Repairing varicoceles through surgery can improve fertility

This study examined whether surgical repair of varicoceles increased fertility in men with low sperm counts.

Varicoceles, or enlarged blood vessels in the scrotum, are found in 40% of infertile men. They are thought to lead to infertility by increasing the temperature in the scrotum, killing the sperm cells. In microsurgical varicocelectomy, the veins are cut to block blood flow to the varicoceles. There are conflicting results, however, as to whether or not this procedure restores fertility. One study reported that sperm counts increased in 57% of men following varicocelectomy, but this was a small study, and the benefits have not yet been shown in a larger number of patients. The current analysis examined whether varicocelectomy improved fertility in men with very low sperm counts.

This retrospective study examined the records and outcomes of 102 patients with very low sperm counts who underwent varicocelectomy. Sperm counts were measured prior to surgery and at three month intervals following, with an average follow-up time of 7.4 months. Hormone levels, including testosterone, follicle-stimulating hormone, and luteinizing hormone, were also measured. Treatment responders were defined as those patients whose sperm motility (ability of sperm to move) improved and sperm counts increased.

Following varicocelectomy, 41.1% of patients were determined to be responders, with both sperm motility and sperm counts improving. Sperm counts improved from an average of 2.4 million/mL to 11.6 million/mL, and sperm motility increased by an average of 9.4%. Spontaneous pregnancy occurred in 17.6% of couples following the procedure, 88.8% of whom were responders. 

Responders were more likely to have had higher sperm counts prior to surgery than non-responders. Sperm counts were the only measure found to have changed following surgery: sperm motility and hormone levels did not change in either patient group.

This study concluded that varicocelectomy improved sperm counts and fertility in men with varicocele, though the sperm count prior to surgery also had an effect on the success rate.