Mahdi Mohammed, Majzoub Ahmad, Elbardisi Haitham, Arafa Mohamed, Khalafalla Kareim, Al Said Sami, El Ansari Walid
Department of Urology, Hamad Medical Corporation, Doha, Qatar.
Department of Urology, Weill Cornell Medicine-Qatar, Doha, Qatar.
Arab J Urol. 2023 May 9;21(3):190-197. doi: 10.1080/2090598X.2023.2206336. eCollection 2023.
Few studies assessed the relationships between BMI and post varicocelectomy semen quality and fertility potential and they reported inconsistent findings.
To assess the association of BMI with semen parameters and reproductive hormones before and after microsurgical varicocelectomy.
Retrospective chart review in a tertiary infertility center. Of 1170 patients with clinical varicocele during the study period (8 years), 813 patients were eligible and included. Patients were grouped into: Group A (kg/m, = 251 patients), B (BMI 25-29.9 kg/m, = 289), C (BMI 30-34.9 kg/m, = 183) and D (kg/m, = 90). Clinical data, semen parameters, sperm DNA fragmentation and hormonal profile were collected before and 3 months after microsurgical varicocelectomy.
Patients' mean age was 35.87 ± 8.17 years. Higher-grade varicocele was significantly more prevalent in the lower BMI groups. BMI was significantly negatively correlated with preoperative sperm concentration, total motility progressive motility and total motile sperm count. Pre-operatively, sperm concentration, total motility, progressive motility and total motile sperm count showed significant differences between BMI groups, where higher BMI (Groups C and D) exhibited the poorest semen parameters. Postoperatively, all groups showed significant improvement in sperm concentration compared with pre-operative values. However, total and progressive motility were significantly improved in Groups A, B and C, while in Group D (highest BMI), total motility improved clinically but not statistically, progressive motility did not display improvement, and total motile sperm count was significantly improved only in Groups B and C. Postoperatively, mean improvements in semen parameters across the BMI groups were not significantly different, except for morphology, which improved significantly more in the less obese patients.
For infertile patients with clinical varicocele undergoing micro-surgical varicocelectomy, BMI appears not to impact the improvements across most of the semen parameters and hormones. The procedure might improve the fertility potential.
很少有研究评估体重指数（BMI）与精索静脉曲张结扎术后精液质量和生育潜能之间的关系，且这些研究报告的结果并不一致。
评估显微外科精索静脉曲张结扎术前、后BMI与精液参数及生殖激素之间的关联。
在一家三级不孕不育中心进行回顾性病历审查。在研究期间（8年）的1170例临床精索静脉曲张患者中，813例符合条件并被纳入研究。患者被分为：A组（BMI＜25kg/m²，n = 251例）、B组（BMI 25 - 29.9kg/m²，n = 289例）、C组（BMI 30 - 34.9kg/m²，n = 183例）和D组（BMI≥35kg/m²，n = 90例）。收集显微外科精索静脉曲张结扎术前及术后3个月的临床资料、精液参数、精子DNA碎片率和激素水平。
患者的平均年龄为35.87±8.17岁。较高等级的精索静脉曲张在较低BMI组中明显更为常见。BMI与术前精子浓度、总活力、前向运动活力和总活动精子数显著负相关。术前，精子浓度、总活力、前向运动活力和总活动精子数在BMI组之间存在显著差异，其中较高BMI（C组和D组）的精液参数最差。术后，与术前值相比，所有组的精子浓度均有显著改善。然而，A组、B组和C组的总活力和前向运动活力显著提高，而在D组（BMI最高），总活力虽有临床改善但无统计学意义，前向运动活力未显示改善，且仅B组和C组的总活动精子数显著提高。术后，除形态学外，各BMI组精液参数的平均改善情况无显著差异，形态学在肥胖程度较低的患者中改善更为显著。
对于接受显微外科精索静脉曲张结扎术的临床精索静脉曲张不育患者，BMI似乎不会影响大多数精液参数和激素水平的改善。该手术可能会提高生育潜能。
