Preoperative Total Testicular Volume as a Predictor of Total Motile Sperm Count Improvement Following Microsurgical Varicocelectomy

ABSTRACT Background Varicocelectomy has been shown to improve semen parameters in men with infertility; however, not all men experience improvement. Identifying preoperative predictors of semen parameter improvement is necessary for counseling and treatment planning. Objective To determine if preoperative total testicular volume is associated with improved total motile sperm count (TMSC) after microsurgical varicocelectomy and to establish an optimal volume threshold for predicting clinical outcomes. Materials and Methods We retrospectively reviewed 110 men who underwent microsurgical varicocelectomy for infertility between January 2017 and May 2024. Inclusion criteria were adult men with preoperative TMSC <15 million and a history of at least 12 months of infertility. Testicular volume was assessed clinically by physical examination. The primary outcome was the upgrade in TMSC category after surgery, defined as a change from azoospermia, in vitro fertilization (IVF), or intrauterine insemination (IUI) to a higher category. Statistical analyses included Wilcoxon signed‐rank, t ‐tests, chi‐squared tests, multivariable logistic regression, and receiver operating characteristic (ROC) curve analysis. Results Of the 110 men, 56 (51%) demonstrated improvements in TMSC category. Men who experienced improvement had higher preoperative total testicular volume (33.0 mL vs. 23.4 mL, p < 0.001). ROC curve analysis identified a total testicular volume threshold of ≥25.5 mL, which was associated with a 12‐fold increased odds of improvement (OR 12.0, 95% CI: 2.6–77.5, p = 0.003). In multivariable analysis, age, BMI, procedure laterality, varicocele grade, and preoperative FSH and total testosterone levels were not independently associated with postoperative improvement in TMSC. Discussion and Conclusions Preoperative total testicular volume is a strong predictor of improvement in TMSC following microsurgical varicocelectomy. These findings support the use of testicular volume in preoperative evaluation.