Background
Varicoceles occur in approximately 15% of all men, often first appearing in adolescence and can be associated with scrotal pain, subfertility, and testicular growth retardation. Varicoceles are the most common cause of secondary infertility in adults. In the absence of scrotal pain, the decision to treat men with varicoceles often hinges on the patient’s desire for paternity. The age of paternity has increased statistically over the last 2 decades and the effects on future fertility in men with varicoceles is unknown. This adds another variable in clinical decision making on the part of parents regarding earlier treatment of varicoceles. In the pediatric age group, testicular size serves as a surrogate for potential testicular insult until it can be proven by semen analysis (SA). Providing a specimen at a fertility clinic can be an embarrassing experience for the donor and may be a barrier to obtaining SA. Here we describe our experience with a novel, at-home SA kit (Fellow Health Inc, San Francisco, CA) as a decision-making tool in adolescent varicocele.
Methods
A retrospective analysis of patients from a single pediatric urology practice from January 1, 2023-April 30, 2024 was performed. All patients that were recommended for an at-home SA kit were reviewed. Patient age, date of kit receipt, date of SA sample, testicular volume differential, SA parameters, and treatment recommendation were collected.
Results
Sixty-two patients were recommended to undergo at-home SA for adolescent varicocele between January 1, 2023 and April 30, 2024. Average age at SA sample collection was 16.9 (IQR 16-17.8) years. SA sample was provided by 48 (77%) patients, at a median of 12 days after recommendation (IQR 6-30.5 days). Four (8%) samples were rejected due to the sample taking > 52 hours to arrive at the laboratory facility. The most common abnormal SA parameter was total motile sperm count (TMSC), of which 29 (66%) samples were abnormally low, while only 19 (40%) samples had a low total sperm count (TSC). 12 patients with abnormal SA had a testicular volume differential of ≥10%. Surgery was recommended for 17 (59%) patients with abnormally low TMSC or TSC. In the remaining 12 patients with abnormal SA for whom surgery was not recommended, a repeat SA in 6-12 months was planned.
Conclusions
In our experience, the use of an at-home semen analysis kit for evaluation of varicocele was had a 77% compliance rate and allowed for confident recommendation to proceed with varicocele correction in 27% of patients. The use of an at-home SA kit has permits an additional datapoint to help counsel patients and families regarding surgical treatment for varicocele. Further studies examining the rates of SA utilization and patient compliance with testing for in-lab versus at-home is ongoing.
