Impact of a second semen analysis on a treatment decision making in the infertile man with varicocele

Objective: To evaluate the impact of second semen analysis (SA) on a treatment decision in infertile men with varicocele and abnormal first SA. Design: Retrospective chart review. Setting: University hospital. Intervention: None. Main Outcome Measure(s): Standard clinical semen analysis. Patient(s): A total of 160 infertile men with varicocele and abnormal first SA were evaluated. Two SA were performed in the same andrology lab 3 to 8 weeks apart. Exclusion criteria were azoospermia, low semen volume, leukocytospermia, febrile illness within 3 months, and habitual heat exposure. Result(s): Despite fluctuation in absolute values of sperm concentration, motility, and morphology, the second SA remained abnormal in 111 out of 112 men (99.1%) with abnormal first SA. Conclusion(s): Initial abnormal SA is a sufficient indication for varicocele treatment because in most patients the second SA remains abnormal and does not change treatment decision. This approach will expedite treatment of infertile men with varicocele and increase its cost effectiveness.