Male congenital hypogonadotropic hypogonadism (CHH) is a heterogenous group of genetic disorders that cause impairment in the production or action of gonadotropin releasing hormone (GnRH). These defects result in dysfunction of the hypothalamic-pituitary-gonadal hormone axis, leading to low testosterone levels and impaired fertility. Genetic testing techniques have expanded our knowledge of the underlying mechanisms contributing to CHH including over 30 genes to date implicated in the development of CHH. In some cases, non-reproductive signs or symptoms can give clues as to the putative genetic etiology, but many cases remain undiagnosed with less than 50% identified with a specific gene defect. This leads to many patients labelled as "idiopathic hypogonadotropic hypogonadism". Medical and family history as well as physical exam and laboratory features can aid in the identification of hypogonadotropic hypogonadism (HH) that is associated with specific medical syndromes or associated with other pituitary hormonal deficiencies. Genetic testing strategies are moving away from the classic practice of testing for only a few of the most commonly affected genes and instead utilizing next generation sequencing techniques that allow testing of numerous potential gene targets simultaneously. Treatment of CHH is dependent on the individual's desire to preserve fertility and commonly include human chorionic gonadotropin (hCG) and recombinant follicle stimulating hormone (rFSH) to stimulate testosterone production and spermatogenesis. In situations where fertility is not desired, testosterone replacement therapies are widely offered in order to maintain virilization and sexual function.

OBJECTIVE:To compare racial differences in male fertility history and treatment. DESIGN:Retrospective review of prospectively collected data. SETTING:North American reproductive urology centers. PATIENT(S):Males undergoing urologist fertility evaluation. INTERVENTION(S):None. MAIN OUTCOME MEASURE(S):Demographic and reproductive Andrology Research Consortium data. RESULT(S):The racial breakdown of 6,462 men was: 51% White, 20% Asian/Indo-Canadian/Indo-American, 6% Black, 1% Indian/Native, <1% Native Hawaiian/Other Pacific Islander, and 21% "Other". White males sought evaluation sooner (3.5 ± 4.7 vs. 3.8 ± 4.2 years), had older partners (33.3 ± 4.9 vs. 32.9 ± 5.2 years), and more had undergone vasectomy (8.4% vs. 2.9%) vs. all other races. Black males were older (38.0 ± 8.1 vs. 36.5 ± 7.4 years), sought fertility evaluation later (4.8 ± 5.1 vs. 3.6 ± 4.4 years), fewer had undergone vasectomy (3.3% vs. 5.9%), and fewer had partners who underwent intrauterine insemination (8.2% vs. 12.6%) compared with all other races. Asian/Indo-Canadian/Indo-American patients were younger (36.1 ± 7.2 vs. 36.7 ± 7.6 years), fewer had undergone vasectomy (1.2% vs. 6.9%), and more had partners who underwent intrauterine insemination (14.2% vs. 11.9%). Indian/Native males sought evaluation later (5.1 ± 6.8 vs. 3.6 ± 4.4 years) and more had undergone vasectomy (13.4% vs. 5.7%). CONCLUSION(S):Racial differences exist for males undergoing fertility evaluation by a reproductive urologist. Better understanding of these differences in history in conjunction with societal and biologic factors can guide personalized care, as well as help to better understand and address disparities in access to fertility evaluation and treatment.

Cystic fibrosis (CF) is a rare autosomal-recessive disorder manifested as multisystem organ dysfunction. The cystic fibrosis transmembrane conductance regulator (CFTR) protein functions as an ion transporter on the epithelium of exocrine glands, regulating secretion viscosity. The CFTR gene, encoded on chromosome 7, is required for the production and trafficking of the intact and functional CFTR protein. Literally thousands of human CFTR allelic mutations have been identified, each with varying impact on protein quality and quantity. As a result, individuals harboring CFTR mutations present with a spectrum of symptoms ranging from CF to normal phenotypes. Those with loss of function but without full CF may present with CFTR-related disorders (CFTR-RDs) including male infertility, sinusitis, pancreatitis, atypical asthma and bronchitis. Studies have demonstrated associations between higher rates of CFTR mutations and oligospermia, epididymal obstruction, congenital bilateral absence of the vas deferens (CBAVD), and idiopathic ejaculatory duct obstruction (EDO). Genetic variants are detected in over three-quarters of men with CBAVD, the reproductive abnormality most classically associated with CFTR aberrations. Likewise, nearly all men with clinical CF will have CBAVD. Current guidelines from multiple groups recommend CFTR screening in all men with clinical CF or CBAVD though a consensus on the minimum number of variants for which to test is lacking. CFTR testing is not recommended as routine screening for men with other categories of infertility. While available CFTR panels include 30 to 96 of the most common variants, complete gene sequencing should be considered if there is a high index of suspicion in a high-risk couple (e.g., partner is CFTR mutation carrier). CF treatments to date have largely targeted end-organ complications. Novel CFTR-modulator treatments aim to directly target CFTR protein dysfunction, effectively circumventing downstream complications, and possibly preventing symptoms like vasal atresia at a young age. Future gene therapies may also hold promise in preventing or reversing genetic changes that lead to CF and CFTR-RD.

Unraveling the mystery of genetics and male infertilityTaking 13 years to complete, the Human Genome Project sequenced the entire euchromatic human genome.The accomplishment was hoped to offer solutions to many of man's most befuddling medical conditions, male infertility a prime example.What was discovered, however, was the tip of the iceberg.The sequence of base pairs only begins to shed light on the complex interplay between pre-translational, translational, and related factors that determine fertility potential.This focused series of Translational Andrology and Urology explores our current understanding of the genetic causes and management of male infertility.Beginning with reviews of the basic genetic etiologies and relevant tests, this series then delves into well-known causes of male infertility including Y chromosome copy number variations, Y chromosome microdeletions, cystic fibrosis transmembrane conductance regulator (CFTR) gene mutations, and hypogonadotropic hypogonadism.A novel review collates the available literature on nutrigenomics, detailing the interplay between diet, genetic makeup, and fecundity.The latter half of this series focuses on management options for the above-mentioned and other genetic etiologies of male infertility.Two articles on Y chromosome microdeletions detail sperm retrieval techniques and assisted reproductive outcomes.Two additional reviews address sperm retrieval techniques and success rates for Klinefelter's syndrome and CFTR mutations.Equally as important, a special review discusses genetic counseling recommendations for men with known and unknown causes of infertility.The last article looks to the future, exploring research on the verge of bettering our understanding of genetic causes of male infertility.On behalf of myself and my co-editor, Dr. Keith A. Jarvi, we would like to thank the editors and copyediting staff at Translational Andrology and Urology for their tireless efforts guiding this special edition from concept to final form.And we would be remiss without offering our sincerest thanks to our review article authors for their efforts in summarizing the available literature on these important topics, even during these trying times.We all are living in a constant state of flux related to the ongoing COVID pandemic-from social isolation

Objective: To characterize the referral patterns and characteristics of men presenting for infertility evaluation using data obtained from the Andrology Research Consortium. Design: Standardized male infertility questionnaire. Setting: Male infertility centers. Patient(s): Men presenting for fertility evaluation. Intervention(s): Not applicable. Main Outcome Measure(s): Demographic, infertility history, and referral data. Result(s): The questionnaires were completed by 4,287 men, with a mean male age of 40 years +/- 7.4 years and female partners age of 37 years +/- 4.9 years. Most were Caucasian (54%) with other races being less commonly represented (Asian 18.6%, and African American 5.5%). The majority (59.7%) were referred by a reproductive gynecologist, 19.4% were referred by their primary care physician, 4.2% were self-referred, and 621 (14.5%) were referred by ''other.'' Before the male infertility investigation, 12.1% of couples had undergone intrauterine insemination, and 4.9% of couples had undergone in vitro fertilization (up to six cycles). Among the male participants, 0.9% reported using finasteride (5 alpha-reductase inhibitor) at a dose used for androgenic alopecia, and 1.6% reported exogenous testosterone use. Conclusion(s): This broad North American patient survey shows that reproductive gynecologists are the de facto gateway for most male infertility referrals, with most men being assessed in the male infertility service being referred by reproductive endocrinologists. Some of the couples with apparent male factor infertility are treated with assisted reproductive technologies before a male factor investigation. The survey also identified potentially reversible causes for the male infertility including lifestyle factors such as testosterone and 5 alpha-reductase inhibitor use. ((C) 2019 by American Society for Reproductive Medicine.)

Direct application therapy refers to non-surgical therapy for erectile dysfunction with delivery mechanism that requires direct, physical contact with the penis. Therapeutic options include intracavernosal vasoactive injection, intraurethral vasodilatory suppository, vacuum-assisted erection device, penile tension rings, topical medication, and shockwave treatment. The following article will review the aforementioned treatments with emphasis on indications and general use, mechanisms of action, and complications of therapy.

the relative cost without adversely affecting the sensitivity.The rate of SSR may be lower than that previously described in the literature.

The male reproductive tract is made up of a series of organs including the testes, epididymides, vas deferens, seminal vesicles, prostate, and the penis with various imaging studies available for each in the evaluation of infertile men. Diagnostic imaging which may be employed includes various X-ray or fluoroscopy, ultrasound (US), and magnetic resonance imaging studies. Scrotal US remains the most commonly used to evaluate the testes and possible varicoceles while transrectal US is useful in cases of suspected central obstruction. Given the complexity of male infertility, appropriate imaging studies remain a crucial component of male infertility evaluation.

You have accessJournal of UrologyInfertility: Epidemiology & Evaluation II1 Apr 2017MP35-17 SPERM ULTRASTRUCTURAL DEFECTS IN MEN WITH SEVERE ASTHENOSPERMIA IS NOT A POOR PROGNOSTICATOR FOR VARICOCELECTOMY OUTCOMES Sarah Ferrara, Keith Jarvi, and Jared Bieniek Sarah FerraraSarah Ferrara More articles by this author , Keith JarviKeith Jarvi More articles by this author , and Jared BieniekJared Bieniek More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1107AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Varicocele repair has been shown to improve semen parameters in men struggling with infertility, although the impact may be less clear in some subgroups, such as those with severe asthenospermia. Electron microscopy (EM) of sperm in men with severe asthenospermia and preserved viability has identified a higher frequency of subcellular ultrastructural defects (USDs) not identifiable with traditional microscopy. The impact of USDs on varicocelectomy results has not been explored, thus this study was designed to determine if the presence of EM-identified sperm defects predicts post-varicocele repair outcomes. METHODS Data from our tertiary male infertility referral center is prospectively collected in a review board-approved database. Semen specimens with severe asthenospermia (<10%) and preserved sperm viability (>50%) at our center are referred for EM testing. We retrospectively reviewed all men with sperm EM testing between 2003-2013 who underwent either surgical varicocelectomy or embolization. Pre- and post-repair semen analyses within one year of repair were collected and analyzed. Statistical analyses were performed using Student's t test for continuous data with p<0.05 reported as significant. RESULTS During our study time period, 54 men had sperm EM testing and underwent varicocele repair. Four patients had inadequate specimens for EM and were excluded. The mean age of the remaining 50 men was 36.1 years. Fold changes in pre- and post-repair sperm concentration, motility, and total motile count (TMC) were 1.50, 2.46, and 3.67, respectively. EM abnormalities were identified in 15/50 (30%) while no abnormalities were noted in 35 (70%). There were no significant differences between sperm concentration, motility, TMC, or morphology when comparing those with normal vs abnormal EM, 1 vs 2+ EM abnormality subtypes, or <50% vs 50+% sperm affected by USDs. Among men with <50% sperm affected by a USD, there was a 1.16 fold change in ejaculate volume as opposed to 0.64 change seen in men with 50+% sperm affected (p=0.03). CONCLUSIONS Post-varicocele repair outcomes in men with sperm EM abnormalities appear to be non-inferior to those without identified abnormalities. Certainly, it will be more challenging for these men with severe asthenospermia to approach normal parameters, but this small series demonstrates that the presence of EM abnormalities should not preclude a discussion about varicocelectomy. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e464-e465 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Sarah Ferrara More articles by this author Keith Jarvi More articles by this author Jared Bieniek More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The inflatable penile prosthesis (IPP) is an effective erectile dysfunction (ED) treatment modality when oral and injectable therapies fail to achieve satisfactory results. Unfortunately, infection of the prosthetic remains a dreaded complication occurring in a small fraction of patients despite advances in device design and surgical techniques. With a prosthetic infection or erosion, classic management has included removal of all hardware with thorough irrigation of the infected spaces. To prevent corporal fibrosis and scarring that can make a subsequent implant challenging, an immediate salvage procedure with a three-piece prosthesis has been advocated when possible. However, there has been recent interest in using malleable devices during salvage procedures to serve as a temporary implant and further improve outcomes. Based on a literature review of immediate salvage procedures for infected penile prostheses, management with typical Mulcahy washout and IPP reimplant may be quite successful in appropriately selected patients. Based on one case series and a second multicenter trial of malleable salvage procedures, utilizing a malleable as a temporary implant is similarly, if not more, successful at eradicating prosthetic infection. The malleable implant not only serves as a temporary space-filling corporal implant to prevent fibrosis, but may also prove an adequate destination therapy for some given the lower than expected rate of delayed conversion to inflatable prosthesis. Future studies are needed to better characterize the role of malleable devices for penile prosthetic salvage and query patient satisfaction with the malleable device and repeated surgeries.

Purpose: We report the safety of surveillance of small testicular masses incidentally discovered during evaluation of male infertility. Materials and Methods: We retrospectively reviewed a prospectively collected database to identify patients with male infertility found to have incidental small testicular masses (hypoechoic lesions less than 10 mm) on scrotal ultrasound. The men were offered close surveillance with interval imaging and office followup. Patient and imaging characteristics were collected to compare the surveillance and surgical groups with additional comparisons between benign and malignant pathologies to elucidate predictors of underlying malignancy. Results: Of 4,088 men in whom scrotal ultrasound was completed for male infertility evaluation 120 (2.9%) were found to have a subcentimeter testicular mass. Average followup was 1.30 years (range 0.1 to 16.9). A total of 18 men (15%) proceeded to extirpative surgery while 102 remained on surveillance at last followup. In those with at least 1 month of followup the mean lesion growth rate was -0.01 mm per year. Reasons for surgery included testicular exploration for infertility, mass growth, positive tumor markers, history of testis cancer, concerning imaging characteristics and patient choice. Six of the 18 men who underwent surgery were found to have malignancy, which was seminoma in all. All malignant lesions were greater than 5mmon initial imaging and demonstrated vascularity, although size and vascularity were not significantly different from those of benign lesions on final pathology findings. No patients demonstrated advanced or recurrent disease. Conclusions: Small testicular masses are not uncommon, especially in the infertile male population. Most of these masses do not show significant growth during long-term evaluation and can be safely surveilled with close followup.

Urothelial melanosis is a rare finding characterized by abnormal pigmentation noted on cystoscopic evaluation and histologically defined by melanin deposition in the urothelium. Although generally considered benign, few cases of urothelial melanosis have been reported in the literature and the risk of recurrence or progression remains largely unknown. Four cases associated with urothelial cell carcinoma have been previously described. Here, we report a case of urothelial melanosis and review previously published cases in the literature.

Male infertility remains a struggle to definitively diagnose and treat with many men labelled as “idiopathic infertility” and eventually requiring assisted reproductive techniques. Along those lines, research groups are continuing to explore current social and environmental factors, including the obesity epidemic, and their effects on male fertility potential. Novel biomarkers of natural fertility status and azoospermia etiology have additionally seen recent attention with ACRV1 and TEX101/ECM1 assays either currently or soon to be commercially available. Despite these advancements, however, medical treatment options have seen little progress. Though surgical therapies have similarly seen little transformation, groups are exploring the use of testicular sperm for couples with elevated sperm DNA fragmentation and either planned or previously failed IVF/ICSI. Concerted collaborative efforts will be needed as we move forward to better understand the challenges men face when struggling to conceive.

Male infertility remains a struggle to definitively diagnose and treat with many men labelled as “idiopathic infertility” and eventually requiring assisted reproductive techniques. Along those lines, research groups are continuing to explore current social and environmental factors, including the obesity epidemic, and their effects on male fertility potential. Novel biomarkers of natural fertility status and azoospermia etiology have additionally seen recent attention with ACRV1 and TEX101/ECM1 assays either currently or soon to be commercially available. Despite these advancements, however, medical treatment options have seen little progress. Though surgical therapies have similarly seen little transformation, groups are exploring the use of testicular sperm for couples with elevated sperm DNA fragmentation and either planned or previously failed IVF/ICSI. Concerted collaborative efforts will be needed as we move forward to better understand the challenges men face when struggling to conceive.

OBJECTIVE:To determine whether obesity affects serum and seminal measures of male reproductive potential among a multi-institutional cohort. DESIGN:Retrospective multi-institutional cohort study. SETTING:Infertility clinics. PATIENT(S):All men referred for male infertility evaluation from 2002 to 2014 (n = 4,440). INTERVENTION(S):None. MAIN OUTCOME MEASURE(S):Collected reproductive parameters included hormonal (gonadotropins, T, E2, PRL) and semen analysis (ejaculate volume, sperm concentration, motility, normal morphology) data. Body mass index (BMI) was calculated for all patients with comparisons to reproductive parameters using univariate and multiparametric models. RESULT(S):Based on World Health Organization definitions, 30.9% of the cohort was normal weight (BMI 18.5-24.9), 45.1% overweight (25-29.9), and 23.3% obese (>30). Neither FSH nor LH demonstrated significant correlations with BMI on multivariate analysis. Total T (r = -0.27) and the T:E2 ratio (r = -0.29) inversely varied with BMI, whereas E2 (r = 0.13) had a direct correlation. On univariate analyses, BMI had weak but significant negative correlations with ejaculate volume (r = -0.04), sperm concentration (r = -0.08), motility (r = -0.07), and morphology (r = -0.04). All parameters remained significant on multivariate modeling with the exception of sperm motility. Rates of azoospermia and oligospermia were also more prevalent among obese (12.7% and 31.7%, respectively) compared with normal weight men (9.8% and 24.5%). CONCLUSION(S):In one of the largest cohorts of male fertility and obesity, serum hormone and semen parameters demonstrated mild but significant relationships with BMI, possibly contributing to subfertility in this population.

For men struggling to conceive with their partners, diagnostic tools are limited and often consist of only a standard semen analysis. This baseline test serves as a crude estimation of male fertility, leaving patients and clinicians in need of additional diagnostic biomarkers. Seminal fluid contains the highest concentration of molecules from the male reproductive glands, therefore, this review focuses on current and novel seminal biomarkers in certain male infertility scenarios, including natural fertility, differentiating azoospermia etiologies, and predicting assisted reproductive technique success. Currently available tests include antisperm antibody assays, DNA fragmentation index, sperm fluorescence in situ hybridization, and other historical sperm functional tests. The poor diagnostic ability of current assays has led to continued efforts to find more predictive biomarkers. Emerging research in the fields of genomics, epigenetics, proteomics, transcriptomics, and metabolomics holds promise for the development of novel male infertility biomarkers. Seminal protein-based assays of TEX101, ECM1, and ACRV1 are already available or under final development for clinical use. Additional panels of DNA, RNA, proteins, or metabolites are being explored as we attempt to understand the pathophysiologic processes of male infertility. Future ventures will need to continue data integration and validation for the development of clinically useful infertility biomarkers to aid in male infertility diagnosis, treatment, and counseling.

OBJECTIVE To determine the applicability of postvasectomy special clearance parameters (<100,000 nonmotile sperm/mL on semen analysis) suggested by the American Urological Association and to define the associated cost savings with avoidance of further testing.MATERIALS AND METHODS We retrospectively reviewed the cohort of men undergoing vasectomy from December 2009 to August 2012 at a single institution. Patient demographics and postvasectomy semen analysis (PVSA) results were collected for clearance parameter comparisons.RESULTS During the study period, 230 patients underwent vasectomy with a mean +/- SD age of 36.4 +/- 6.5 years. Among the cohort, 83.5% were married and 95.2% had one or more children. The initial PVSA was completed by 111 (48.3%) patients at a mean of 17.8 weeks (range 4-45) following vasectomy. Sperm was identified on initial PVSA in 40 patients (36.0%); 1 patient was found to have motile sperm. Of 39 patients, 38 (97.4%) with nonmotile sperm on PVSA could be cleared to cease other contraceptives based on the most recent clearance guidelines. For those completing an initial PVSA, postvasectomy clearance increased from 64.0% to 98.2% representing a potential cost savings of $2356 in repeat semen testing.CONCLUSION Postvasectomy contraceptive clearance can be greatly increased when rare nonmotile sperm parameters are included although postvasectomy semen testing compliance remains poor. (C) 2015 Elsevier Inc.

Obesity has been suggested as a contributing factor in male subfertility but correlations with semen parameters have been mixed, therefore, this study was designed to analyze the relationships between body mass index (BMI) and measures of male fertility among a large multi-institutional cohort. Retrospective review of prospectively-collected demographic data to calculate measures of obesity from three North American male infertility clinics with correlation to semen and reproductive hormonal parameters. Self-reported or measured height and weight were captured in review board-approved databases at male infertility clinics since 2002. Men with semen analysis or reproductive hormone parameters at initial evaluation were included to reduce effects of infertility-related treatments. BMI was calculated for all patients with comparisons to reproductive parameters performed utilizing ANOVA, chi squared, and Spearman's rank correlations as appropriate with p<.05 reported as significant. Complete height and weight data to calculate BMI was available for 4440 patients with a mean age of 36.1 (±7.6) years. Based on WHO definitions, 30.9% of the cohort was normal weight (BMI 18.5-24.9), 45.1% overweight (25-29.9), and 23.3% obese (>30). Semen analysis and reproductive hormone results were collected for 4236 (95.4%) and 2973 (67.0%) men, respectively. The gonadotropins FSH and LH demonstrated weak positive correlations with BMI with only LH reaching significance (r=0.04, p=0.06; r=0.06, p=0.01). Testosterone (r= -0.27, p<0.001) and the T/E ratio (r= -0.29, p<0.001) were noted to have significant negative relationships with BMI while estradiol (r=0.13, p<0.001) varied directly. Prolactin levels were not related to obesity measures. BMI had weak but significant negative correlations with semen volume (r= -0.04, p=0.01), sperm concentration (r= -0.08, p<0.001), motility (r= -0.07, p<0.001), total motile count (r= -.10, p<0.001), and morphology (r= -0.04, p=0.02). The rates of azoospermia and oligospermia were also found more frequently among obese (12.7% and 31.7%, respectively) compared to normal weight men (9.8% and 24.5%, p<.001). In one of the largest cohorts of male fertility and measures of obesity, all semen parameters demonstrated mild but significant negative relationships with BMI. Reproductive hormones are also altered with greatest effects on testosterone and the T/E ratio which may contribute to subfertility in this population.

Scrotal ultrasonography is a sensitive test for detection of varicoceles however there is controversy over its role in the evaluation and management of male infertility patients. This study aims to determine if ultrasound-measured testicular vein sizes correlate with physical exam findings and ultimately predict results following varicocelectomy. Retrospective review of preoperative scrotal ultrasounds for patients undergoing varicocelectomy with correlation to clinical varicocele grading and post-operative outcomes. Clinical data for patients presenting to an infertility clinic was collected in an institutional review board-approved database. A review of patients undergoing varicocele surgical repair or embolization from 2003-2012 was performed. Measures of testicular vein size before and after Valsalva maneuver were extracted from available scrotal ultrasound reports. Descriptive statistics were performed on the collated data with Student's t tests, ANOVA, and Spearman's rank correlation utilized as appropriate with p<.05 reported as significant. Of 302 patients undergoing varicocelectomy, semen parameters and scrotal ultrasounds were available for 276 patients (91.4%) with a mean age of 40.1 (range 23-68). Clinical grades 1, 2, and 3 left varicoceles were reported in 104 (35.2%), 123 (41.7%), and 67 (22.7%) men, respectively, with solitary left and bilateral varicoceles noted in 113 (40.9%) and 157 (56.9%). Mean post-Valsalva left testicular vein diameter was 4.1mm (IQR 3.5-4.5) and right was 3.8mm (IQR 3.1-4.2). Vein size was significantly different between grades 1, 2, and 3 left varicoceles (p<.001) but did not differ significantly for right grades (p=.08). Amongst men with grade 1 or 2 left varicoceles, those with vein size >3.5mm had an average 3.13 fold change in TMC post-operatively versus 1.79 if veins <3.5mm (p=.04). For all varicocele grades, a positive correlation was noted between maximal left vein diameter and change in motility (r=.12, p=.04) but neither left nor right vein diameter had significant correlations with sperm concentrations, total motile count (TMC), or change in TMC. For men with grade 1 or 2 varicoceles by physical examination, testicular vein size as measured by scrotal ultrasound is independently predictive of post-varicocelectomy outcomes. Men with larger veins measured by ultrasound had close to a 75% greater fold increase in TMC than those with small veins.