Varicocele grade, laterality, and reproductive outcomes: evidence from a large tertiary-center cohort study

Grado, lateralidad del varicocele y resultados reproductivos: evidencia de un estudio de cohorte en un centro terciario de alta complejidad

Background: The study aimed to assess the impact of varicocele grade and laterality on semen quality in infertile men and their association with reproductive outcomes following microsurgical varicocelectomy. Methods: This retrospective study included 2871 infertile men diagnosed with clinical varicocele at a tertiary urology center (2005–2022). Varicocele grade (I–III) and laterality (unilateral/bilateral) were classified per World Health Organization (WHO) 2000 guidelines. Semen analysis followed WHO 1999/2010 criteria. A subgroup underwent microsurgical varicocelectomy and was followed for 12 months to assess spontaneous pregnancy and time to conception. Results: Unilateral varicocele was found in 64.9% and bilateral in 35.1%. Grade II varicocele predominated (80.6%), with Grades I and III comprising 11.4% and 8.0%, respectively. Normal semen parameters were observed in 55.5% of patients; the remainder had abnormalities such as asthenozoospermia (28.9%), oligozoospermia (6.9%), and azoospermia (3.9%). Semen quality did not differ significantly across grades or laterality (p > 0.05). Among surgical patients, 40.7% achieved spontaneous pregnancy within 12 months (mean time to conception: 4.3 ± 0.03 months). Neither varicocele grade nor laterality significantly influenced pregnancy rates or timing. Conclusions: Varicocele grade and laterality were not significantly associated with semen quality or postoperative pregnancy outcomes. These findings support individualized patient selection for varicocelectomy, considering broader clinical and reproductive factors rather than varicocele classification alone.

Resumen

Antecedentes: Evaluar el impacto del grado y la lateralidad del varicocele sobre la calidad del semen en hombres infértiles y su asociación con los resultados reproductivos después de la varicocelectomía microquirúrgica. Métodos: Este estudio retrospectivo incluyó a 2871 hombres infértiles diagnosticados con varicocele clínico en un centro urológico terciario (2005–2022). El grado (I–III) y la lateralidad (unilateral/bilateral) del varicocele se clasificaron según las directrices de la Organización Mundial de la Salud (OMS) 2000. El análisis seminal siguió los criterios de la OMS 1999/2010. Un subgrupo se sometió a varicocelectomía microquirúrgica y fue seguido durante 12 meses para evaluar el embarazo espontáneo y el tiempo hasta la concepción. Resultados: Se identificó varicocele unilateral en el 64.9% y bilateral en el 35.1%. Predominó el varicocele de grado II (80.6%), mientras que los grados I y III representaron el 11.4% y 8.0%, respectivamente. Se observaron parámetros normales de semen en el 55.5% de los pacientes; el resto presentó anomalías como astenozoospermia (28.9%), oligozoospermia (6.9%) y azoospermia (3.9%). La calidad del semen no difirió significativamente entre los distintos grados ni según la lateralidad (p > 0.05). Entre los pacientes operados, el 40.7% logró embarazo espontáneo dentro de los 12 meses (tiempo medio hasta la concepción: 4.3 ± 0.03 meses). Ni el grado ni la lateralidad del varicocele influyeron significativamente en las tasas de embarazo ni en el tiempo hasta la concepción. Conclusiones: El grado y la lateralidad del varicocele no se asociaron significativamente con la calidad del semen ni con los resultados reproductivos posteriores a la cirugía. Estos hallazgos respaldan la selección individualizada de pacientes para varicocelectomía, considerando factores clínicos y reproductivos más amplios en lugar de basarse únicamente en la clasificación del varicocele.

Varicocele; Varicocelectomy; Semen; Pregnancy

Palabras Clave

Varicocele; Varicocelectomía; Semen; Embarazo

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