Sperm Retrieval and Intracytoplasmic Sperm Injection in Men With Nonobstructive Azoospermia, and Treated and Untreated Varicocele

Purpose: We evaluated the impact of varicocelectomy on the sperm retrieval success rate using microsurgical testicular sperm extraction and intracytoplasmic sperm injection in men with clinical varicocele and nonobstructive azoospermia. Materials and Methods: The study included 96 men with complete nonobstructive azoospermia with a history of clinical unilateral or bilateral varicocele. Of the patients 66 previously underwent successful varicocelectomy and 30 had any grade of varicocele at sperm extraction. Results: Mean patient age was 34.8 and 32.3 years in the treated and untreated groups respectively. There were no differences in mean follicle-stimulating hormone, testicular volume, infertility duration or female partner age between the 2 groups. The proportion of female factor problems in the 2 groups was similar. The distribution of varicocele grade in the treated and untreated groups was not different. The sperm retrieval rate was significantly higher in the treated group (53% vs 30%, OR 2.63, 95% CI 1.05-6.60, p = 0.036). There was no significant difference in the normal 2PN fertilization rate (63.9% vs 53.6%). The rate of high quality embryos and mean number of transferred embryos were similar in the groups. The clinical pregnancy rate in the treated and untreated groups was 31.4% and 22.2%, respectively (p > 0.05). Conclusions: Our results suggest that varicocele repair significantly increased the sperm retrieval rate in patients with clinical varicocele and nonobstructive azoospermia.