Presentation Authors: Graham Machen*, Pranav Dadhich, Jay Sandlow, Milwaukee, WI
Introduction: The association of varix ligation improving semen parameters in subfertile men is well established. However, it remains difficult to identify which men will benefit the most from intervention. We set out to characterize the impact of varicocele grade on post-procedural semen parameters, with the hypothesis that the repair of larger varicoceles would be associated with an increased improvement.
Methods: A comprehensive review of literature was performed by systematically searching Pubmed, Ovid/MEDLINE, Scopus, and Google Scholar through Sept 30 2018 to identify studies reporting a change in semen parameters for men undergoing varicocele ligation. A study was included if it reported changes in sperm concentration for varicocele grades I-III. Studies were restricted to adult populations (age greater than 18), and were excluded if either baseline or follow up semen analyses were omitted. Sperm concentration (million/mL) were utilized, as this was the most common means of reporting post op improvement. Sperm motility and morphology were excluded due to substantial variability in reporting.
Results: A total of 13 studies involving 1087 men met criteria for inclusion and were used to calculate weighted means and standard deviation for pre- and post-operative semen analyses. Two studies were randomized while the remaining were retrospective cohort analyses. See table 1 for summary of results.
Conclusions: Men with all grades of varicocele demonstrated a statistically significant increase in sperm concentration after surgery. Furthermore, the change between pre- and post- procedural sperm concentrations increased as the grade of varicocele increased, with patients with grade III varicoceles experiencing the greatest benefit from surgery. While these findings are provocative, there was marked heterogeneity among the reviewed studies, and further analysis is needed.