Effect of Microsurgical Varicocele Ligation in Patients with Isolated Oligozoospermia

Abstract Study question Is varicocelectomy effective in improving the semen quality of patients with isolated oligozoospermia (IO)? Summary answer Varicocelectomy is a valid option for infertile men with clinical varicocele and documented IO considering the significant improvement in semen concentration. What is known already Varicocele is the leading correctable cause of male factor infertility and its surgical treatment has been associated with sound improvement in semen quality and fertility potential. While varicocelectomy is clearly indicated in men with abnormal semen parameters, its effect on men with isolated abnormalities is less commonly assessed. Study design, size, duration The charts of 1521 patients who underwent microsurgical subinguinal varicocelectomy for clinically palpable varicocele between 2011-2021 were retrospectively reviewed. Infertile patients with IO were included in the study group, while data from patients with oligoasthenoteratozoospermia (OAT) were utilized for comparison. Participants/materials, setting, methods Men with azoospermia, a history of genitourinary infection, and those utilizing peri-operative fertility medications were excluded. The collected data included patient's demographics, varicocele grade and veins’ sizes, and their semen (semen analysis, WHO 2010; sperm DNA fragmentation, Halosperm) and hormone parameters before and up to 6 months after varicocelectomy. Data were analyzed using Wilcoxon Signed Ranks test and chi-squared tests. A p value <0.05 was considered significant. Main results and the role of chance A total of 96 patients with IO and 123 patients with OAT were included in the study. Patients with IO had a mean age of 32.5 ± 7 years, and an average testis volume of 15.6ml. The varicocele was of grades 2 and 3 in 58% and 38% of patients. Among the IO group, a significant increase in sperm concentration was identified postoperatively (p = 0.01). Surprisingly, results revealed a significant decrease in sperm total motility, however, the postoperative median was still within the normal range (45.5%). No significant changes were observed in other semen or hormone parameters. When a comparison was made with the OAT group, 83% of patients with IO had an improvement in sperm concentration compared to 63.9% of patients in OAT group following varicocelectomy (P = 0.044). However, a higher percentage of patients showed an improvement in total motility among the OAT group (67.6%) in comparison to the IO group (42.9%) (p = 0.04). Limitations, reasons for caution Results were obtained from a relatively small sample size. However, varicocele treatment is not necessarily considered as the first treatment option in men with mild or isolated derangements in semen quality. Wider implications of the findings Results of this study shed the light on the effect of varicocele treatment in men with isolated oligozoospermia and hence may be beneficial for patient counselling in the clinic. Trial registration number not applicable