BJU international · 2025
Impact of microsurgical varicocelectomy on sperm capacitation and birth outcomes.
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Kuchakulla Manish, Gurayah Aaron A, Marinaro Jessica A, Brant Aaron, Gaffney Christopher D, Xie Philip, Punjani Nahid, Kang Caroline, Gal Jonathan, Palermo Gianpiero D, Kashanian James A
Аннотация
OBJECTIVE: To assess the impact of microsurgical subinguinal varicocelectomy on sperm capacitation, semen parameters, pregnancy rates, and live birth outcomes in men with clinical varicoceles.
PATIENTS AND METHODS: We retrospectively reviewed 260 consecutive men with clinical varicoceles who underwent a microsurgical subinguinal varicocelectomy procedure by a single surgeon from January 2019 to March 2024. Of these, 46 men had pre- and postoperative semen analyses and sperm capacitation tests. The primary outcome measure was change in the sperm capacitation score (Cap-Score™; Androvia LifeSciences, Mountainside, NJ, USA). Secondary outcome measures included change in semen parameters, change in probability of generating a pregnancy (PGP), pregnancy rates, and live birth rates.
RESULTS: Among all 46 patients, there was an improvement in median sperm concentration (21.9 vs 30.0 million/mL; P < 0.01), mean total motile sperm count (TMSC; 33.9 vs 49.5 million; P = 0.04), mean sperm capacitation as measured by Cap-Score (23.6% vs 27.7%; P < 0.01), and mean PGP (27.4% vs 34%; P < 0.01) after varicocelectomy. Of the 33 couples trying to conceive, 24 (72.7%) achieved a live birth or ongoing clinical pregnancy after varicocelectomy; however, 13 of these 24 couples (54.1%) utilised in vitro fertilisation. A normal postoperative sperm concentration and Cap-Score were associated with a 60% chance of achieving pregnancy via natural conception or intrauterine insemination (IUI).
CONCLUSION: Significant improvements in sperm concentration, TMSC, Cap-Score, and PGP were observed at 3 months after surgery. Patients with a normal post-varicocelectomy Cap-Score and semen concentration had the highest probability of conception naturally or through IUI.
PATIENTS AND METHODS: We retrospectively reviewed 260 consecutive men with clinical varicoceles who underwent a microsurgical subinguinal varicocelectomy procedure by a single surgeon from January 2019 to March 2024. Of these, 46 men had pre- and postoperative semen analyses and sperm capacitation tests. The primary outcome measure was change in the sperm capacitation score (Cap-Score™; Androvia LifeSciences, Mountainside, NJ, USA). Secondary outcome measures included change in semen parameters, change in probability of generating a pregnancy (PGP), pregnancy rates, and live birth rates.
RESULTS: Among all 46 patients, there was an improvement in median sperm concentration (21.9 vs 30.0 million/mL; P < 0.01), mean total motile sperm count (TMSC; 33.9 vs 49.5 million; P = 0.04), mean sperm capacitation as measured by Cap-Score (23.6% vs 27.7%; P < 0.01), and mean PGP (27.4% vs 34%; P < 0.01) after varicocelectomy. Of the 33 couples trying to conceive, 24 (72.7%) achieved a live birth or ongoing clinical pregnancy after varicocelectomy; however, 13 of these 24 couples (54.1%) utilised in vitro fertilisation. A normal postoperative sperm concentration and Cap-Score were associated with a 60% chance of achieving pregnancy via natural conception or intrauterine insemination (IUI).
CONCLUSION: Significant improvements in sperm concentration, TMSC, Cap-Score, and PGP were observed at 3 months after surgery. Patients with a normal post-varicocelectomy Cap-Score and semen concentration had the highest probability of conception naturally or through IUI.