Evaluation of the Effect of Varicocelectomy on Semen Parameters and Fertility

Abstract

Background: Varicocele is the major reversible cause of male infertility. It is observed in 35%–40% of all men with primary infertility and in up to 80% of those with secondary infertility. While varicocele can be associated with testicular discomfort and atrophy, the negative effects of varicocele on male fertility and semen parameters, as well as recent evidence identifying varicocele as a risk factor for hypogonadism, are the most relevant ramifications of the condition. Objective: To evaluate the negative effect of varicocele on semen parameters (concentration, motility, volume and morphology) and the outcome of varicocelectomy on semen parameters and paternity in infertile men. Patients and Methods: This is a prospective study done in the period from January 2008 to October 2012 at Iraq, Baqubah teaching hospital and private clinic in which 120 patients are included (those men who are infertile and diagnosed to have varicocele on physical examination), all those patients are sent for 3 seminal fluid analysis in different times and different labs , those with impaired semen parameters are subjected to varicocelectomy through high scrotal incision this had been underwent by the same consultant surgeon, then follow up of these patients was done at 3,6,12 months by seminal fluid analysis. Results: The results were as follow, grade 3{(45 patients) the semen parameters improvement were as follow. Mean sperm count from10..6 x106 mL preoperatively to 36.4 x106ml post operatively. Mean sperm Motility improve from 21.3% to 31.4%. Mean semen Volume from 1.3 ml to 3 ml. Serm morphology were abnormal sperm in 18 patients preoperatively , and in 8 patients only post operatively remain abnormal sperm morphology}. Grade 2 {(25 patients) the improvement were as follow. Mean sperm count from17.3 x106ml to 32.4x106ml. Mean sperm Motility from25.4% to35.6 %. Mean semen Volume from 1.9 ml to3ml. Sperm morphology were abnormal in 9 patients preoperatively and in 5 patients postoperatively}. Grade 1 {(20 patients) the improvement were as follow, Mean sperm Count from21.5 x106ml to36.7x106ml, Mean sperm Motility from31.6% to 36.2%, Mean semen Volume from 2.8ml to 3.8 ml, Sperm morphology were abnormal in 6 patients preoperatively and in 2 patients postoperatively. Subclinical varicocele (30 patients) the improvement was very little as follow, Mean sperm Count from 25.4x106ml to 28.3 x106ml, Mean sperm Motility from 23.3% to 26.4%, Mean semenVolume from 2ml to 2.3 ml, Sperm morphology were abnormal in 5 patients preoperatively and in 3 patients postoperatively, 8 (6.66%) patients from grade 3 had got pregnant during the 12 months after operation, 3(2.50%) patients from Grade 2 got pregnancy within 12 months of follow up after operation. One(0.83%) patient got pregnancy from Grade 1 during 12 months of follow up after surgery. Conclusion: Infertile men with clinical varicocele are a good candidate for varicocelectomy and they will get benefits in term of semen parameters improvement and in parity.