PERCUTANEOUS RETROGRADE VARICOCELE EMBOLIZATION IN INFERTILITY WITH SEMINAL AND HORMONAL EVALUATION
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Background: Varicocele develops as a result of dilatation and tortousity of pampiniform plexus of veins. Varicocele is considered to be a potential cause of infertility; it can be treated by percutaneous retrograde embolization of the internal spermatic vein in order to improve sperm parameters and male fertility. Objective: To evaluate the effect of internal spermatic vein (ISV) embolization on spermatogenesis and serum testosterone, free testosterone, leutinizing hormone (LI I) and follicular stimulating hormone (FSH). patients and methods: This study included (112) infertile men treated for varicocele by percutaneous retrograde varicocele embolization of the internal spermatic vein, 103 of them had left varicocele while 9 had bilateral varicocele They were reviewed after six months of embolization for the degree of improvement of varicocele by Doppler, changes in the semen parameters, serum testosterone, free testosterone, LH and FSH. Results: Follow up of the patients after six months of embolization revealed complete resolution of varicocele in 77.1% and an improvement in 15.3% and no improvement in 7.6% (p<0.001). In 103 patients mean sperm concentration increased from 22.1+ 1.9 million/m1 to 26+ 2.1 million/m1 (p<0.001); mean sperm motility increased from 33.32+ 2 % to 40.5 4- 2.2% (p<0.001) and mean sperm morphology increased from 33.9+2.3 % to 58.2+2.1% (p<0.001). Mean serum testosterone concentration rose after embolization from 12.07+ 6.07 nmo1/1 to 17.22 + 8.43 nino1/1 (p<0.001).Mean serum free testosterone concentration increased from 10.93+2.44 pg/ml to 20.21+7.7.69 pg/ml (p<0.001 ).No significant differences were noted in mean serum LH (3.1+0.5 mIU/m1 before and 2.9+ 0.6 mIU/m1 post embolization) and serum FSH (4.8+1.0 mILI/m1 before and 4.3+0.8 after embolization) Conclusion: ISV embolization is well tolerated technique, apparently induces an improvement in semen parameters, and an increase in both serum testosterone and free testosterone in infertile patients with varicocele. Key words: Embolization, varicocele, testosterone, infertility, internal spermatic vein.