Impact of microscopic varicocelectomy on semen parameters and fertility outcomes

Impacto de la varicocelectomía microscópica en los parámetros seminales y los desenlaces de fertilidad

Background: This study aimed to evaluate the postoperative changes in semen parameters and natural pregnancy rates following microsurgery performed for male infertility in a single tertiary center. Methods: Between November 2017 and January 2024, 168 subfertile men with clinically palpable varicocele and at least one year of infertility history underwent microsurgery under spinal anesthesia. Patients with confounding conditions such as cryptorchidism, genital infections, prior scrotal surgeries, or female partner factors impairing fertility were excluded. Preoperative and postoperative semen analyses (1–3 months before and 6–8 months after surgery) were performed according to The World Health Organization guidelines. Semen parameters assessed included sperm concentration, progressive motility, and morphology. Patients were followed for at least 12 months postoperatively, and pregnancy outcomes (spontaneous or assisted reproductive technology were recorded. Results: The mean age of participants was 29.5 ± 4.6 years. The majority had Grade II or III varicocele, and 58.3% presented with left-sided varicocele. Postoperatively, significant improvements were observed in all semen parameters: median sperm concentration increased from 12.5 to 18 million/mL (p < 0.001), progressive motility improved from 25.74% ± 11.32% to 29.33% ± 7.72% (p < 0.001), and morphologically normal sperm percentage increased from 1% to 3% (p < 0.001). Overall, 96.4% of patients achieved successful paternity; 80.8% conceived spontaneously while 19.2% required assisted reproductive technology. The mean time to conception was 22.0 ± 5.7 months. Conclusions: Microsurgical subinguinal varicocelectomy was associated with improvements in semen parameters and high subsequent natural pregnancy rates in men with clinical varicocele. These findings support microsurgical subinguinal varicocelectomy as a reasonable first-line surgical option in appropriately selected patients, while recognizing that the need for assisted reproductive technology may still arise. Further multicenter studies are warranted to confirm long-term reproductive outcomes and refine patient selection.

Resumen

Antecedentes: Este estudio tuvo como objetivo evaluar los cambios posoperatorios en los parámetros seminales y las tasas de embarazo natural tras la microcirugía realizada por infertilidad masculina en un único centro terciario. Métodos: Entre noviembre de 2017 y enero de 2024, 168 varones subfértiles con varicocele clínicamente palpable y al menos un año de historial de infertilidad se sometieron a microcirugía bajo anestesia espinal. Se excluyeron los pacientes con condiciones de confusión como criptorquidia, infecciones genitales, cirugías escrotales previas o factores de la pareja femenina que afectaran la fertilidad. Los análisis seminales preoperatorios y posoperatorios (1–3 meses antes y 6–8 meses después de la cirugía) se realizaron conforme a las directrices de la Organización Mundial de la Salud. Los parámetros seminales evaluados incluyeron concentración espermática, motilidad progresiva y morfología. Los pacientes fueron seguidos durante al menos 12 meses en el posoperatorio y se registraron los desenlaces de embarazo (espontáneo o mediante técnicas de reproducción asistida). Resultados: La edad media de los participantes fue de 29.5 ± 4.6 años. La mayoría presentaba varicocele de grado II o III, y el 58.3% tenía varicocele izquierdo. En el posoperatorio se observaron mejoras significativas en todos los parámetros seminales: la mediana de la concentración espermática aumentó de 12.5 a 18 millones/mL (p < 0.001), la motilidad progresiva mejoró de 25.74% ± 11.32% a 29.33% ± 7.72% (p < 0.001) y el porcentaje de espermatozoides morfológicamente normales aumentó de 1% a 3% (p < 0.001). En conjunto, el 96.4% de los pacientes logró paternidad; el 80.8% concibió de forma espontánea y el 19.2% requirió técnicas de reproducción asistida. El tiempo medio hasta la concepción fue de 22.0 ± 5.7 meses. Conclusiones: La varicocelectomía subinguinal microscópica se asoció con mejorías en los parámetros seminales y con altas tasas posteriores de embarazo natural en varones con varicocele clínico. Estos hallazgos respaldan a la varicocelectomía subinguinal microscópica como una opción quirúrgica de primera línea razonable en pacientes apropiadamente seleccionados, reconociendo que la necesidad de técnicas de reproducción asistida puede seguir siendo necesaria en algunos casos. Se precisan estudios multicéntricos adicionales para confirmar los resultados reproductivos a largo plazo y optimizar la selección de candidatos.

Infertility; Varicocele; Varicocelectomy; Semen; Spermiogram; Microsurgery

Palabras Clave

Infertilidad; Varicocele; Varicocelectomía; Semen; Seminograma (espermograma); Microcirugía

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