Infertility Due To Varicocele: Is Surgery The Answer? | 3521
Journal of Gastrointestinal & Digestive System
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To evaluate the effect of varicocele on semen and its changes following varicocelectomy.
The study included 112 subjects of which 71 subjects were of varicocele (46 with and 25 without infertility) and 41
subjects were controls (20 fertile adults and 21 adults with infertility without varicocele). All subjects underwent detailed semen
analysis (including volume, pH, sperm counts, motility, morphology and sperm function test), FNAC of bilateral testes and
hormonal analysis (LH, FSH, Testosterone). Bilateral low ligation (under loupe magnification) of varicocele was done in Doppler
confirmed cases and changes in above parameters were recorded post operatively. The subjects were followed up for a period of
6 months. The parameters were compared and analyzed among the four groups and also with post operative values in subjects of
varicocele using Student?s t-test or Chi-square test as applicable. Some data showed wide variation, so Mann Whitney?s test was
also used where applicable. Statistical significance was defined if the p value was <0.05.
On pre-operative evaluation subjects with varicocele were found to have significantly low sperm counts, low sperm
motility, deranged sperm function and higher proportion of sperms with abnormal morphology in semen as compared to
controls. The semen parameters improved markedly within 3-6 months after bilateral varicocele ligation with significant increase
in sperm counts, motility and also functional capacity of sperm (morphology and sperm function test). There was significant
improvement in the subjects? hormonal status and grade of testicular histology after surgery. The extent of impairment and post
operative improvement of all parameters was related to the grade of varicocele.
Varicocele has an adverse effect on male fertility by affecting semen parameters. Bilateral varicocele ligation causes
a progressive and significant improvement of semen parameters and thus increases the chances of conception. Therefore, though
the indication of surgery for symptomatic varicocele is well established, we also recommend surgery in all cases of varicocele
associated with infertility or oligospermia.
Anurag Mishra is a young surgeon currently doing his residency in prestigious Maulana Azad Medical College. He has keen interest in clinical
research and participates in various conferences both in India and abroad. He already has presented his work in 2 international (in Nanjing, China
and Paris, France) and various national meetings as oral presentation. He also has deep interest in academic and sees himself as professor in a
good medical college in coming times.
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