Effect of varicocelectomy on sperm count, motility and morphology: comparative randomized study of different approaches

ABSTRACT

This prospective study was undertaken to estimate the effect of varicocelectomy on the count, motility and sperm morphology and how the morphological criteria predict outcome in patient population. Also, to estimate which approach can improve this outcome in a comparative randomized study. Between June 1996 and June 2000, a total number of 346/425 patients suffering from varicocele with primary infertility passed the exclusion criteria and agreed randomization. Their mean age was 33.4 years. All patients were clinically examined and fully investigated using semen analyses, testicular ultrasound and color doppler flow imaging. Bilateral high ligation, bilateral laparoscopic approach and subinguinal varicocelectomy with 5.5X magnification were carried out in 119, 112 and 115 patients respectively. Postoperatively, patients were followed up at 1, 3, 6 and 12 months intervals. Surgical correction of varicocele was associated with significant overall improvement in sperm count and motility in all-surgical groups. According to WHO classification, the percentage of sperms with normal morphology was significantly increased with a significant decrease in percentage of amorphous forms. Also, according to Kruger classification, there was a significant improvement in the overall percentage of normal forms after varicocelectomy. Moreover, the pregnancy rate was significantly higher in the subinguinal approach with magnification [53%] when compared with high ligation and laparoscopic groups [21.8% and 29.4% respectively]. On the other hand, postoperative hydrocele formation occurred more frequently in the high ligation approach [24.3%] when compared with laparoscopic [5.3%] and subinguinal [0%] approaches. Also the postoperative recurrence was significantly higher in the high ligation group [23.5%] when compared with the laparoscopic [14.2%] and the sabinguinal with magnification groups [0.8%]. From this study, we conclude that varicocelectomy has a positive effect on sperm count, motility and morphology and the subinguinal varicocelectomy with magnification is a safe, and a minimal invasive approach to varicocelectomy that lessens the incidence of hydrocele formation and varicocele recurrence, and assures preservation of testicular artery. Moreover, it has a higher positive effect on the sperm motility and morphology, which are the predictors of pregnancy