Dubin Justin M, Greer Aubrey B, Kohn Taylor P, Masterson Thomas A, Ji Lunan, Ramasamy Ranjith
Department of Urology, University of Miami, Miami, FL.
Baylor College of Medicine, Houston, TX.
Urology. 2018 Jan;111:99-103. doi: 10.1016/j.urology.2017.10.010. Epub 2017 Oct 16.
To evaluate the outcomes of men who underwent varicocelectomy for total motile sperm count (TMSC) <2 million and to perform a cost-effectiveness analysis of intrauterine insemination (IUI) and in vitro fertilization with intracyctoplasmic sperm injection after varicocelectomy.
We prospectively collected data of men with TMSC <2 million who underwent microsurgical subinguinal varicocelectomy. Men with azoospermia were excluded. Serum testosterone, luteinizing hormone, and follicle-stimulating hormone were measured preoperatively. Postoperative semen analysis was collected first at 3 months and then every 3 months thereafter. Cost-effectiveness for assisted reproductive technologies was calculated using reported costs.
A total of 17 men underwent varicocele repair for TMSC <2 million. The mean sperm concentration, motility, and TMSC was 1.1 ± 1.4 million/mL, 15.5% ± 12.8%, and 0.44 ± 0.54 million prior to varicocelectomy, respectively. After varicocelectomy, 14 of 17 men had improvements in TMSC. The mean change in sperm concentration, motility, and TMSC was 4.3 ± 4.7 million/mL, 12% ± 17.2%, and 6.0 ± 8.5 million, respectively. The mean postoperative sperm concentration, motility, and TMSC was 5.4 ± 5.4 million/mL, 27.5% ± 25.1%, and 6.5 ± 8.5 million, respectively. A total of 10 of 17 men had TMSC greater than 2 million. Of the 10 men, 1 man achieved spontaneous pregnancy and 7 men underwent a cycle of IUI; 2 of the 7 (28.6%) men achieved successful pregnancy with IUI (cost per pregnancy: $35,924).
Varicocelectomy increases TMSC in severely oligospermic patients, thus providing previously ineligible couples an opportunity to elect for IUI, a less invasive and less expensive alternative to in vitro fertilization with intracyctoplasmic sperm injection.
评估因总活动精子数（TMSC）<200万而接受精索静脉曲张切除术的男性的治疗效果，并对精索静脉曲张切除术后宫内人工授精（IUI）和卵胞浆内单精子注射体外受精进行成本效益分析。
我们前瞻性收集了TMSC<200万且接受显微外科腹股沟下精索静脉曲张切除术的男性的数据。排除无精子症患者。术前测量血清睾酮、促黄体生成素和促卵泡生成素。术后精液分析首先在3个月时收集，此后每3个月收集一次。使用报告的成本计算辅助生殖技术的成本效益。
共有17名男性因TMSC<200万接受了精索静脉曲张修复术。精索静脉曲张切除术之前，精子浓度、活力和TMSC的平均值分别为110±140万/mL、15.5%±12.8%和44±54万。精索静脉曲张切除术后，17名男性中有14名的TMSC有所改善。精子浓度、活力和TMSC的平均变化分别为430±470万/mL、12%±17.2%和600±850万。术后精子浓度、活力和TMSC的平均值分别为540±540万/mL、27.5%±25.1%和650±850万。17名男性中有10名的TMSC大于200万。在这10名男性中，1名实现了自然妊娠，7名接受了一个周期的IUI；7名男性中有2名（28.6%）通过IUI成功妊娠（每次妊娠成本：35924美元）。
精索静脉曲张切除术可提高严重少精子症患者的TMSC，从而为之前不符合条件的夫妇提供选择IUI的机会，IUI是一种侵入性较小且成本较低的替代卵胞浆内单精子注射体外受精的方法。
