Subsequent impaired fertility (with or without sperm worsening) in men who had fathered children after a left varicocelectomy: A novel population?
Giorgio Cavallini1, Giovanni Beretta2, Giulio Biagiotti3, Roberto Mallus4, Carlo Maretti5, Edoardo Pescatori6, Gianni Paulis7
1 Department of Andrology, Gynepro-Medical Group, Via Tranquillo Cremona 8, 40137 Bologna, Italy
2 Department of Andrology, Centro Italiano Fertilita e Sessualita, Via Della Fortezza 6, 50129 Firenze, Italy
3 Department of Andrology, Andros-Italia, Outpatient Clinic of Perugia, Via Somaglia 10, 29121 Piacenza, Italy
4 Department of Urology, Clinica San Marco, Via XXI Aprile 7, 04100 Latina, Italy
5 Department of Andrology, Centro Medico Cirm, Outpatient Clinic of Piacenza, Via Somaglia 10, 29121 Piacenza, Italy
6 Department of Andrology, Andrological Section, Hesperia Hospital, Via Arquà 80/1, 41125 Modena, Italy
7 Department of Andrology, Complex Operative Unit of Urology, Regina Apostolorum Hospital, 00041 Albano Laziale, Rome, Italy
via Mascheraio 46, 44121 Ferrara
Objectives: The objective of this paper was to assess whether the beneficial effects of a varicocelectomy on fertility are transitory or definitive after a first fathering.
Materials and Methods: This was a retrospective study which involved seven andrological centers. The files of 2223 patients who underwent subinguinal ligation of a high grade left varicocele for (oligo)(astheno)(terato)-spermia and infertility between January 1 st , 2002 and January 1 st 2013 were reviewed. Inclusion criteria for the patients were the following: Sperm count improvement and fathering a child after an uneventful left varicocelectomy; 745 patients were considered. Patients who had undergone three assessments for (in-) fertility: Before surgery, before the first fathering and after the first fathering were included in the study. Each assessment included: Clinical history, physical examination, two sperm analyses, bilateral scrotal Duplex scans, blood hormonal levels [follicle stimulating hormone (FSH), luteinising hormone (LH), testosterone (T) and prolactin (PRL)].
Results: Forty patients were finally studied; they all had an improved sperm count and had fathered once after surgery. Fifteen had fathered twice and still had their sperm count increased after the second fathering. Twenty-five patients could not father twice; 13 patients had their sperm count decreased after the first fathering and 12 did not. A decrease in testicular volume and an increase in FSH paralleled the worsening of sperm concentration, motility and morphology after fathering. No other differences could be observed between the groups.
Conclusions: Our data indicated that the beneficial effects of a varicocelectomy might be transitory in some cases.