Sarcouncil Journal of Medical Series

Abstract: Varicocele is a very common and correctable factor that contributes to male subfertility, often accompanied by a decline in semen parameters, a change in the microenvironment of the testicles, and a decrease in serum testosterone. The objective of the present study was to quantify the changes in semen parameters, serum testosterone level, and spontaneous pregnancy rate after inguinal varicocelectomy in patients with clinical varicocele grade II/III. Our study analysed a group of 113 men (mean 31.4 ± 5.2 years) with clinical varicoceles (Grade II, n=68 and III, n=45). Pre- and post-operative (6 months) semen analysis (concentration, total motile sperm count, progressive motility, normal morphology, and volume) and fasting serum testosterone levels were measured. Clinical parameters such as pregnancies that were achieved by spontaneous means, as well as postoperative complications, were recorded and analyzed systematically. Marked improvements were seen for all important fertility parameters at 6 months after surgery. Sperm concentration increased by 36.3% (18.2 to 24.8 × 10⁶/mL), and total motile sperm count rose by 50.5% (32.5 to 48.9 × 10⁶). Semen motility improved (28.4–38.6%) in progressive motility and normal morphology (Kruger criteria) increased (3.2–4.9%). The volume of semen showed a slight improvement (2.8–3.0 mL). The testosterone level in the blood was raised by 13.6% (345 to 392 ng/dL). 82 patients improved in concentration and 76 in motility at the parameter level. This spontaneous pregnancy rate was 30.1% (34/113). The procedure had a very good safety profile, with the only reported complications being hydrocele (3.5%) and recurrence (2.7%), and 93.8% of patients had no complications. Semen quality is significantly improved after inguinal varicocelectomy, and serum testosterone is raised, resulting in a clinically significant spontaneous pregnancy rate at 6 months after surgery, and low complications. These results support the procedure as a safe, effective, and evidence-based procedure for men with clinically significant varicoceles who would like to restore fertility.