Role of varicocelectomy in infertile patients with clinical varicocele and isolated sperm defects

This study investigated the outcomes of microsurgical subinguinal varicocelectomy (MSV) on semen and hormonal parameters in cases with isolated sperm defects (oligozoospermia, asthenozoospermia, or teratozoospermia). A retrospective review of charts of patients who underwent MSV for clinically palpable varicocele between January 1, 2011 and January 1, 2019 at Hamad Medical Corporation was undertaken. All patients diagnosed with isolated oligozoospermia, asthenozoospermia, or teratozoospermia in the preoperative semen analysis were included. Men with multiple sperm defects, genetic abnormalities, azoospermia, history of genitourinary infection, exposure to chemotherapy or radiotherapy, or prior use of peri-operative fertility treatment were excluded. Data extracted from the electronic medical records included (collected before MSV and up to 6 months postoperatively): demographics (age), clinical data (fertility-related medical history and surgical interventions), family history (consanguinity and infertility), physical examination findings from general and local genital exam (varicocele side and grade), laboratory data such as semen analysis, sperm DNA fragmentation tests, and hormone levels (follicle-stimulating hormone, luteinizing hormone, total testosterone, estradiol, and prolactin), and imaging (scrotal color Doppler ultrasound). A total of 331 patients with isolated sperm defects were included. Postoperatively, 83.3% of patients showed an improvement in sperm concentration with a median increase of 7 millions/mL. Postoperatively, 76.7% of isolated asthenozoospermic patients showed an improvement in total motility and 66.0% had an improvement in progressive motility with median increases of 15.0% and 7.5%, respectively. Postoperatively, 70.0% of the teratozoospermic patients showed an improvement in normal sperm morphology with a median increase of 6%. No changes were observed in other semen or hormone parameters that were examined. MSV is a valid and effective treatment modality for patients with isolated sperm defects that significantly corrects their respective semen abnormality and improves their chances of natural conception.