Comparison of the Pre- and Post- Varicocoelectomy Serum reproductive Hormone Profiles and Semen Character istics in Infertile Men with Clinical Varicocoeles.

Abstract

Background: To evaluate the early outcome of varicocoelectomy on the levels of serum reproductive hormonal and semen parameters in infertile men with clinical varicocoele. Patients and methods: Forty- five(45) men with infertility and clinical varicocoele had serum levels of Follicle stimulating hormone(FSH), Luitenizing hormone(LH), Prolactin and total Testosterone and seminal fluid parameters measured preoperatively at recruitment time and 3 and 6 months post-varicocoelectomy. Results: The patients' mean age was 34.6 ± 3.1 years (range 29-40 years). Most of the patients, 37 (82.2%) had primary infertility. 33 (73.3%) men had bilateral varicocoele. Although the reproductive hormone parameters were all within normal limits, the testosterone levels increased from mean of 4.85 ± 1.6 ng/mL to 5.66 ± 1.8 ng/mL (P<0.001). A significant increase in the testosterone level was found in males with low normal testosterone level (<4ng/ml), from 3.34 ± 0.5 ng/mL to 4.55 ± 1.4 ng/mL (P< 0.001). There was a significant decrease in serum FSH post-varicocoelectomy (p<0.001). The sperm concentration, total sperm count and progressive motility all showed significant increases at 6 months (p<0.001 respectively). The pre-operative varicocoele laterality or grade did not affect changes in serum reproductive hormone parameters and changes in semen characteristics. Conclusion: Open varicocoelectomy significantly increases the serum testosterone. There is a favorable response on testosterone production in those with low normal testosterone with a mean total testicular volume of 26.6ml. It also improves the semen characteristics and these improvements are not influenced by the preoperative varicocoele grade or laterality.