ارزش آناليز مني قبل از جراحي واريكوسلكتومي در پيش بيني بهبودي آن بعد از جراحي در موارد ناباروري هاي همراه با واريكوسل

Preoperative Semen Analysis As a Predictor of Seminal Improvement Following Varicocelectomy In Varicocele Associated Male Factor Infertility

The goal of infertile male management is to improve the quality of semen sufficiently to allow the couple to conceive with the least invasive and the most economical method. Varicocele is the most common treatable cause of male factor infertility and its deleterious effects such as oligoasthenospermia, are likely multifactorial. Thus, with presence of varicocele in male partner of an infertile couple, surgical repair as the current standard of care is offered. It is hoped that varicocelectomy will allow the infertile patient with a clinical varicocele not only to improve the likelihood of pregnancy through natural conception, but also increase the chance of conception with a less invasive and less costly technique. However, it has been suggested that the serious oligoasthenospermic patient may not benefit from varicocelectomy substantially. In this study, from 330 patients with varicocele associated male factor infertility who underwent varicocelectomy during 92 months, 252 patients were included because their postoperative and preoperative seminal parameters were available. Preoperatively, the patients were divided into three groups, based on their preoperative total Motile Count (TM). Patient with TM >20 million (mild oligoasthenospermia) was defined as Group A, with TM, between 5 million and 20 million (moderate oligoasthenospermia) as group B, and TM<5 million (severe oligoasthenospermia) as group C. Postoperative dividing of patients was done based on postoperative TM. Retrospective data analysis has been suggested that men with mild to moderate oligoasthenospermia (TM>5 million) had significantly better seminal improvement following varicocelectomy. While preoperative dividing showed no difference in pregnancy rates. Men who achieved a postoperative TM>20 million were more likely to achieve conception by less invasive techniques. Varicocelectomy may be the most cost-effective initial intervention in infertile males with varicocele with preparative TM>5 million. Patients with preoperative TM<5 million and concomitant female factor infertility may be better initial candidates for IVF/ICSI.