Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
Hong Kong Med J. 2013 Aug;19(4):334-40. doi: 10.12809/hkmj133884. Epub 2013 May 6.
To investigate the impact of subinguinal microsurgical varicocelectomy on semen parameters and pregnancy outcomes in couples with male factor subfertility.
Case series.
Male Infertility Clinic in an academic institution in Hong Kong.
The clinical records of 42 consecutive subfertile male patients who had subinguinal microsurgical varicocelectomy (from January 2000 to December 2009) were retrospectively reviewed. All the patients had a known history of subfertility and abnormalities in one or more semen parameters. Female subfertility factors were not addressed. Only grade 2 or higher clinically palpable varicoceles were operated on.
Preoperative and postoperative semen analyses based on the World Health Organization criteria; the outcome measures included changes in semen parameters and whether a pregnancy ensued.
The mean age of patients and their spouses were 38 and 33 years, respectively. The mean duration of infertility was 4 years; 37 patients had primary infertility and five had secondary infertility. The mean (± standard deviation) sperm concentration improved from 12 ± 19 million/mL to 23 ± 29 million/mL following varicocelectomy (P<0.001), the mean sperm motility improved from 26% ± 16% to 32% ± 18% (P<0.001), and the mean normal morphology increased from 5% ± 7% to 6% ± 6% (P<0.001). Postoperatively, 23 (55%) of the patients achieved pregnancy, 11 (26%) being spontaneous, 1 (2%) by intrauterine insemination, and 11 (26%) by in-vitro fertilisation. Among 20 patients with severe preoperative oligospermia (<5 million/mL), statistically significant improvements occurred in postoperative mean sperm concentration, motility and morphology (all P<0.001), and five (25%) of them achieved a spontaneous pregnancy. There was one intra-operative injury to the testicular artery with immediate repair and no testicular atrophy. Five (12%) of the patients had recurrences. No preoperative factors appeared predictive of a pregnancy ensuing.
In couples with male infertility due to varicoceles, subinguinal microsurgical varicocelectomy was shown to improve sperm concentrations, motility and morphology, and the likelihood of a pregnancy. Spontaneous pregnancy was achieved in 25% of the couples in which the man had severe oligospermia.
研究精索内显微外科精索静脉曲张手术对男性因素不育夫妇精液参数和妊娠结局的影响。
病例系列。
香港某学术机构男性不育诊所。
回顾性分析 2000 年 1 月至 2009 年 12 月期间 42 例连续精索静脉曲张不育男性患者的临床记录。所有患者均有已知的不育病史和一项或多项精液参数异常。女性不育因素未予处理。仅对 2 级或以上可触及的临床精索静脉曲张进行手术。
基于世界卫生组织标准的术前和术后精液分析；观察指标包括精液参数的变化和妊娠情况。
患者及其配偶的平均年龄分别为 38 岁和 33 岁。不孕的平均持续时间为 4 年；37 例为原发性不孕，5 例为继发性不孕。精索静脉曲张手术后，精子浓度从 12±19 百万/ml 平均提高到 23±29 百万/ml（P<0.001），精子活力从 26%±16%平均提高到 32%±18%（P<0.001），正常形态率从 5%±7%平均提高到 6%±6%（P<0.001）。术后 23 例（55%）患者妊娠，11 例（26%）为自然妊娠，1 例（2%）为宫腔内人工授精，11 例（26%）为体外受精。在 20 例术前严重少精子症（<500 万/ml）患者中，术后平均精子浓度、活力和形态均有统计学显著改善（均 P<0.001），其中 5 例（25%）自然妊娠。术中睾丸动脉损伤 1 例，立即修复，无睾丸萎缩。5 例（12%）患者复发。术前无任何因素预测妊娠。
对于精索静脉曲张导致男性不育的夫妇，精索内显微外科精索静脉曲张手术可提高精子浓度、活力和形态，提高妊娠率。在精子严重少精症的夫妇中，有 25%自然妊娠。
