A comparison of Somatometric Assessments and Semen Analysis in 487 adolescent males
Alexander H. Fang, BS1, Israel Franco, MD, FAAP, FACS2, Joseph Boroda, BA1, Ronnie Fine, MD1, Steven C. Friedman, MD, FAAP, FACS3, Jaime Freyle, MD3, Vinaya Bhatia, MD4, Jessica Sommer, BS1, Paul F. Zelkovic, MD, FAAP, FACS5, Lori Landau-Dyer, MD5, Mark Horowitz, MD, FAAP, FACS1, Richard N. Schlussel, MD6, Jordan S. Gitlin, MD1.
1NYU Langone Hospital - Long Island, Mineola, NY, USA, 2Yale School of Medicine, New Haven, CT, USA, 3Maimonides Medical Center, Brooklyn, NY, USA, 4University of Wisconsin School of Medicine and Public Health, Madison, WI, USA, 5Westchester Medical Center, Valhalla, NY, USA, 6Hackensack University Medical Center, Hackensack, NJ, USA.
Background:
The anatomic explanation for dilation of the pampiniform plexus is known to be exacerbated in males with decreased adiposity. Two common measures of adiposity are body mass index (BMI) and body surface area (BSA). Previously published literature on somatometric measurements has reported an association between prevalence of varicoceles in adolescent patients and BMI. Additionally, positive correlations have been demonstrated between total testicular volume (TTV) and total motile sperm count (TMSC) as an indicator of future infertility. However, there has been a paucity of insight on TTV in relation to BMI and BSA, and this value’s correlation to TMSC. Our aim was to evaluate if somatometric measures, in particular BMI and BSA, are correlated to TMSC in Tanner V males with a left-sided varicocele.
Methods:
We conducted a retrospective single institution chart review over 14 years on adolescent males with clinically diagnosed left-sided varicoceles, with subsequent analysis on 112 patients meeting eligibility criteria. All patients analyzed underwent at least one testicular ultrasonographic measurement, height and weight measurement at time of ultrasound and one SA. Subsequent calculation of BMI and BSA was conducted with BSA calculated using the Mosteller formula and abnormal TMSC was defined by WHO 2010 criteria for minimal reference ranges. Spearman’s correlation, ROC analysis and descriptive statistics were performed using SPSS.
Results:
487 patients were identified via a database search with varicoceles, data on 112 Tanner V adolescent males with a mean age ± SD of 18.5 ± 2.33 years were evaluated with 160 SA performed. Mean TTV was 36.01 ± 12.05 cc. Median TMSC in the cohort was 66.19 million IQR (29.60 - 122.75). Median BMI in the cohort was 22.34 IQR (20.76 - 24.16) and median BSA was 1.86 IQR (1.76 - 1.98). There was a significant positive correlation between TTV/BMI and TMSC (ρ 0.31, p <0.001) and TTV/BSA and TMSC (ρ 0.31, p <0.001). However, BMI and BSA alone could not predict TMSC (p=0.678, p=0.248, respectively). ROC analysis was performed on both TTV/BMI and TTV/BSA with a Youden index analysis which determined an optimal TTV cutoff of 1.31 cc/(kg*m2), 17.81 cc/m2 respectively, to predict abnormal TMSC (NPV = 0.93, NPV =0.94, respectively).
Conclusions:
There are a variety of measurements that have been assessed in Tanner V adolescent males with left-sided varicoceles demonstrating association of the etiology with TMSC. Our observations suggest that left-sided varicoceles in Tanner V adolescent males are associated with two novel somatometric parameters (TTV/BMI and TTV/BSA) in relation to TMSC. In particular, for patients with similar testicular volumes, a lower BMI and BSA is associated with increased TMSC, suggesting an association with BMI, BSA and TMSC regarding sperm quality. Such findings may offer clinical guidance in patients who defer SA. 
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