Factors predicting paternity after varicocele surgery
Aziz, WA1; Rafi, A1; Ali, M2; Biyabani, R1
1: Aga Khan University Hospital, Pakistan; 2: The Indus Hospital, Pakistan
Objective: To determine whether semen parameters improve after varicocele ligation in patients presenting with clinical varicocele and to identify factors predicting paternity after varicocele ligation.
Materials and methods: Patients undergoing varicocele ligation for infertility during last 1years at our institute were included. Patients undergoing varicocele ligation for pain, those with subclinical varicocele, or normal preoperative semen parameters were excluded. Paternity after varicocele repair was identified by telephonic follow up. Data was analyzed using SPSS version 19. Mean improvement in semen parameters after varicocelectomy was compared using paired sample t-test. Logistic regression analysis was used to identify factors correlating with paternity.
Results: We identified 195 patients, 77 patients were included in analysis after exclusion. Median age was 32 years (S.D ± 8.157). Patient presented after a mean duration of 3.18years (S.D± 2.372) since marriage. The mean size of varicocele on Doppler ultrasound was 3.97mm (S.D± 0.65). Varicocelectomy was performed by Microscopic subinguinal approach in 51(66.27%), Open inguinal approach in 7 (9.1%) and Laparoscopic approach in 19(24.7%) patients. Patients were followed with Semen analysis postoperatively with mean duration of follow up of 5.35 months (S.D1.841). Overall 19 patients (24.7%) reported paternity on telephonic interview whereas 58 (75.3%) reported no paternity. Preoperative and postoperative semen parameters were compared using paired sample t test which indicated that postoperative count, morphology and rapid linear progression were significantly improved when compared to corresponding preoperative values (all p=0.00). Whereas difference in preoperative motility (mean=36.74, S.D=16.877) and postoperative motility (mean=37.78, S.D=15.696) was not statistically significant (t= -.546, p=.587). Binary logistic regression analysis suggested that smoking is a significant factor predicting paternity.
Conclusion: Semen parameters improve after varicocelectomy in patients having clinical varicocele and subnormal semen parameters. Smokers have a lower probability of achieving paternity after varicocele surgery. This data is useful in counselling patients preoperatively for varicocelectomy and also highlights the correlation of smoking and infertility.
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