What is the indication of varicocelectomy in men with nonobstructive azoospermia?

Objective: To investigate the effect of microsurgical varicocelectomy in nonobstructive azoospermic patients. The surgical outcomes were correlated with the histopathologic patterns of testicular specimens.

Methods: A total of 19 nonobstructive azoospermic men who underwent testicular biopsy and varicocelectomy were included in the study. In 15 patients, unilateral varicocelectomy was performed, and in 4, bilateral varicocelectomy was performed. An inguinal approach with a microsurgical technique was used. Postoperative semen analyses were performed in each patient 3 months after varicocelectomy.

Results: Testicular histologic examination revealed hypospermatogenesis in 3 patients, maturation arrest in 6, and germ cell aplasia in 10. After a mean follow-up of 7.4 months, motile sperm in the ejaculate was identified in 7 (36.4%) of the nonobstructive azoospermic patients. Of these 7 patients, 2 had hypospermatogenesis, 4 had maturation arrest, and 1 had Sertoli cell-only syndrome. All 7 patients had improvement in their sperm concentration and motility (0.36 x 10(6)/mL and 47.1%, respectively). However, 2 of these 7 patients with motile sperm after varicocelectomy had recurrence of the azoospermic state at their second postoperative semen analysis. Pregnancy was achieved by natural intercourse for 1 of the men (5.3%) with hypospermatogenesis.

Conclusions: Microsurgical varicocelectomy may offer patients with nonobstructive azoospermia an opportunity to have sperm in their ejaculate and even the possibility of natural conception. Microsurgical varicocelectomy can be considered a viable option in selective patients with nonobstructive azoospermia and varicocele, instead of the less cost effective and more bothersome assisted reproductive techniques.