P-6: Pregnancy Rate after Varicocelectomy:Long-Term Outcome in A Large Number of Varicocele Individuals

Background: Varicocele is commonly existed among infertile men and causes testis damage. Disorder of spermatogenesis was observed in varicocele individuals and leads to low quality sperm parameters and chromatin damage. Chromatin damage plays a critical role in pregnancy outcomes through in vitro or in vivo fertilization. Varicocelectomy considered as standard treatment of clinical varicocele. Improving pregnancy outcomes following varicocelectomy is under debate. Therefore, the aim of this study was to evaluate of sperm quality and pregnancy outcome after varicocelectomy in large population. Materials and Methods: Microsurgical varicocelectomy was performed as part of patient management on 145 infertile men with grade II or III varicocele. Sperm parameters (concentration, motility and morphology) was assessed according to World Health Organization (WHO, 2012) criteria and protamine content was evaluated with chromomycin A3 (CMA3) staining. In addition, spontaneous clinical pregnancy and miscarriage rates were evaluated over 12 months after surgery. Results: Varicocele individuals (N=145) were divided into two groups based on pregnancy outcomes after varicocelectomy. One group included partners of 81 individuals whom became pregnant (pregnant group), while the other group included individuals whom partner did not became pregnant (non-pregnant group). In both groups, semen parameters and chromatin packaging significantly improve after varicocelectomy. The percentages of spontaneous cumulative pregnancies post-surgery were 33.1% (3 months), 42.06% (6 months), 46.2% (9 months), 48.9% (12 months), and 55.8% (after 12 months). Percentages of spontaneous cumulative miscarriage post-surgery also were 2.46% (3 months), 4.93%(6 months), 4.93% (9 months), 6.17% (12 months), and 6.17 % (after 12 months). Conclusion: Varicocelectomy can improve semen quality and chromatin integrity in varicocele individuals but the differential factors between the individuals whose partners became pregnant in comparison to those that did not achieved pregnancy remains to be determined. Also these data sugget that if spontaneous pregnancy is not achieved within 6 12 month following surgery, assisted reproductive techniques (ART) are strongly recommended.