Varicocele and the Outcomes of Microdissection Testicular Sperm Extraction in Non-Obstructive Azoospermia: A Case-Control Study

Despite the advances in the management options [1-3], no adequate sperm retrieval can be achieved in a considerable proportion of non-obstructive azoospermia (NOA) patients [4]. Besides the technical improvements, optimization of the patient’s clinical status is one possible means by which the outcomes of sperm retrieval procedures could be improved. For example, lifestyle changes and habitual modifications (e.g. smoking cessation) may enhance spermatogenesis prior to extraction [5]. Hormonal optimization has also been attempted, although with varying success rates [6,7]. One possible optimization intervention is varicocele repair [8]. Varicocele is a relatively common pathology [9], found in around 5%-10% of azoospermia cases [10]. Its negative effects on fertility has been recognized [11]; a study of over 9000 men presenting to infertility clinics indicated a significant association between varicoceles and abnormal semen findings, testicular-volume parameters, as well as other parameters of testicular function [12]. Others have suggested varicocele to be age-related with a progressively detrimental effect on fertility [13]. Correcting varicocele may result in improved fertility [14,15]. In 1952, Tulloch reported the first post-varicocele-repair spontaneous pregnancy, suggesting its potential positive effect on infertility outcomes [16]. A prospective randomized clinical trial of infertile men with palpable varicocele showed higher likelihood of semen-characteristics improvement and spontaneous pregnancy in repaired vs. conservatively-treated varicoceles [17].