AB128. The impact of hormonal factors on sperm motility improvement after subinguinal microsurgical varicocele

Objective: For infertile patients with varicoceles, subinguinal microsurgical varicocele repair is well-documented to improve sperm quality. However, not all men with varicoceles are necessary for surgical repair; neither every patient may benefit from this operation. Men with varicoceles but normal semen parameters may still have normal hormonal profile, but men with varicoceles and OAT syndrome may present with abnormal hormones. In our previous study, for patient with idiopathic and varicocele-related OAT syndrome, several hormonal factors are correlated with semen parameters. The purpose of this study is to see if these factors may still associate semen parameters improvements after the subinguinal microsurgical repair for patients with varicoceles and OAT syndrome.

Methods: From 2003 to 2014, totally 155 non-azoospermic infertile males had received subinguinal microsurgical varicocele repair in our hospital. They were assessed with semen parameters and serum hormone profiles pre- and 3-month post-operatively. Semen parameters included sperm concentration, percentage of motile sperm and normal form. Hormonal analyses included follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T), estrodiol (E2), prolactin (Prl), and their combinative ratios including T/E, T/FSH, T/LH, T/(FSH×LH), Prl×T/FSH, Prl×T/LH, Prl×T/(FSH×LH), and Prl×T. Each factor and parameter was divided into increasing or non-increasing group. The correlation between changes of each hormonal combinative profile and improving semen parameter was also calculated respectively with paired t-test and Chi-square test.

Results: In the included 154 infertile males with varicoceles, 90 (58.1%) were of left side varicocele, 63 (40.6%) were of bilateral, and 2 (1.3%) was of right side only. All patients were presented with abnormality in at least one of the three semen parameters (OAT syndrome). After the surgery, sperm concentration and sperm motility were increased significantly (P=0.015 and <0.001 respectively). Hormonal change was noted by increase in T, E2, Prl and decrease in FSH, LH after the surgery. Only changes on T (P=0.046), Prl (P=0.007), Prl×T/FSH (P=0.002), Prl×T/LH (P<0.001), and Prl×T (P<0.001) reached statistical significance. The increase of percentage of motile sperm was significantly correlated with positive change on T (P=0.041), Prl (P=0.046), T/(FSH×LH) (P=0.042), Prl×T/FSH (P=0.001), Prl×T/LH (P=0.007), Prl×T/(FSH×LH) (P=0.011), and Prl×T (P=0.004). Among them, the change of Prl×T/FSH could predict a most significantly increase in sperm motility after the surgery.

Conclusions: In our non-azoospermic varicocele-bearing infertile men receiving subinguinal microsurgical varicocele repair, their sperm count and motility improved after the operation. For the most significantly increased semen parameters, which are motility, several hormonal profiles were associated. Among them, increase of Prl×T/FSH was the most significant correlative factor to sperm motility improvement after the surgery. This result gives us another picture for the role of hormones on patients with varicoceles and OAT syndrome.

Keywords: Varicocele; OAT syndrome; male infertility; hormone