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Association of May-Thurner Syndrome with Semen Parameters Among Men with Varicocele
Catherine Gu, MD, Carol Benson, MD, Mary Frates, MD, Matthew Menard, MD, John Ernandez, MD, Martin Kathrins, MD.
Brigham and Women's, Boston, MA, USA.

Background: May-Thurner Syndrome (MTS) is an anatomic variant condition in which the right common iliac artery (CIA) overlies and compresses the left common iliac vein (CIV). MTS has been associated with an increased risk of lower extremity deep vein thrombosis. Such iliac venous congestion may impair drainage of spermatic cord cremasteric and deferential veins. Though varicoceles are well known for their impact on fertility, it is not clear what effect MTS may have on fertility potential and semen parameters. We hypothesize that MTS may be an independent contributing factor to abnormal semen parameters in the setting of a left varicocele (Grade II/III or III/III). The objective of this study is to compare bulk semen parameters of men with varicoceles and MTS versus varicocele alone.
Methods:Men with a Grade II/III or III/III palpable left sided varicocele and baseline semen parameters were examined. Varicocele was confirmed by scrotal ultrasound demonstrating pampiniform venous dilation. In cases of recurrent varicocele after previous surgical repair, sustained reversal of pampiniform venous flow with Valsalva was demonstrated. Pelvic doppler ultrasounds were performed to determine whether MTS was present. MTS was diagnosed based on both >50% narrowing of the left CIV as it crosses under the right CIA and abnormal distal venous waveform. Baseline semen and hormonal parameters were analyzed with two sample t-tests.
Results:Of the 20 patients examined, 10 were found to have both a left varicocele and MTS. The results of our analysis are in Table 1. No differences were noted in age, sperm concentration, total motile count, FSH, or total testosterone. Men with a left varicocele and MTS presented with lower total motility than men without MTS.
Table 1

MTS (n=10)No MTS (n=10)p (two-sided)
Age (years)29.38.634.56.80.15
Concentration (million/mL)26.317.022.2236.90.75
Total motility (%)23.311.742.23260.05
Total Motile Count (million)14.311.131.968.70.43
Recurrent left varicocele360.18
Total testosterone (ng/dL)5171465512040.68

Conclusions:In our initial cohort of men with left varicocele and semen analysis results, patients with concurrent MTS were found to have lower overall sperm motility. Further research is needed in larger cohorts to confirm these findings.

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