Preoperative semen analysis as a predictor of seminal improvement following varicocelectomy.

Objective: To determine the predictive role of preoperative semen analysis on both seminal improvement and pregnancy rates following varicocelectomy.

Design: Retrospective data analysis.

Setting: Two academic medical center infertility clinics.

Patient(s): One hundred ten consecutive patients who underwent varicocelectomies. Seminal improvement data were available for 84 patients, and pregnancy data were available for 58 patients.

Intervention(s): Stratification of patients based on preoperative total motile sperm count (TM). Varicocelectomy was performed on all patients.

Main Outcome Measure(s): TMs, pregnancy rates, and conception techniques following varicocelectomy of each preoperative group.

Result(s): Men with mild to moderate oligoasthenospermia (TM >5 million) had significantly better seminal improvement following varicocelectomy. While preoperative stratification showed no difference in pregnancy rates (when assisted reproductive techniques were included), men who achieved a postoperative TM >20 million were more likely to achieve conception by less invasive techniques (natural and intrauterine insemination vs. in vitro fertilization [IVF]).

Conclusion(s): Varicocelectomy may be the most cost-effective initial intervention in males with TM >5 million. Patients with TM <5 million and concomitant female factor infertility may be better initial candidates for IVF.