P-061 Effect of Varicocelectomy on fertility potential and pregnancy outcome: results of a large cohort from a tertiary medical center
Authors: Al Saeedi A , Arafa M , Elbardisi H , Altyeb A  B , Assadiq G  A , Al Malki A , Khalafalla K , Al Kubaisi K , Fadol N  I , Al-Said S , Majzoub A 
Published: July 2024

Abstract

Study question
Does varicocelectomy improve semen parameters, hormones & pregnancy outcomes in infertile men with clinical varicocele?

Summary answer
In infertile men with clinical varicocele, sperm count, motility, and DNA fragmentation improved significantly after varicocelectomy. Pregnancy outcomes improved for both spontaneous and assisted reproduction.

What is known already
Infertility is estimated to impact 15% of couples attempting to conceive worldwide. Varicocele has been identified as the most common surgically correctable cause of male infertility. Despite the significant role of varicocele in the pathogenesis of male infertility, the impact of varicocele repair (VR) on conventional semen parameters & pregnancy outcomes remains controversial. Few systematic reviews and meta-analyses (SRMAs) evaluated the impact of VR on sperm concentration, total motility, and progressive motility, mostly using a before-after analytic approach with fewer studies reporting on pregnancy outcomes.

Study design, size, duration
This was a retrospective study of 2171 patients presenting with infertility & clinical varicocele between 2014 and 2024.

Participants/materials, setting, methods
Exclusion criteria were prior medications, medical illnesses causing infertility, or endocrine disorders.
All participants underwent sub-inguinal microsurgical varicocelectomy. Data regarding patient demographics, clinical findings, semen analysis, serum hormone levels & pregnancy outcomes were collected pre and post-operatively. Variables were examined before & after varicocelectomy. X2 test and Kruskal-Wallis test were used to analyze categorical and numerical values, respectively. A p value &lt; 0.05 was considered statically significant.

Main results and the role of chance
A 2171 participants were included. The mean age ± SD of the study population was 33.65 ± 8.54 years. Their mean right testicular size, left testicular size, right vein size, and left vein size were 14.38 ± 4.56,13.46 ± 3.49, 2.47±0.79 & 3.99 ±1.33 respectively. When subdividing them by grade of varicocele, on the right side, grades 1, 2, and 3 were detected in 692 (31.9%), 491 (22.6%), and 63 (2.9%), respectively. While on the left side, grades 1, 2, and 3 varicoceles were detected in 303 (13.9%), 999 (46%) & 867 (39.9%), respectively. Indication for surgery was pain (37%, primary infertility (42.9%), secondary infertility (18.3%), and others (3.6%). The majority performed unilateral varicocelectomy (1776 {81.8%}), while 396 (18.2%) underwent bilateral varicocelectomy. Varicocelectomy significantly improved sperm count, total & progressive motility & DNA fragmentation. Pregnancy outcomes improved postoperatively for both spontaneous (32.3%) & assisted reproduction (25.2%). No significant change was found in hormones postoperatively.

Limitations, reasons for caution
Retrospective study, single center experience.

Wider implications of the findings
It is important in patients’ counselling & choose the best management for this group of patients.

Trial registration number
NA