effect of varicocelectomy on seminal parameters and serum hormones [follicle stimulating hormone [FSH], testosterone] in infertile men with varicocele

ABSTRACT

To assess the effects of varicocelectomy on testicular functions; semen quality and serum hormones [FSH, testosterone] in patients suffering from infertility and having clinical varicoceles. Fifty-three infertile patients, their ages ranged from 25-45 years and having clinical varicoceles [14 bilateral, 39 left side only], underwent inguinal varicocelectomy. Semen analysis [at least 3 times] was performed before varicocelectomy and 6 and 12 months after the operation. Also serum hormones [FSH, testosterone] were measured before and 6 months after surgery. Before varicocelectomy the patients were classified into 4 groups according to their total motile sperm counts [TMS]. After varicocelectomy the mean relative increases in TMS were calculated for each group. Also the mean increase or decrease in serum testosterone and FSH were calculated. The patients were followed for a mean follow up of 25 months [range 6-55] and all pregnancies that occurred during the follow up were reported.Patients with mild .and moderate oligoasthenospermia showed significantly better seminal improvement following varicocelectomy, than patients with severe oligoasthenospermia and patients with azoospermia, in whom the improvement in semen quality was little after the operation. Serum FSH decreased in about 35% of the patients, from a mean of 13.8 +/- 2.4 before varicocelectomy to a mean of 9.6 +/- 1.8 mIU/mL by 6 months after the operation. Also serum testosterone increased, in about 50% of the patients, from a mean of 5.2 +/- 1.5 before varicocelectomy to a mean of 8.5 +/- 1.6 ng/mL by 6 months after the operation.There were 13 pregnancies by natural conception during the follow up period.Most of these pregnancies occurred 6 months to 2 years after surgery and most were in postoperative group A [10 pregnancies] when the TMS improved> 30 million. Varicocelectomy is the most effective initial intervention in males with mild or moderate oligoasthenospermia with clinical varicoceles. Varicocelectomy improves testicular functions, with significant increase in serum testosterone and significant improvement in sperm concentration and motility