(341) Post-varicocelectomy Semen Parameter Outcomes Are Independent of BMI

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Abstract Introduction Men with increased body mass index (BMI) and/or obesity have a higher incidence of infertility and poor semen quality. Varicocelectomy is a procedure that removes dilated veins of the pampiniform plexus, which drains blood from the testicle. Studies have shown improvement in semen parameters and fertility with varicocelectomy. However, there is limited research on the impact of BMI on post-varicocelectomy semen parameters. Objective To evaluate the relationship between BMI and post-varicocelectomy semen parameters. Methods We performed a multi-institutional retrospective study analyzing adult male patients seen between 2013 to 2023 who underwent a subinguinal microsurgical varicocelectomy for non-severe male factor (>1M/mL semen concentration) infertility. Men 18 years or older at the time of surgery who had a pre-operative semen analysis and a 3-month post-operative semen analysis were included. Those with severe oligozoospermia defined as a semen concentration of <1 million/mL were excluded. Varicocele diagnosis was made during a physical exam with a sub-specialist. BMI was obtained within one year of surgery and treated as both a linear and categorical variable (healthy weight, overweight, obese). Results 139 patients were included in the final analysis with a median BMI of 27.4 (IQR 24.4–30.1). 44 patients (31.7%) were of healthy weight with a BMI less than 25. 58 patients (41.7%) were overweight with a BMI greater than or equal to 25. 37 patients (26.6%) were obese with a BMI greater than or equal to 30. Among the men categorized as obese, 10 patients (7.2%) had class 2 obesity with a BMI greater than or equal to 35. Median improvement in TMSC among all patients was 4.83 million/ejaculate. Approximately half of patients (48.9%, 68/139) had a significant improvement (>50%) in TMSC following varicocelectomy. A linear model of change in total motile sperm count (ΔTMSC) regressed on BMI revealed no significant relationship (β=0.00001, p=0.97). In obese patients (BMI >30), neither absolute increase (p=0.25) nor percent increase (p=0.64) in TMSC were associated with BMI. Similarly, in overweight patients (BMI >25), neither absolute increase (p=0.71) nor percent increase (p=0.44) in TMSC were associated with BMI. There was no statistically significant relationship between BMI and other semen parameters including concentration, volume, pH, motility, and total count. Furthermore, there was no significant difference in median change in post-operative semen parameters by BMI category (p=0.35). Lastly, neither left nor right varicocele grade were predictors of change in semen parameters. Conclusions In this multi-institutional cohort, there was no relationship between BMI and improvement in semen parameters post varicocelectomy. While further validation is needed, these findings indicate that patient counseling for expected outcomes after a varicocelectomy should be agnostic to the patient’s BMI. Disclosure No

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