The Relationship Between Post-operative Semen Parameter Changes And Time After Microsurgical Varicocelectomy

Background:Varicocele(VC)is the most common identifiable cause of male infertility,observed in up to 35% of patients with primary male infertility and 80% of secondary male infertility.The proposed mechanisms of varicocele may include: hypoxia,heat stress,increased oxidative stress,autoimmunity and reflux of adrenal catecholamines,which remains controversial.The American Society for Reproductive Medicine(ASRM)claims that patients after varicocelectomy should have at least 12 months’ of follow-up or until pregnancy to evaluate the semen parameter changes,but ASRM revised the criterion in 2014,which meaned that time to improvement in semen parameters was generally 3 to 6 months,post-operatively.However,data from China about interval required for varicocelectomy to improve semen parameters were scarce.Aim: The aim of this study was identify post-operative semen parameter changes with time factor.Methods: We monitored and followed-up 153 men who underwent microsurgical varicocele repair with 4 semen analysis tests.In addition,they were allocated into 3 groups as < 5 million,5 to 9 million,9million on the basis of original total motile sperm count [total motile sperm count(TMC)was calculated by volume(ml)concentration(millions/ml)motility(%)].Then,statistic method is applied to process the data.Results: The sperm concentration and the sperm motility significantly improved after surgery,respectively.In addition,TMCs in 3 groups at post-operative 3,6 and 12 months were significantly higher than those before varicocelectomy.However,the major increase in sperm parameters of all groups occurred at 3 months after varicocelectomy was similar to the results at 6 months and 12 months,respectively.Conclusion: Our observational findings and data suggest that microsurgical varicocelectomy could improve semen quality for men with varicocele,but no significant difference was seen about the level of improvement in TMCs at 3,6 and 12 months in group,post-operatively.Therefore,urologists should evaluate the outcomes as early as 3 months after microsurgical varicocelectomy and propose patients to use other therapies,if necessary.