicocele–the most common cause of male factor infertility? Hum Reprod Update 8:53–58
Baazeem A, Belzile E, Ciampi A, Dohle G, Jarvi K, Salonia A, Weidner W, Zini A (2011) Varicocele and male factor infertility treatment: a new meta-analysis and review of the role of varicocele repair. Eur Urol 60:796–808
Kroese AC, de Lange NM, Collins J, Evers JL (2012) Surgery or embolization for varicoceles in subfertile men. Cochrane Database Syst Rev 10: CD000479
Weedin JW, Khera M, Lipshultz LI (2010) Varicocele repair in patients with nonobstructiveazoospermia: a meta-analysis. J Urol 183:2309–2315
Schlegel PN, Goldstein M (2011) Alternate indications for varicocele repair: non-obstructive azoospermia, pain, androgen deficiency and progressive testicular dysfunction. Fertil Steril 96:1288–1293
Inci K, Hascicek M, Kara O, Dikmen AV, Gürgan T, Ergen A (2009) Sperm retrieval and intracytoplasmic sperm injection in men with nonobstructive azoospermia, and treated and untreated varicocele. J Urol 182:1500–1505
Haydardedeoglu B, Turunc T, Kilicdag EB, Gul U, Bagis T (2010) The effect of prior varicocelectomy in patients with nonobstructive azoospermia on intracytoplasmic sperm injection outcomes: a retrospective pilot study. Urology 75:83–86
Zampieri N, Bosaro L, Costantini C, Zaffagnini S, Zampieri G (2013) Relationship between testicular sperm extraction and varicocelectomy in patients with varicocele and nonobstructive azoospermia. Urology 82:74–77
Kadioglu A, Tefekli A, Cayan S, Kandirali E, Erdemir F, Tellaloglu S (2001) Microsurgical inguinal varicocele repair in azoospermic men. Urology 57:328–333
Gat Y, Bachar GN, Everaert K, Levinger U, Gornish M (2005) Induction of spermatogenesis in azoospermic men after internal spermatic vein embolization for the treatment of varicocele. Hum Reprod 20:1013–1017
Pasqualotto FF, Sobreiro BP, Hallak J, Pasqualotto EB, Lucon AM (2006) Induction of spermatogenesis in azoospermic men after varicocelectomy repair: an update. Fertil Steril 85:635–639
Poulakis V, Ferakis N, de Vries R, Witzsch U, Becht E (2006) Induction of spermatogenesis in men with azoospermia or severe oligoteratoasthenospermia after antegrade internal spermatic vein sclerotherapy for the treatment of varicocele. Asian J Androl 8:613–619
Lee JS, Park HJ, Seo JT (2007) What is the indication of varicocelectomy in men with nonobstructiveazoospermia? Urology 69:352–355
Ishikawa T, Kondo Y, Yamaguchi K, Sakamoto Y, Fujisawa M (2007) Effect of varicocelectomy on patients with unobstructiveazoospermia and severe oligospermia. BJU Int 101:216–218
Abdel-Meguid TA (2012) Predictors of sperm recovery and azoospermia relapse in men with non-obstructive azoospermia after varicocele repair. J Urol 187:222–226
Inci K, Gunay LM (2013) The role of varicocele treatment in the management of non-obstructive azoospermia. Clinics 68(1):89–98
Matthews GJ, Matthews ED, Goldstein M (1998) Induction of spermatogenesisand achievement of pregnancy after microsurgical varicocelectomy in men with azoospermia and severe oligoasthenospermia. Fertil Steril 70:71–75
Kuroiwa T, Hasuo K, Yasumori K, Mizushima A, Yoshida K, Hirakata R, Komatsu K, Yamaguchi A, Masuda K (1991) Transcatheter embolization of testicular vein for varicocele testis. Acta Radiol 32:311–314
Diegidio P, Jhaveri JK, Ghannam S, Pinkhasov R, Shabsigh R, Fisch H (2011) Review of current varicocelectomy techniques and their outcomes. BJU Int 108:1157–1172
Dubin L, Amelar R (1971) Etiologic factors 1294 consecutive cases of male infertility. Fertil Steril 22:469–474
Practice Committee of the American Society for Reproductive Medicine in collaboration with the Society for Male Reproduction and Urology (2008) Evaluation of the azoospermic male. Fertil Steril 90:74–77
Pezzella A, Barbonetti A, Micillo A, D’Andrea S, Necozione S, Gandini L, Lenzi A, Francavilla F, Francavilla S (2013) Ultrasonographic determination of caput epididymis diameter is strongly predictive of obstruction in the genital tract in azoospermic men with normal serum FSH. Andrology 1:133–138
World Health Organization (2000) WHO Manual for the Standardized Investigation and Diagnosis of the Infertile Couple. Cambridge University Press, Cambridge
Cina A, Minnetti M, Pirronti T, Spampinato MV, Canadè A, Oliva G, Ribatti D, Bonomo L (2006) Sonographic quantitative evaluation of scrotal veins in healthy subjects: normative values and implications for the diagnosis of varicocele. Eur Urol 50:345–350
Annoni F, Colpi GM, Marincola FM, Negri L (1998) Doppler examination in varicocele: a standard method of evaluation. J Androl 9:248–252
Hanley JA, McNeil BJ (1983) A method of comparing the areas under receiver operating characteristic curves derived from the same cases. Radiology 148:839–843
Schlegel PN (2011) The role of varicocele repair in nonobstructive azoospermia must be evaluated with controlled trials rather than observational studies. Fertil Steril 95:486
Devroey P, Liu J, Nagy Z, Goossens A, Tournaye H, Camus M, Van Steirteghem A, Silber S (1995) Pregnancies after testicular sperm extraction and intracytoplasmic sperm injection in non-obstructive azoospermia. Hum Reprod 10:1457–1460
Tournaye H, Liu J, Nagy PZ, Camus M, Goossens A, Silber S, Van Steirteghem AC, Devroey P (1996) Correlation between testicular histology and outcome after intracytoplasmic sperm injection using testicular spermatozoa. Hum Reprod 11:127–132
Silber SJ, Nagy Z, Devroey P, Camus M, Van Steirteghem AC (1997) The effect of female age and ovarian reserve on pregnancy rate in male infertility: treatment of azoospermia with sperm retrieval and intracytoplasmic sperm injection. Hum Reprod 12:2693–2700
Hauser R, Botchan A, Amit A, Yosef DB, Gamzu R, Paz G, Lessing JB, Yogev L, Yavetz H (1998) Multiple testicular sampling in non-obstructive azoospermia—is it necessary? Hum Reprod 13:3081–3085
Kim ED, Leibman BB, Grinblat DM, Lipshultz LI (1999) Varicocele repair improves semen parameters in azoospermic men with spermatogenic failure. J Urol 162:737–740
Osmanagaoglu K, Vernaeve V, Kolibianakis E, Tournaye H, Camus M, Van Steirteghem A, Devroey P (2003) Cumulative delivery rates after ICSI treatment cycles with freshly retrieved testicular sperm: a 7-year follow-up study. Hum Reprod 18:1836–1840
Ishikawa T, Shiotani M, Izumi Y, Hashimoto H, Kokeguchi S, Goto S, Fujisawa M (2009) Fertilization and pregnancy using cryopreserved testicular sperm for intracytoplasmic sperm injection with azoospermia. Fertil Steril 92:174–179
Iaccarino V, Venetucci P (2012) Interventional radiology of male varicocele: current status. Cardiovasc Intervent Radiol 35:1263–1280
Aboulghar MA, Mansour RT, Serour GI, Fahmy I, Kamal A, Tawab NA, Amin YM (1997) Fertilization and pregnancy rates after ICSI using ejaculate semen and surgically retrieved sperm. Fertil Steril 68:108–111
Verheyen G, Vernaeve V, Van Landuyt L, Tournaye H, Devroey P, Van Steirteghem A (2004) Should diagnostic testicular sperm retrieval followed by cryopreservation for later ICSI be the procedure of choice for all patients with nonobstructiveazoospermia? Hum Reprod 19:2822–2830
Acknowledgments
Supported by Ministero dell’Università e Ricerca (I).
Conflict of interest
Authors declare no competing interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
D’Andrea, S., Giordano, A.V., Carducci, S. et al. Embolization of left spermatic vein in non-obstructive azoospermic men with varicocele: role of FSH to predict the appearance of ejaculated spermatozoa after treatment. J Endocrinol Invest 38, 785–790 (2015). https://doi.org/10.1007/s40618-015-0259-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40618-015-0259-x