Predictive parameters of semen outcome improvement after varicocele treatment by scleroembolization: a retrospective study

Luca De Toni; Giordana Ferraioli; Matteo Todisco; Sara Congiu; Pierfrancesco Palego; Andrea Graziani; Nicola Caretta; Giuseppe Grande; Giorgio De Conti; Massimo Lafrate; Fabrizio Dal Moro; Alberto Ferlin; Andrea Garolla

doi:10.1007/s40618-026-02844-0

Male Fertility · Male Factor Treatment

Predictive parameters of semen outcome improvement after varicocele treatment by scleroembolization: a retrospective study

De Toni L, Ferraioli G, Todisco M, Congiu S, Palego P, Graziani A, Caretta N, Grande G, De Conti G, Lafrate M, Moro FD, Ferlin A, Garolla A

Published July 2026 Journal of endocrinological investigation

DOI 10.1007/s40618-026-02844-0 PMID 42053703 PMC PMC13451323

RRM Academy Synopsis

Semen counts rose after scleroembolization in 85 men with varicocele

In a retrospective study of 85 men with varicocele, sperm concentration and motile sperm count rose six months after scleroembolization. Slow left testis blood flow before treatment went with doubled counts.

Key Findings

The varicocele grade fell from baseline (P < 0.001), with more than 90% of the 85 men at grade one or lower at the six-month visit.
Sperm concentration and total motile sperm count both rose at six months (P < 0.001 each), with no difference between the anterograde (42 men) and retrograde (43 men) groups.
In ROC analysis, baseline left testis mean transit time (L-MTT) was the only measure prognostic of both doubled total count (AUC = 0.834) and doubled motile count (AUC = 0.805).
In regression, baseline type A motility (progressive) was associated with doubling of total sperm count (P = 0.033) and total motile sperm count (P = 0.047).

Interpretation

The study is a retrospective cohort from one Italian university hospital, with no untreated comparison group. The design shows an association between treatment and higher counts, and cannot show that treatment caused the rise. Only men whose procedure succeeded and who returned at six months were analyzed. Pregnancy data were unavailable, so sperm counts stood in for fertility. The ultrasound cutoffs were calculated in the same 85 men. The results describe men with varicocele and low sperm counts.

RRM Context

Restorative reproductive medicine evaluates both partners and looks for a cause first. Varicocele is a physical finding in the man that an exam and ultrasound can identify. The authors note that very low sperm counts and very high FSH go with other causes of testicular impairment that benefit little from varicocele treatment.

Our editorial summary of this paper, not the article's abstract.

Abstract

Purpose

Varicocele is a recognized male factor of infertility. Surgical/microsurgical correction represents a therapeutical option to improve fertility outcomes but predictive parameters for the identification who can actually benefit from varicocele correction are under investigated. Here we aimed to identify baseline predictors of semen outcome improvement after varicocele treatment by scleroembolization approach.

Methods

85 patients receiving varicocele treatment by anterograde scleroembolization (ASE, N = 42) or retrograde scleroembolization (RSE, N = 43) were retrospectively recruited. Basal and 6-months follow-up evaluation of semen, hormonal and ultrasound parameters (US) were performed to address the respective effect of varicocele treatment. In addition, basal parameters were assessed as clinical outcome predictors.

Results

Varicocele grade reduction was observed in more than 90% of patients (P < 0.001). Compared to basal, significant increase of sperm concentration (10.0 ± 9.2 × 106cells/mL vs. 23.4 ± 26.9 × 106cells/mL; P < 0.001), total sperm count (TSC 39.0 ± 54.5 × 106cells vs. 70.3 ± 90.6 × 106cells, P < 0.001) and total motile sperm count (TMS, 9.8 ± 12.8 × 106cells vs. 36.7 ± 58.1 × 106cells, P < 0.001), was observed, with no differences between RSE or ASE. All US parameters were also improved (all P < 0.001). Logistic regression analysis of basal semen and ultrasound parameters showed that basal sperm motility and left testis-mean transit time (L-MTT) were associated with TSC and TMS doubling at follow-up. However, Receiver Operating Characteristic curve analysis showed that only basal L-MTT basal sperm was consistently associated with TSC and TMS doubling at follow-up (respectively: AUC = 0.834, CI: 0.747-0.921 and AUC = 0.805, CI: 0.708-0.901; both P < 0.001).

Conclusion

Baseline sperm count and US parameters represent useful clinical descriptors to address those subjects eligible for varicocele correction.

Topics

Male Fertility › Male Factor Treatment › Surgical Management · Reproductive Surgery › Definitive and Ablative Procedures › Hysterectomy

Luca De Toni, Giordana Ferraioli, Matteo Todisco, Sara Congiu, Pierfrancesco Palego, Andrea Graziani, Nicola Caretta, Giuseppe Grande, Giorgio De Conti, Massimo Lafrate, Fabrizio Dal Moro, Alberto Ferlin, Andrea Garolla

L Toni, G Ferraioli, M Todisco, S Congiu, P Palego, A Graziani, N Caretta, G Grande, G Conti, M Lafrate, F Moro, A Ferlin, A Garolla

PMID 42053703 42053703 DOI 10.1007/s40618-026-02844-0 10.1007/s40618-026-02844-0 De Toni et al. 2026, De Toni 2026

Predictive parameters of semen outcome improvement after varicocele treatment by scleroembolization: a retrospective study

Semen counts rose after scleroembolization in 85 men with varicocele

Key Findings

Interpretation

RRM Context

Abstract

Topics

By this author

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