Professional Documents
Culture Documents
Induction of Spermatogenesis in Azoospermic Men After Varicocele Repair
Induction of Spermatogenesis in Azoospermic Men After Varicocele Repair
Hasan Farsi
K.A. University Hospital
King Faisal Specialist
Hospital
Jeddah
Case Report
26y male with 1ry infertility of 3y.
Examination: Bilateral normal testes, Bilateral grade
II varicocele.
Semen x2 Azooepermia, Volume 2-3cc, normal
semen fructose
FSH was normal.
Bilateral inguinal varicocelectomy, testicular biopsy:
– Hypospermatogenisis
18 months later one child
Semen:
– Volume: 1.5 cc
– Conc.: 3 m/cc
– Motility: 25%
Varicocele
68 infertile men
Seminal plasma levels of two ROS and six antioxidants on the
day prior to varicocelectomy
Same parameters were measured again 3 and 6 months post-
operatively.
concluded that varicocelectomy reduces ROS levels and
increases antioxidant activity of seminal plasma from infertile
men with varicocele.
Conclusion: Varicocelectomy reduces ROS levels and
increases antioxidant activity of seminal plasma from infertile
men with varicocele.
4.3-13.3%
Consideration of sterility; subfertility in
the male
10 azoospermic patients
2 pregnancies
14 Azo sclerotherapy
– 7/14 produced sperms
Sperm con 3.1 ± 1.2 × 106/mL
Mean sperm: 2.2 ± 1.9%
mean sperm normal morphology:
7.8 ± 2.2%
2 pregnancies
Poulakis V. Asian J Androl. 2006 Sep;8(5):613-9.
Embolization of Varicocele
17 azo microsur
Spermatozoa in the ejacultae 47% (8/17)
Only 35% (6/17) of them had motile sperm
Mean time for appearance of spermatozoa in
the ejaculates was 5 months (3 to 9 months).
– 26 No defect
Same semen parameters
All had varicocelectomy
54% VS 0% improvement
CONCLUSIONS: 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.
Paternity after varicocelectomy: preoperative
sonographic parameters of success.
What are the sonographic findings that could predict the outcome of
varicocele repair in the treatment of male infertility?
107 patients with varicocele.
FSH
Histology
FSH
Germinal Aplasia
Maturation arrest at spermatocyte stage
Hypospermatogenisis
Maturation arrest at spermatid stage
….continue: predectors of success
13 Azoospermic patients
– Age
– Preoperative sex hormones
No association
– Unilaterl VS Bilateral
– Varicocele grade
subclinical in 73 patients
Clinical in 66 patients, based on palpation in
addition to ultrasonography.
Conclusion: ligation of varicoceles detected
using Doppler ultrasonography, whether
palpable or not, results in an increase in
sperm concentration and motility.
Pierik FH, Rotterdam, The Netherlands. Int J Androl. 1998 Oct;21(5):256-60.
76 underwent varicocele repair
Improvement: Clinical VS subclinical:67% VS 41%
But: Equal number were worse postoperatively and,
thus, mean sperm count was unchanged for the
group with subclinical varicocele
Conclusion: The results of our study suggest that
subclinical varicocelectomy is of questionable
benefit.
350 patients:
– Ejaculated sperm
– Epididymal
– Testicular
Adequate treatment may spare the need for TESE as preparation for ICSI in
>30% of azoospermic patients.
In men with spermatogenic failure, freshly ejaculated sperm are easier to use,
and fertilization ability in ICSI is higher with normal semen than with sperm
retrieved by TESE
Y o u
h an k
T