Free sex steroid and sex hormone-binding globulin levels in oligozoospermic men with varicoceles

Objective: To measure free T, free E(2), and sex hormone-binding globulin (SHBG) levels in oligozoospermic men with varicoceles. Design: Retrospective study. Patients: Sixty-four infertile patients with varicoceles. Setting: A university-based tertiary care referral center. Interventions: Assessment of seminal cellular characteristics, gonadotropin responses to GnRH, total and free T, and E(2) and SHBG levels before and after varicocele ligation. Results: Thirty-eight men had excessive preoperative gonadotropin responses to GnRH. These men had lower than normal levels of free T and higher than normal levels of free E(2) and SHBG. Thirty men had improvements in seminal parameters, and sex steroid and SHBG values after surgery. Seven spontaneous pregnancies and three pregnancies through IUI occurred in their partners postoperatively. Twenty-six men had normal preoperative responses to GnRH and normal free T, E(2), and SHBG levels. None had postoperative improvements in their semen analyses and no spontaneous pregnancies occurred in their partners. Three pregnancies occurred with IUI. Conclusions: The men with excessive responses to GnRH had abnormal free sex steroid levels. The majority had improvements in semen analyses after varicocele repair and pregnancies occurred in their partners. The men with normal gonadotropin responses to GnRH had normal free sex steroid levels. Varicocele ligation had no effect on their semen parameters or fertility potential.