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Alves and Oliveira
332 Rev Assoc Med Bras 2017; 63(4):332-335
ORIGINAL ARTICLE
Should azoospermic patients with varicocele disease undergo
surgery to recover fertility?
Leonardo de Souza Alves 1*, Francisco Batista de Oliveira2
1MD, Urologist, Faculdade de Ciências Médicas de Minas Gerais (FCM-MG). Director of Procriar – Instituto de Urologia e Andrologia. Full Member of the Sociedade Brasileira de Urologia (SBU), the American Urological
Association (AUA), and the American Confederation of Urology (CAU). Full Member of the Colégio Brasileiro de Cirurgiões (CBC), Belo Horizonte, MG, Brazil
2MD, Gynecologist, Endocrinologist, FCM-MG, Belo Horizonte, MG, Brazil
Summary
Study conducted at Procriar –
Instituto de Urologia e Andrologia,
Belo Horizonte, MG, Brazil
Article received: 8/18/2016
Accepted for publication: 10/19/2016
*Correspondence:
Address: Rua da Bahia, 2.696,
sala 1.303
Belo Horizonte, MG – Brazil
Postal code: 30160-012
Introduction: Varicocele disease is well-known cause of infertility in men. The
presence of spermatic varices veins create a hostile environment to spermatogenesis.
It results in reduced quality of the spermproduction and in some cases can determine
a total absence of sperm. The varicocelectomy procedure in patients with non-
obstructive azoospermia (NOA) can raise the rates of sperm in the semen analysis.
A positive rate for sperm, even if very low, may be sufficient to enable the capture
of sperm intended for in-vitro fertilization without the use of donor sperm.
Objetive: To evaluate the raise of sperm in NOA patients with varicocele disease
who were submitted to a bilateral procedure to recovery sperm production.
Method: We analized the sperm results of 25 NOA patients who undergone to
a bilateral varicocelectomy procedure.
Results: From a total of 25 patients, three (12%) recovered sperm count four
months after procedure. One year after the procedure, five (20%) patients reco-
vered sperm production.
Conclusion: Patients with varicocele disease and azoospermia, without genetic
changes or obstruction of the spermatic tract, should undergo surgical procedure
to recover sperm.
Keywords: azoospermia, infertility, varicocele, surgery.
Introduction
Should azoospermic patients with varicocele be operated?
In cases of marital male infertility evaluation, absence
of sperm on a sperm test is often a frustrating and de-
vastating result for the couple. The azoospermic “couple”
is referred to an assisted reproductive program many
times already condemned to resort to the use of a sperm
donor. However, something else can be offered to these
patients. An etiological diagnosis should be performed
and, depending on the cause, treatment options can be
offered. The diagnosis of varicocele disease in an azoos-
permic patient justifies the ressection of espermatic veins
to improve spermatogenesis.
Objective
To evaluate patients with non-obstructive azoospermia
(NOA) and varicocele undergoing bilateral surgical cor-
rection for recovery of sperm production.
Method
In a retrospective study conducted from 2002 to 2015 at a
private urologic service, we analyzed 25 patients with com-
bined varicocele and azoospermia (the inclusion criteria).
The patients had two consecutives sperm samples showing
absence of sperm cells, collected within an interval of 3 to
5 days. The semen volume should be greater than 3 mL in
the studied group. Physical examination identified presen-
ce of vas deferens and uni or bilateral varicocele. The results
of laboratory tests of FSH, LH, total testosterone and fruc-
tose were within the normal range. All selected patients
underwent karyotyping and Y-chromosome microdeletion
analysis. All 25 patients underwent bilateral surgical repair
of varicocele. Sub-inguinal approach assisted by loupe
magnification was performed by the surgical team. They
all received the pre-surgical guidelines and signed an in-
formed consent form. Patients were discharged from the
hospital on the same day as the surgical procedure. The