Skip to main content
SpringerLink
Log in

Embolization of left spermatic vein in non-obstructive azoospermic men with varicocele: role of FSH to predict the appearance of ejaculated spermatozoa after treatment

  • Original Article
  • Published:
Journal of Endocrinological Investigation Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Czaplicki M, Bablok L, Janczewski Z (1979) Varicocelectomy in patients with azoospermia. Arch Androl 3:51–55

    Article  CAS  PubMed  Google Scholar 

  2. Gorelick JI, Goldstein M (1993) Loss of fertility in men with varicocele. Fertil Steril 59:613–616

    CAS  PubMed  Google Scholar 

  3. Redmon JB, Carey P, Pryor JL (2002) Varicocele–the most common cause of male factor infertility? Hum Reprod Update 8:53–58

    Article  PubMed  Google Scholar 

  4. 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

    Article  PubMed  Google Scholar 

  5. Kroese AC, de Lange NM, Collins J, Evers JL (2012) Surgery or embolization for varicoceles in subfertile men. Cochrane Database Syst Rev 10: CD000479

  6. Weedin JW, Khera M, Lipshultz LI (2010) Varicocele repair in patients with nonobstructiveazoospermia: a meta-analysis. J Urol 183:2309–2315

    Article  PubMed  Google Scholar 

  7. 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

    Article  PubMed  Google Scholar 

  8. 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

    Article  PubMed  Google Scholar 

  9. 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

    Article  PubMed  Google Scholar 

  10. 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

    Article  PubMed  Google Scholar 

  11. Kadioglu A, Tefekli A, Cayan S, Kandirali E, Erdemir F, Tellaloglu S (2001) Microsurgical inguinal varicocele repair in azoospermic men. Urology 57:328–333

    Article  CAS  PubMed  Google Scholar 

  12. 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

    Article  PubMed  Google Scholar 

  13. 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

    Article  PubMed  Google Scholar 

  14. 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

    Article  PubMed  Google Scholar 

  15. Lee JS, Park HJ, Seo JT (2007) What is the indication of varicocelectomy in men with nonobstructiveazoospermia? Urology 69:352–355

    Article  PubMed  Google Scholar 

  16. 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

    PubMed  Google Scholar 

  17. 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

    Article  PubMed  Google Scholar 

  18. Inci K, Gunay LM (2013) The role of varicocele treatment in the management of non-obstructive azoospermia. Clinics 68(1):89–98

    Article  PubMed Central  PubMed  Google Scholar 

  19. 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

    Article  CAS  PubMed  Google Scholar 

  20. 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

    Article  CAS  PubMed  Google Scholar 

  21. 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

    Article  PubMed  Google Scholar 

  22. Dubin L, Amelar R (1971) Etiologic factors 1294 consecutive cases of male infertility. Fertil Steril 22:469–474

    CAS  PubMed  Google Scholar 

  23. 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

    Google Scholar 

  24. 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

    Article  CAS  PubMed  Google Scholar 

  25. World Health Organization (2000) WHO Manual for the Standardized Investigation and Diagnosis of the Infertile Couple. Cambridge University Press, Cambridge

    Google Scholar 

  26. 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

    Article  PubMed  Google Scholar 

  27. Annoni F, Colpi GM, Marincola FM, Negri L (1998) Doppler examination in varicocele: a standard method of evaluation. J Androl 9:248–252

    Google Scholar 

  28. 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

    Article  CAS  PubMed  Google Scholar 

  29. 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

    Article  PubMed  Google Scholar 

  30. 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

    Article  CAS  PubMed  Google Scholar 

  31. 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

    Article  CAS  PubMed  Google Scholar 

  32. 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

    Article  CAS  PubMed  Google Scholar 

  33. 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

    Article  CAS  PubMed  Google Scholar 

  34. 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

    Article  CAS  PubMed  Google Scholar 

  35. 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

    Article  PubMed  Google Scholar 

  36. 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

    Article  PubMed  Google Scholar 

  37. Iaccarino V, Venetucci P (2012) Interventional radiology of male varicocele: current status. Cardiovasc Intervent Radiol 35:1263–1280

    Article  PubMed  Google Scholar 

  38. 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

    Article  CAS  PubMed  Google Scholar 

  39. 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

    Article  CAS  PubMed  Google Scholar 

Download references

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

  1. Department of Life, Health and Environment Sciences, Andrology, University of L’Aquila, Via Vetoio, 67100, L’Aquila, Italy

    S. D’Andrea, M. Costanzo, A. De Gregorio, A. Micillo, F. Francavilla, S. Francavilla & A. Barbonetti

  2. Interventional Radiology Unit, University Hospital San Salvatore, L’Aquila, Italy

    A. V. Giordano, S. Carducci & L. Sacchetti

  3. Department of Epidemiology, University of L’Aquila, L’Aquila, Italy

    S. Necozione

Authors
  1. S. D’Andrea
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. V. Giordano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Carducci
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. L. Sacchetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. Necozione
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Costanzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. A. De Gregorio
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. A. Micillo
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. F. Francavilla
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. S. Francavilla
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. A. Barbonetti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. Francavilla.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40618-015-0259-x

Keywords

Search

Navigation