Response to varicocelectomy in oligospermic men with and without defined genetic infertility

To compare the clinical characteristics of infertile men who have varicocele with and without a genetic anomaly, and report the results of varicocelectomy in these two cohorts of men.

Study subjects included 33 men who underwent genetic counseling and testing for a diagnosis of oligospermia with varicocele. Seven men were diagnosed with coexisting genetic infertility (genetic [+]; abnormal karyotype in 4, Y chromosome microdeletion in 3), and 26 men with varicocele and no genetic abnormality (genetic [-]). Five patients (Y chromosome microdeletions in 2, abnormal karyotype in 3) in the genetic (+) group and 14 patients in the genetic (-) group underwent microsurgical subinguinal varicocelectomy. Semen and hormonal parameters, physical examination findings, as well as the response to varicocele repair were compared between the two groups. Varicocele response was defined as a 50% increase in total motile sperm count in the ejaculate.

Mean preoperative seminal and hormonal parameters were not statistically significantly different between the two groups. Significant differences were observed in the volume of the right and left testicles between the two groups (left: P = 0.007; right: P = 0.04). Although 7 of 13 evaluable patients (54%) in the genetic (-) group had a seminal response to varicocelectomy, none of 5 patients in the genetic (+) group showed improvement in semen quality.

From this early experience, men with varicocele and genetic lesions appear to have a poorer response to varicocele repair than men without coexisting genetic lesions. These data may have implications for counseling male factor infertility patients contemplating varicocele treatment.