Microsurgical repair of even subclinical Varicoceles improves Fertility in men

The researchers performed a retrospective review on 190 infertile men who underwent a microsurgical varicocele repair by two surgeons from 2009 to 2017. Varicoceles were diagnosed by both physical exam and ultrasound and subsequently classified as “palpable” or “subclinical.” Subclinical varicoceles were not readily palpable on physical examination and were further defined as possessing veins in excess of 3.0 mm of diameter with retrograde flow on Valsalva while standing.

The subjects were stratified into one of three categories based on their pre- and postoperative semen analysis parameters, as defined by their total motile count (TMC) and eligibility for specific assisted-reproductive technology (ART) procedures: IVF (<5 million TMC), IUI (5–9 million TMC), and natural pregnancy (>9 million TMC). Changes in category after varicocele repair were assessed and the proportion of men in each category with clinical varicoceles to those with subclinical varicoceles were compared.

It was found that after varicocelectomy, the entire cohort experienced a mean improvement in their TMC of 8.9 million. Out of total men who were preoperatively characterized as IVF-only candidates, 49% remained in this group, 13% were upgraded to IUI, and 38% were upgraded to a natural pregnancy. The differential between these two increases in TMC was not found to be statistically significant, whereas the rates of “upgrade” between men with palpable and subclinical varicoceles were similar.

The authors concluded that Men with subclinical varicoceles have similar, clinically meaningful improvement in total motile sperm count ( TMC0 after varicocele repair compared to men with palpable varicoceles. There was no difference between the groups for clinical improvement in terms of intrauterine insemination and natural pregnancy.