(337) Microsurgical Varicocelectomy Improves Seminal Parameters in Infertile Men: 10-year Experience in a University Hospital

Abstract

Abstract Introduction Varicocele is the most common treatable cause of male infertility. Although the exact mechanisms by which varicocele causes infertility have not been fully identified, there is evidence of an improvement in seminal parameters and pregnancy rates after varicocelectomy, especially if the technique is performed with an operating microscope Objective This study seeks to compare pre- and post-operative seminal and hormonal parameters of infertile patients undergoing microsurgical varicocelectomy in a local cohort Methods Retrospective analytical study of male patients with a diagnosis of infertility and clinical varicocele, who underwent microsurgical varicocelectomy in a University Hospital, between April 2013 - April 2023. Demographic variables, varicocele grade and laterality, reproductive hormone levels, seminal parameters and postoperative complications were collected from the clinical history database. Pre and postoperative seminal parameters and reproductive hormones were compared using non-parametric statisticians were used for data analysis with the Jamovi Software. P<0.05 was considered statistically significant Results There were 136 varicocelectomies in the period, 56 patients were excluded due to incomplete data collection and finally 80 patients were analyzed. Median age was 34.5 years (IQR 31-38), with a median infertility duration of 2 years (IQR 1-4). All patents had primary infertility. The median testicular volume was 15 cc (IQR 15-20 cc). 82.5% of varicoceles were Grade ≥2, 70.6% patients presented left varicocele and 28% were bilateral. Of the reproductive hormones, only FSH showed a statistically significant decrease of the pre- and post-operative median values, being 5.8 IU/L (IQR 3.9-8.9) and 2.7 IU/L (IQR 2.5-2.9) (p=0.001), respectively. Median sperm concentration before and after surgery was 7 million/mL (IQR 2-23) and 18 million/mL (IQR 3.3-73.5), respectively (p=0.02). Median preoperative and postoperative sperm progressive motility was 29% (IQR 15-48) and 40% (IQR 27-60), respectively (p=0.004). Seminal volume and normal morphology did not show significative changes after surgery. Only 2 patients (2.5%) presented a grade 1 Clavien-Dindo postoperative complication (mild infection of surgical site) Conclusions In this study, infertile patients with a clinical diagnosis of varicocele showed a statistically significant improvement in sperm concentration and progressive motility and a significant decrease in FSH levels after microsurgical varicocelectomy. The reduction of this pituitary hormone may reflect an improvement in testicular spermatogenesis Disclosure No.