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. |
