Analysis of Outcomes of Surgical Treatment for Varicocele in Primary Infertility Based on Seminal Parameters and Pregnancy Rate

Introduction: Varicocele is the most commonly observed and correctable cause of male factor infertility. The exact pathophysiology of varicocele is not known for certain. The purpose of our study was to analyze the effect of varicocele on the semen composition characteristics by semen analysis before and after varicocele ligation and also to assess the improvement in fertility status after varicocele ligation. Patients and Methods: A prospective, non-randomized study for a study period of 21⁄2 years with a total number (n) of 51 cases was carried out. Screening, identification, evaluation, and treatment were given to the patients attending our infertility clinic over a period from August 2010 to January 2013. A detailed semen analysis was done after 3 days of sexual abstinence. The specimen was examined within 1 h of collection. The history and clinical data of the patients were analyzed using SPSS software and comparison done using paired Student’s t-test. Results: The median sperm concentration of 51 patients in baseline semen analysis was 8 million/ml, and the median total sperm count of 51 patients was 18 million. The median forward (A + B%) motility percentage of sperms in 51 cases was 20%. The median normal morphology of sperms in 51 patients was 8%. Except 4 patients (7.4%) who were smokers, others did not have any smoking history or exposure to tobacco in any form. On comparing the data, post-operative sperm count and motility improvement were slightly better in sub-inguinal varicocelectomy surgery as compared with other modalities such as inguinal surgery and laparoscopic surgery. Conclusions: Varicocelectomy gives a statistically significant improvement in sperm concentration, motility, and overall morphology. All approaches to varicocelectomy (sub-inguinal, inguinal, or laparoscopic) have shown a significant improvement in seminal parameters, with sub-inguinal approach being good in improving motility parameter.