Smoking and obesity negatively affect the favourable outcome of varicocelectomy in sub-fertile men

Effects of smoking on varicocelectomy outcomes: a retrospective cohort study

PURPOSE

To evaluate the effects of smoking on semen parameters and spontaneous pregnancy development by comparing smoker and non-smoker varicocelectomy patients.

METHODS

This study included 63 male patients with primary infertility for at least one year, and underwent microscopic subinguinal varicocelectomy at the Erzurum City Hospital urology clinic between 2020 and 2023. Patient files were retrospectively evaluated, and 27 patients were assigned to smoker group, whereas 36 patients were assigned to non-smoker group. Demographic data, semen parameters, spontaneous pregnancy development and timing were compared between two groups.

RESULTS

No statistically significant differences were observed in age, partner's age, BMI, clinical presentation, varicocele grade, side of varicocele, testicular volume, or testicular vein diameters (p > 0.05). The mean age of the study group was determined to be 30.7 ± 4.9 years. In the non-smoker group, 27 patients (75%) had only subfertility complaints, while 9 patients (25%) also experienced scrotal pain. Progressive motility was significantly higher in the non-smoker group at the 3rd month (28.11 ± 5.78 vs. 24.51 ± 4.24, p < 0.05) and 6th month (29.61 ± 5.16 vs. 26.22 ± 4.14, p < 0.05) evaluations. When comparing the rates of pregnancy development, the non-smoker group was determined to have a higher rate (53%), but this comparison was not statistically significant. (p < 0.05) Regarding the timing of pregnancy, the non-smoker group was associated with earlier spontaneous pregnancy. (5.84 ± 2.26 vs. 9.20 ± 2.30, p < 0.05).

CONCLUSION

Smoking negatively affects the outcomes of varicocelectomy in terms of semen parameters, spontaneous pregnancy development and timing. Prospective, randomized, and larger sample-sized studies are required on this subject.

TRIAL REGISTRATION

This study was approved by the Ataturk University Local Ethics Committee (approval number: B.30.2.ATA.0.01.00/234).

Does an increase in adipose tissue 'weight' affect male fertility? A systematic review and meta-analysis based on semen analysis performed using the WHO 2010 criteria

INTRODUCTION

Obesity negatively impact on the metabolism of sex hormones, leading to reduced testosterone serum levels. However, how the obesity could negatively impact on the overall gonadal function, particularly on male fertility, remained unclear so far.

OBJECTIVE

To systematically review evidences regarding the influence of body weight excess on the sperm production.

METHODS

A meta-analysis was conducted, searching all prospective and retrospective observational studies reporting male subjects older than 18 years old, with body weight excess from overweight to severe obesity were considered. Only studies using the V edition of the World Health Organization (WHO) manual for semen analysis interpretation were considered. No specific interventions were considered. Search was focused on studies comparing overweight/obese to normal weight subjects.

RESULTS

Twenty-eight studies were considered. Total sperm count and sperm progressive motility were significantly lower in overweight compared to normal weight subjects. Meta-regression analyses demonstrated that patients' age impacted on sperm parameters. Similarly, obese men showed lower sperm concentration, total sperm number, progressive and total motilities, and normal morphology lower than normal weight subjects. Reduced sperm concentration in obese men was influenced by age, smoking habit, varicocele, and total testosterone serum levels at meta-regression analyses.

CONCLUSIONS

The male potential fertility is reduced in subjects with increased body weight, compared to normal weight men. The higher was the increased body weight, the worst was the sperm quantity/quality. This result comprehensively included obesity among non-communicable risk factor for male infertility, shedding new lights on the negative impact of increased body weight on overall gonadal function.

Efficacy of varicocelectomy on semen parameters and conception rates

Objective

Varicocele, the dilation of the pampiniform plexus of the spermatic cord. It is discovered incidentally in most patients. Symptoms vary, but its impact is especially experienced in the field of fertility and reflected in semen parameters. Varicocelectomy is a surgical approach to correct the varicocele, however, reports are conflicting regarding its success. Our aim was to evaluate the efficacy of varicocelectomy on semen parameters and conception rates in patients who underwent surgery and its association with comorbidities such as diabetes, hypertension, and obesity.

Materials and Methods

This cross-sectional study included the complete medical records of 86 patients. Data collection form included the patient's age, body mass index (BMI), chronic diseases, smoking, surgical history, medication usage, and the reason for performing surgery. Presurgical and postsurgical semen parameters were evaluated 3 months before surgery and an average of 6 months postoperatively. Data were analyzed with SPSS, Chi-square test, and independent and paired t-test.

Results

No significant difference was found between primary and secondary infertility regarding semen analysis, postoperative semen analysis indicated an improvement in semen motility at 180 min with no effect on other parameters. Using spontaneous intercourse or in vitro fertilization (IVF) after varicocelectomy was significantly associated with increasing conception rates irrespective of the type of infertility. Diabetes, hypertension, BMI, and smoking did not appear to affect semen parameters.

Conclusion

Patients who underwent varicocelectomy had improved sperm motility at 180 min and subsequently had a higher chance of successful conception either through spontaneous intercourse or IVF. Further studies are needed to understand the relationship between conception and sperm motility. Semen parameters were not affected if the patient had comorbidities such as diabetes and hypertension. Furthermore, smoking and BMI did not appear to affect the conception rate.

Impact of body mass index on semen parameters and reproductive hormones among men undergoing microsurgical subinguinal varicocelectomy

Background

Few studies assessed the relationships between BMI and post varicocelectomy semen quality and fertility potential and they reported inconsistent findings.

Objective

To assess the association of BMI with semen parameters and reproductive hormones before and after microsurgical varicocelectomy.

Materials and Methods

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/m2, n = 251 patients), B (BMI 25-29.9 kg/m2, n = 289), C (BMI 30-34.9 kg/m2, n = 183) and D (kg/m2, n = 90). Clinical data, semen parameters, sperm DNA fragmentation and hormonal profile were collected before and 3 months after microsurgical varicocelectomy.

Results

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.

Conclusion

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.

Varicoceles in Men With Non-obstructive Azoospermia: The Dilemma to Operate or Not

The knowledge on male reproduction is constantly expanding, especially in treating infertility due to non-obstructive azoospermia (NOA). Varicocele is occasionally diagnosed in a subpopulation of males with NOA. Varicocele repair in NOA-men may contribute to the reappearance of spermatozoa in semen. However, spontaneous pregnancies are observed in only a small percentage of NOA-men post-varicocelectomy. Additionally, it has been reported that the repair of varicocele in NOA-men (before the performance of sperm retrieval techniques) may increase the testicular sperm recovery rate. In addition, it increases the pregnancy rate in intracytoplasmic sperm injection (ICSI) programs in NOA-men without spermatozoa in the semen post-varicocelectomy. In addition, to the improvement in Sertoli cellular secretory function, varicocelectomy may increase the secretory function of Leydig cells, which subsequently results in improved androgen production, raising the probability to negate the need for testosterone replacement therapy in cases of late-onset hypogonadism. On the other hand, the benefit of varicocelectomy in patients with NOA is still debatable. The current review study aims to provide a critical and extensive review of varicocele repair in males with NOA. This study additionally focuses on the impact of varicocele repair on sperm retrieval rates and its influence on the ICSI outcomes for those couples who remain negative for spermatozoa in their semen samples post-varicocelectomy.