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  • Title: Further observations on the role of varicocele in human male infertility.
    Author: Macleod J.
    Journal: Fertil Steril; 1969; 20(4):545-63. PubMed ID: 5795037.
    Abstract:
    108 patients with varicocele and severe oligospermia and other disturbances in semen quality were studied as a supplement to an earlier study of 77 patients. All 108 subjects in Group 2 were cases of primary sterility lasting from 1 to several years. In many patients, the presence of varicocele was predicted on the basis of the seminal cytology. The operation performed for ablation of the varicocele was in most cases a high ligation of the internal spermatic vein above the varicocele. Results are based on at least 2 semen examinations before operation and 2-6 done after a minimal time lapse of about 4 months postoperatively. The average sperm count/ml before operation was 19 million, but following ligation 58% of subjects remained under 20 million/ml, compared to 30% in Group 1. 36% of patients in Group 2 but only 6.4% in Group 1 remained under 10 million/ml. The number of subjects with sperm-count levels of 40 million/ml or more increased from 18 to 25 after operation. Only 17 men showed a substantial postoperative increase, while the counts in 11 fell considerably. 97% in Group 2 had fewer than 60% normal oval-form sperm and 64% had fewer than 41%. After ligation, 77% in Group 2 remained in the 60% or under class, compared to 67% in Group 1. In Group 2, 95% of patients showed the stress pattern common in varicocele before ligation; the proportion fell to 39% following ligation, compared to 28% in Group 1. In Group 2 86% of subjects had sperm motility below the normal range before operation. The sperm motility of 80 of the 108 subjects improved within a period of 9 months following the operation. 48 postligation pregnancies in the group had occurred by the time of writing, and only 3 miscarriages had been reported. The mean period of sterility before treatment was 2.76 years. The average time necessary for the 1st pregnancy was 8.3 months. 28 individuals were not seen within the last year and lost to follow-up, so that the pregnancy rate of 44% may be too low. In approximately 35% of pregnancies, the conception apparently occurred at sperm counts of 10 million/ml or less. 3 conclusions are suggested by the work: 1) tests available to assess female fertility appear to be good 2) sperm motility is the most important factor in semen quality, and 3) pregnancies are possible at very low count levels providing the motility of the few cells present is good.
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