Fertility and Sterility
Volume 91, Issue 3 , Pages 826-830, March 2009

Differences in the clinical characteristics of primarily and secondarily infertile men with varicocele

  • Thomas J. Walsh, M.D., MS.

      Affiliations

    • Department of Urology, University of California, San Francisco, California
    • Corresponding Author InformationReprint requests: Thomas J. Walsh, M.D., M.S., Department of Urology, University of California San Francisco, 1600 Divisadero Street, Box 1695, San Francisco, CA 94143-1695 (FAX 415-885-7443).
    • ,
  • Alex K. Wu, B.S.

      Affiliations

    • Department of Urology, University of California, San Francisco, California
    • ,
  • Mary S. Croughan, Ph.D.

      Affiliations

    • Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California
    • ,
  • Paul J. Turek, M.D.

      Affiliations

    • Department of Urology, University of California, San Francisco, California
    • Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, California

Received 11 September 2007; received in revised form 24 December 2007; accepted 24 December 2007. published online 04 March 2008.

Objective

To compare the clinical characteristics of primarily and secondarily infertile men with varicocele.

Design

Cross-sectional analysis.

Setting

Male infertility clinic, tertiary health care center.

Patient(s)

Two hundred ninety-five infertile men with palpable varicoceles.

Intervention(s)

Clinical evaluation including patient reproductive history (including assessment of primary or secondary infertility), physical examination, hormonal assessment and at least two semen analyses.

Main Outcome Measure(s)

Differences in the characteristics of men with primary vs. secondary infertility.

Result(s)

Two hundred five subjects were identified with primary infertility and 90 with secondary infertility. Secondarily infertile men were older (39.6 years vs. 35.0 years), with older partners (35.4 years vs. 33.2 years), but had higher sperm densities (51.3 vs. 36.0 million/mL) and a greater percentage of morphologically normal sperm (30.6% vs. 24.1%). A lower proportion of secondarily infertile men had total motile sperm count (TMC) <20 million compared with primarily infertile men (31.1% vs. 46.5%). Groups did not differ regarding infertility duration, tobacco or alcohol use, varicocele grade or laterality, testis volumes, or hormonal parameters. In multivariate modeling, secondary infertility (vs. primary) was an independent predictor of TMC >20 million (odds ratio 1.9).

Conclusion(s)

Men with secondary infertility are older and have older partners than primarily infertile men, yet they have significantly better sperm concentrations. Infertility in this group may be influenced by maternal reproductive potential.

Key Words: Male infertility, varicocele, primary infertility, secondary infertility

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 T.J.W. has nothing to disclose. A.K.W. has nothing to disclose. M.S.C. has nothing to disclose. P.J.T. has nothing to disclose.

 Dr. Walsh is a Men's Reproductive Health Research K12 Scholar supported by National Institute of Child Health and Human Development K12 grant HD053943012 (TW), San Francisco, California.

PII: S0015-0282(07)04380-4

doi:10.1016/j.fertnstert.2007.12.071

Fertility and Sterility
Volume 91, Issue 3 , Pages 826-830, March 2009

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