Effect of Varicocelectomy on Spermatogenesis

Shim, Hong Bang; Lee, Hee Yong

Abstract

A total of 37 randomized patients with left sided varicocele were investigated for the past 5 years to evaluate the effects of varicocelectomy on semen quality and fecundity. They were 14% of infertile males who hospitalized for surgical treatment except vasectomy reversal cases. According to severity of varicocele, patients were divided into three grades such as Grade I (Valsalva positive, consisted of 8 cases). Grade II (palpable, consisted of 18 cases) and Grade III (visible, consisted of 11 cases). Their, mean age was 29 years(20-40 years) (Table 1), and duration of marital life, 3 years(1-15 years). Mean levels of plasma FSH(6. 39 IU/l), LH(6. 25 IU/I) and testosterone (6. 97 ng/ml) were within normal ranges. There were no significant differences in hormonal levels among the grades of varicocele (Table 2), Oligospermias and normospermias were distributed in these grades of varicoceles almost the same extent. This means that the size or grade of varicocele was not closely correlated with degree of spermatogenic failure. Spermiogram of total patients was as follows: mean volume. 2. 9 ml; motility, 34%; normal shape, 68%; and azoospermia in 3 cases; counts of less than 20 X 10`/ml in 21 cases; and more than 20 x 10 6/ml in 13 cases with mean count of 26 x 10 6/ml(Tables 3 and 4). Of these, 6 subjects with sperm counts of more than 41 x10 6/ml were submitted to control series without surgery and the remaining 31 patients with sperm counts of less than 40 x 10 6/ml underwent varicocelectomy by high ligation of internal spermatic vein. After the operation, sperm appeared in 1 of the 3 azoospermia. Numbers of patients with sperm counts of less than 20 x 10 6/ml decreased from 21 to 19 cases, and those with more than 21 x 10 6/ml increased from 7 to 10 cases following the surgery. No significant changes in volume, motility and morphology could be demonstrated after varicocelectomy(Tables 5. 6 and 7). When judging by tentative criteria of fertility unit (total sperm counts( 10 6) x motility(%) x morphology(%) / 10 6) of more than 1 unit, improvement was observed in only 9 patients(29%) after the operation(Table 5). Three conceptions (10%) occurred in those submitted to varicocelectomy in 1 to 36 months after the operation and 1 pregnancy(17%) resulted in control series. In the present series of patients with varicocele, no significant beneficial effects were observed on semen quality and pregnancy rate after varicocelectomy(Tables 5 and 6).