Time to improvement in semen parameters after microsurgical varicocelectomy in men with severe oligospermia

We aimed to determine the time and predictive factors of semen quality improvement in men with severe oligospermia after microsurgical varicocelectomy.

Men with total motile sperm count (TMSC) <5 million on two semen analyses were identified from May 2015 to August 2017. Postoperative semen analysis was collected at 3-6 months and >6 months. We evaluated preoperative factors for successful semen quality upgrading based on assisted reproductive technology (ART) eligibility: in vitro fertilization [IVF] (<5 million), intrauterine insemination (IUI) (5-9 million), and natural pregnancy (>9 million). We compared men with TMSC <5 million to those with TMSC 5-9 million. Data are reported as means and standard error of the mean (SEM). Pregnancy data was collected by phone interview at >6 months postoperatively RESULTS: A total of 33 men were included. TMSC improved from 1.5±0.2 to 7.3±1.8 million at 3-6 months (p<0.05) and 12.2±3.6 million at >6 months (p<0.05). There was no statistical difference in TMSC between 3-6 months and >6 months. Sixteen (48.5%) men upgraded semen quality into the range of natural pregnancy. Preoperative TMSC from 2-5 million was predictive of upgrading semen quality. Twenty-four couples were contacted by phone; 20 were attempting pregnancy in the postoperative period and five (25%) of them had achieved natural pregnancy.

Men with TMSC <5 million can expect the largest improvement in TMSC from 3-6 months postoperatively with minimal improvement thereafter. Preoperative TMSC >2 million was most predictive of semen quality upgrading.