To Find the Effect of Microsurgical Varicocelectomy on Sperm Motility in Infertile Men
Mir Abid Jan, Irshad Khan, Muhammad Shahid Bhatti, Shahjehan, Khadija Saleem, Khalil Ur Rehman
Abstract
Background: Varicocele is a common cause of male infertility and is associated with impaired spermatogenesis and reduced sperm quality. Microsurgical varicocelectomy is performed to improve semen parameters and potentially enhance fertility.
Objective: To evaluate the effect of microsurgical varicocelectomy on sperm motility and sperm count in infertile men with clinically palpable varicocele.
Methods: This prospective interventional study was conducted at the Institute of Kidney Diseases, MTI-Hayatabad Medical Complex, Peshawar, from October 2022 to March 2023. A total of 23 infertile men aged 20–45 years with clinically palpable grade I–III varicocele were included. All patients underwent subinguinal microsurgical varicocelectomy. Semen analysis was performed before surgery and three months after surgery. Sperm motility and sperm count were compared using a paired t-test.
Results: The mean sperm motility increased from 24.95% before surgery to 41.98% three months after microsurgical varicocelectomy (p<0.001). Mean sperm count increased from 2.97 million/mL to 9.85 million/mL (p<0.001). Improvement was observed across different age groups, varicocele grades, and durations of infertility.
Conclusion: Microsurgical varicocelectomy was associated with significant improvement in sperm motility and sperm count in infertile men with clinically palpable varicocele.
Key Words: Varicocele, infertility, microsurgical varicocelectomy, sperm motility, sperm count, semen analysis.
Introduction
Infertility affects a significant proportion of couples, with male factors contributing to approximately half of infertility cases. Varicocele is characterized by abnormal dilatation of the veins of the spermatic cord and represents one of the common correctable causes of male infertility.
The presence of varicocele may negatively affect spermatogenesis and sperm quality. Increased scrotal temperature, oxidative stress, reactive oxygen species, lipid peroxidation and sperm DNA damage have been proposed as mechanisms contributing to impaired semen parameters.
Varicocelectomy aims to correct the abnormal venous circulation and may improve testicular function, sperm production and sperm quality. Microsurgical techniques provide magnification that allows identification and preservation of the testicular artery and lymphatic vessels while allowing ligation of the abnormal spermatic veins.
Previous studies have reported improvements in sperm concentration and motility following varicocelectomy. However, the degree of improvement may vary according to varicocele grade, baseline semen quality, duration of infertility and other patient characteristics.
The present study was conducted to evaluate the effect of microsurgical varicocelectomy on sperm motility and sperm count among infertile men with clinically palpable varicocele.
Materials and Methods
This prospective interventional study was conducted at the Institute of Kidney Diseases, MTI-Hayatabad Medical Complex, Peshawar, from October 2022 to March 2023.
A total of 23 infertile men between 20 and 45 years of age were included. All patients had clinically palpable grade I–III varicocele confirmed by clinical examination and Doppler ultrasonography.
Patients had a history of infertility for at least one year and normal levels of FSH, LH and testosterone.
Patients with previous varicocele repair, previous testicular surgery, obstructive azoospermia, hydrocele, testicular tumors, diabetes mellitus or hypertension were excluded.
Among the 23 patients, 15 had bilateral varicocele and 8 had unilateral left-sided varicocele.
All patients underwent subinguinal microsurgical varicocelectomy by a single experienced surgeon. Internal spermatic veins were identified and ligated while preserving the testicular artery and lymphatic vessels.
After surgery, patients were prescribed analgesics and advised to use scrotal support. Strenuous physical activity was avoided for six weeks.
Semen samples were collected by masturbation after an abstinence period of 3–5 days and analyzed within one hour of collection. Sperm motility was recorded as the percentage of motile spermatozoa.
Semen analysis was performed before surgery and three months following surgery. Data were analyzed using SPSS version 25. A paired t-test was used to compare preoperative and postoperative semen parameters. A p-value of less than 0.05 was considered statistically significant.
Results
A total of 23 infertile men were included in the study. The mean age was 33.09 years and the mean BMI was 23.93 kg/m². The mean duration of infertility was 5.22 years.
Overall mean sperm motility increased from 24.95% before surgery to 41.98% after surgery, with a statistically significant difference (p<0.001).
Mean sperm count increased from 2.97 million/mL before surgery to 9.85 million/mL after surgery, also showing a statistically significant improvement (p<0.001).
Table 1. Effect According to Age
| Age group | Preoperative motility | Postoperative motility | Preoperative count | Postoperative count |
|---|---|---|---|---|
| 20–35 years | 25.46% | 42.62% | 3.17 | 8.46 |
| 36–45 years | 24.29% | 41.15% | 2.72 | 11.66 |
Both age groups demonstrated significant improvement following surgery.
Table 2. Effect According to BMI
| Group | Preoperative motility | Postoperative motility | Preoperative count | Postoperative count |
|---|---|---|---|---|
| Obese | 22.10% | 44.20% | 2.38 | 10.01 |
| Non-obese | 25.38% | 41.65% | 3.06 | 9.83 |
Improvement in sperm motility was statistically significant in both groups.
Table 3. Effect According to Duration of Infertility
| Duration | Preoperative motility | Postoperative motility | Preoperative count | Postoperative count |
|---|---|---|---|---|
| 1–5 years | 24.46% | 41.86% | 2.70 | 9.94 |
| 6–10 years | 25.59% | 42.14% | 3.33 | 9.74 |
Both groups showed significant improvement following microsurgical varicocelectomy.
Table 4. Effect According to Varicocele Grade
| Grade | Preoperative motility | Postoperative motility | Preoperative count | Postoperative count |
|---|---|---|---|---|
| Grade I | 24.54% | 42.30% | 2.84 | 10.44 |
| Grade II | 25.62% | 40.24% | 2.68 | 8.59 |
| Grade III | 25.22% | 42.80% | 3.50 | 9.72 |
Significant improvements were observed across all three grades of varicocele.
Discussion
The present study demonstrated a significant improvement in sperm motility and sperm count following microsurgical varicocelectomy.
Mean sperm motility increased from 24.95% to 41.98%, while sperm count increased from 2.97 million/mL to 9.85 million/mL. These findings indicate that correction of clinically palpable varicocele may improve semen parameters in infertile men.
The improvement observed in sperm motility may be related to correction of abnormal venous circulation, reduction in testicular temperature and reduction of oxidative stress. Varicocele has been associated with increased reactive oxygen species and impaired sperm function, and surgical correction may help reverse some of these abnormalities.
The improvement was observed in different age groups and across different grades of varicocele. Patients with different durations of infertility also demonstrated improvement following treatment.
Previous studies have similarly reported improvements in sperm motility and concentration following varicocelectomy. The findings of the present study are therefore consistent with the reported benefits of microsurgical varicocelectomy on semen parameters.
Microsurgical techniques may provide advantages because of the ability to identify and preserve important structures, including the testicular artery and lymphatic vessels, while effectively ligating the abnormal veins.
Conclusion
Microsurgical varicocelectomy significantly improved sperm motility and sperm count in infertile men with clinically palpable varicocele.
The improvement was observed across different age groups, durations of infertility and grades of varicocele. These findings support microsurgical varicocelectomy as a surgical approach for improving semen parameters in appropriately selected infertile men with varicocele.
References
- Ghazi et al. Studies evaluating changes in sperm motility and concentration following varicocelectomy.
- Cannarella et al. Meta-analysis evaluating the effect of varicocelectomy on semen parameters.
- Studies evaluating sperm DNA fragmentation and changes following varicocele repair.
- Zini and Soetandar. Studies assessing semen parameters following varicocelectomy.
- Mei et al. Studies evaluating the timing and duration of improvement following varicocelectomy.
- Zhang et al. Studies investigating metabolic abnormalities associated with varicocele and male infertility.