Андрология и генитальная хирургия (Jan 2018)
Varicocele and non-obstructive azoospermia – where to start?
Abstract
Background. Male etiology is responsible for nearly half of cases of infertility. Frequency of azoospermia in infertile men reaches 30 %; varicocele is diagnosed in almost 40 % of the patients. Varicocele- associated infertility has traditionally been considered an indication for surgical treatment. At the same time, the main method of sperm retrieval in azoospermia is testicular biopsy (testicular sperm extraction, TESE).Objective: to assess the efficacy of surgical treatment in patients with non-obstructive azoospermia (NOA) and varicocele.Materials and methods. The study included 327 patients with NOA and varicocele aged between 22 and 48 years treated in the Department of Andrology and Urology at the V. I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology in 2012– 2016. Study participants were divided into two comparable groups. Patients in the first group underwent microsurgical varicocelectomy (Marmara procedure) on the first stage and testicular biopsy (micro-TESE) on the second stage. Patients in the second group underwent micro-TESE with no surgical correction of varicocele prior to it.Results. In the first group, the appearance of spermatozoa in ejaculate was observed in 84 (44.4 %) patients 6 month post microsurgical varicocelectomy. Upon micro-TESE, spermatozoa suitable for use in assisted reproductive technologies were obtained in 60 (56.7 %) men. Treatment was effective in 144 (76.2 %) patients from the first group. In the second group, spermatozoa were retrieved in 66 (47.8 %) men upon micro-TESE.Conclusion. Microsurgical varicocelectomy increases treatment efficacy in males with NOA and varicocele. In the absence of severe degeneration of the seminiferous epithelium, 72.6 % of patients had the opportunity of becoming a genetic parent, avoiding in some cases testicular biopsy.
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