RESUMO
There is no general consensus as to the ability of varicocelectomy to improve fertility. The objective of this retrospective study was to evaluate the post-operative improvement in male fertility [based on sperm parameters] and the pregnancy rate. This is a retrospective study of 50 patients with palpable varicocele who were subjected to varicocelectomy by the Palomo technique at the Urological Department of Grand Yoff Hospital, Dakar, Senegal. The examined parameters were the spermiogram characteristics [concentration, total motility after 1 hour, vitality] and the spermiocytogram [percentage of normal morphology]. These were tested once before and twice after the operation [between 3 and 9 months postoperatively and then again after 9 months]; the postoperative pregnancy rate was evaluate in 35 patients. In all patients the spermiogram revealed an improvement in the average values of all parameters, without actual normalization, except for morphology [spermiocytogram]. The post-operative results were statistically significant only for the sperm concentration. The majority of patients [76% to 92%] showed pre-operative spermiogram values below normal, except for morphology [28%] [spermiocytogram]. In 48% to 64% of patients the spermiogram characteristics improved, depending on the parameter taken into consideration. Improvement was particularly more evident in those patients who had presented with low average values. Prognostic factors predicting a good postoperative outcome were the age of the patients [less than 35 years], bilateral varicocele, secondary infertility and a shorter duration of infertility. We did not study the possible correlation between the degree of varicocele and pregnancy. The post-operative pregnancy rate was 31.42%. The fertile patients were younger, had a shorter average duration of previous infertility and had parameters which were constantly higher as compared to those patients who remained infertile. The post-operative improvements in fertility and pregnancy were quite limited in this study. Due to the relatively high incidence of varicocele in the male population, it appears necessary to improve awareness on its occurrence, its consequences and the results of its treatment on fertility. Moreover, a stronger cooperation between gynecologists, reproductive biologists, radiologists and uro-andrologists may allow for an integrated study of infertile couples. It also appears necessary to improve the psychological approach to these couples, particularly to the female partner