Effect of varicocele repair on sperm retrieval rate and testicular histopathological patterns in men with nonobstructive azoospermia

Abstract

Varicocele adversely affects semen parameters. However, the effect of varicocele repair on the sperm retrieval rate and testicular histopathological patterns in men with nonobstructive azoospermia has not been widely reported. We retrospectively assessed the sperm retrieval rates and testicular histopathological patterns in men with nonobstructive azoospermia who were referred to the Urology Clinic in Dr. Cipto Mangunkusumo Hospital (Jakarta, Indonesia) and Bunda General Hospital (Jakarta, Indonesia) between January 2009 and December 2019. We compared patients who had undergone a surgical sperm retrieval procedure for assisted reproductive technology no earlier than three months after varicocele repair and those who had not undergone varicocele repair. The study included 104 patients (age range: 26-54 years), 42 of whom had undergone varicocele repair before the sperm retrieval procedure and 62 who had not. Motile spermatozoa were found in 29 (69.1%) and 17 (27.4%) patients who had undergone varicocele repair before the sperm retrieval procedure and those who had not undergone the repair, respectively (relative risk: 2.51; 95% confidence interval: 1.60-3.96; P < 0.001). A predicted probabilities graph showed consistently higher sperm retrieval rates for patients with varicocele repair, regardless of their follicle-stimulating hormone levels. Patients who underwent varicocele repair showed higher testicular histopathological patterns (P = 0.001). In conclusion, men with nonobstructive azoospermia and clinical varicocele who underwent varicocele repair before the sperm retrieval procedure had higher sperm retrieval rates compared to those who did not undergo varicocele repair.

Keywords: azoospermia; follicle-stimulating hormone; sperm retrieval rate; testicular histopathology; varicocele.

Figure 1

Five testicular histopathological patterns based on spermatogenesis. (a) Sertoli cell-only (A). (b) Early maturation arrest with spermatocyte cells (B). (c) Late maturation arrest with spermatids (C). (d) Hypospermatogenesis, which is marked by decreased number of normal spermatozoa (D). (e) Normal spermatogenesis (E).

Figure 2

Predicted probabilities for SRR based on FSH level between patients who did not undergo varicocele repair and patients who had varicocele repair. P < 0.001. SRR: sperm retrieval rate; FSH: follicle-stimulating hormone.