Impact of obesity on the characteristics and prognosis of patients with varicocele-related infertility
Objective To study the impact of obesity on the clinical characteristics and prognosis of patients with varicocele-related infertility.Methods 200 patients with varicocele-related infertility who underwent microscopic varicocelectomy were selected as the study subjects.The baseline data such as age,course of disease,spermatic vein diameter,spermatic vein diameter during the Valsalva maneuver,sperm density,sperm motility,semen volume,percentage of sperm with normal morphology,testicular volume,testosterone(T),follicle-stimulating hormone(FSH),and luteinizing hormone(LH)were compared among patients with different body mass index(BMI),waist-to-hip ratios and body-fat rates.The above basic data of all subjects and obese patients before and after operation were compared.The postoperative follow-up of patients was recorded,and the factors influencing pregnancy in their spouse were analyzed.Results The preoperative sperm density in patients with BMI≥22.92 kg/m2 was(20.21±4.68)×106/ml and the preoperative percentage of sperm with normal morphology was(3.86±0.78)%,which were lower than(22.63±6.67)×106/ml and(4.11±0.89)%in patients with BMI<22.92 kg/m2(Z=-4.770,-2.912;P=0.001,0.004<0.05).The sperm motility was(33.09±11.61)%in patients with BMI≥22.92 kg/m2,which was worse than(36.86±13.20)%in patients with BMI<22.92 kg/m2(Z=-2.835,P=0.005<0.05).The testicular volume was(10.69±1.87)ml in patients with BMI≥22.92 kg/m2,which was smaller than(11.25±2.23)ml in patients with BMI<22.92 kg/m2(Z=-3.148,P=0.002<0.05).The preoperative sperm density in patients with waist-to-hip ratio≥0.85 was(20.53±4.95)×106/ml and the preoperative percentage of sperm with normal morphology was(3.84±0.72)%,which were lower than(22.45±6.66)×106/ml and(4.15±0.94)%in patients with waist-to-hip ratio<0.85(Z=-3.306,-3.450;P=0.001,0.001<0.05).The sperm motility was(33.64±11.67)%in patients with waist-to-hip ratio≥0.85,which was lower than(36.51±13.37)%in patients with waist-to-hip ratio<0.85(Z=-2.356,P=0.018<0.05).Patients with body fat rate>18%had lower preoperative sperm density of(19.11±4.80)×106/ml than(23.36±5.99)×106/ml in patients with body fat rate≤18%,worse sperm motility of(32.40±11.44)%than(37.12±13.04)%in patients with body fat rate≤18%,and smaller testicular volume of(10.58±1.83)ml than(11.29±2.21)ml in patients with body fat rate≤18%(Z=-9.542,-3.892,-3.494;P=0.001,0.001,0.001<0.05).All patients'surgeries were successfully completed,with 1 patient with intraoperative complication(intraoperative bleeding,which was satisfactorily stopped afterward);8 patients with postoperative complications(5 cases of scrotal edema,2 cases of postoperative urinary tract infection,and 1 case of wound hemorrhage),all of which were improved after conservative treatment.BMI in patients whose spouses were pregnant was(21.34±3.30)kg/m2 and the body fat rate was(17.96±3.58)%,which were lower than(23.54±3.16)kg/m2 and(18.99±3.27)%in patients whose spouses were not pregnant(Z=-6.205,-2.952;P=0.001,0.003<0.05).The waist circumference was(75.33±9.82)cm in patients whose spouses were pregnant,which was smaller than(78.95±10.94)cm in patients whose spouses were not pregnant(Z=-2.932,P=0.003<0.05).The sperm density was(24.15±7.68)×106/ml in patients whose spouses were pregnant,which was higher than(20.67±5.04)×106/ml in patients whose spouses were not pregnant(Z=-5.006,P=0.001<0.05).The sperm motility was(37.61±13.23)%in patients whose spouses were pregnant,which was higher than(34.2±12.28)%in patients whose spouses were not pregnant(Z=-2.043,P=0.041<0.05).BMI,waist circumference,body fat percentage,sperm density,and sperm viability with P<0.05 were included in the multifactorial analysis,and only BMI was found to be an independent influence[P=0.001<0.05,OR=0.815,95%CI=(0.746,0.890)].Of the 100 patients with BMI≥22.92 kg/m2,10 cases(10%)had a pregnant spouse.After operation,the spermatic vein diameter,spermatic vein diameter during the Valsalva maneuver,sperm density,sperm motility,testicular volume,T,FSH,LH and semen volume in all subjects and obese patients were improved compared with those before operation(P<0.05).Conclusion Obesity may negatively affect patients with varicocele-related infertility,yet microscopic varicocelectomy could improve their fertility.
万方数据
维普
