Background: Varicocele repair is often suggested to improve reproductive outcomes, but there is no clear indications on which subjects are more likely to benefit from treatment. We assessed spermatogenetic and endocrine function of the testis in a population of young subjects with a 12-month follow-up following percutaneous treatment.
Methods: We retrospectively reviewed data from 77 young patients (mean age 23.3 years, range 1835) followed in our center for treatment of isolated left varicocele and with no other condition possibly affecting testicular development, such as cryptorchidism, orchitis, testicular tumors and chromosomal aberrations. Varicocele recurrence was also considered as an exclusion criterion. Statistical analysis was performed with robust linear mixed effects regression models, with each subject acting as his own control. Spermatogenetic function was assessed by semen analysis following the WHO guidelines. Endocrine assessment included serum FSH, LH, inhibin B, total testosterone and estradiol.
Results: 19/77 subjects (24.7%) had left testicular hypotrophy (LTH, >20% difference between left and right testicular volume). Treatment significantly improved sperm progressive motility during follow-up in subjects with pre-treatment LTH (β=7.46±2.27, P=0.007), independently of testicular volume increase. A significant negative effect of pre-treatment varicocele grade was observed for sperm morphology at the end of follow-up for both grade 3 (β=−3.72±1.6, P=0.024) and 4 (−3.64±1.82, P=0.035). No significant effects were observed for sperm concentration (both total and per ml), even after adjusting for LTH and varicocele grade. A significant increase in serum Inhibin B was observed during follow-up, and we observed a statistically significant effect of the change of FSH on serum inhibin B levels (β=34.2±11.75, P=0.008).
Conclusions: Treatment of isolated left varicocele is associated with minor improvements in sperm parameters, but the clinical relevance of these findings is still debated. In regards to endocrine function of the affected testis, we observed a significant increase in inhibin B levels according to changes in FSH levels, suggesting that Inhibin B production by Sertoli cells is stimulated by FSH during follow-up.
18 - 21 May 2019
European Society of Endocrinology