Varicocelectomy May Improve Results for Sperm Retrieval and Pregnancy Rate in Non-Obstructive Azoospermic Men.

Background: Assessing the net-results of microsurgical varicocelectomy in infertile men with non-obstructive azoospermic (NOA) and clinical varicocele in five years at Royan Institute.

Materials and Methods: This is a descriptive retrospective cohort study. A backward-looking review of patients treated for NOA and varicocele from march 2011 to march 2016 was performed. In addition, MDTESE results of 57 patients with NOA and clinical varicocele, with 537 NOA patients without varicocele were compared.

Results: Of 57 patients who underwent varicocelectomy, eight patients (14%) had sperm on sperm analysis post-operatively. One of the eight patients was single, and one of them had spontaneous pregnancy (1/7) 14%, and one had a child by microinjection (1/7) 14%. Out of these 8 patients, 6 had hypospermatogenesis pathology. Of 38 patients who underwent MDTESE, 14 patients (36%) had sperm on their testis tissues, but one of them had no egg fertilization. Therefore, the fertilization rate was (92%). Of the remaining 13 patients, 3 had live child birth (3/13) 23%. Sperm retrieval rate (SRR) in NOA men without clinical varicocele was lower from those who had varicocele and NOA (22 vs. 36%). Also live birth rate in NOA men with varicocelectomy was higher than NOA men without varicocele (23 vs. 11%).

Conclusion: Microsurgical varicocelectomy in NOA men may have positive effects on post-operative sperm in ejaculate and natural or assisted pregnancies, but it seems that the effect is more significant on MDTESE results and following successful microinjection. Meanwhile, SRR and live birth rate was higher in our patients compare to NOA men without clinical varicocele.