Abstract
The study aimed to determine the effect of microsurgical sub-inguinal varicocelectomy on semen parameters among men seeking infertility treatment in Ghana. This was an intervention study conducted at Tamale Teaching Hospital in the Tamale Metropolis from September 2017 to August 2021. The study involves two groups; the surgery group (n = 75) and the observed group (n = 63). Duplicate semen samples (mean values adopted) were collected at the onset and assessed according to the criteria established by World Health Organization (WHO), 2010. Varicocelectomy was performed for the surgery group and no intervention was given to the observed group. The two groups were followed for 180 days and repeated semen samples were collected and analyzed. The data was computed using GraphPad Prism (v8.0) at an alpha of 0.05. All the men had varicocele and were aged between 46.0 and 67.0 years old. There was no difference between semen parameters among the two groups before the surgery. However, after 180 days of follow-up, all of the semen parameters significantly improved in the surgery group (p < 0.0001), while sperm concentration (p = 0.0068), progressive motility (p = 0.0281), and normal sperm morphology (p = 0.0015) decreased in the observed group. The surgery group had an overall percent increase in total sperm count (840.7%; p = 0.0197), sperm concentration (582.1%; p = 0.0125), total viable sperms (155.2%; p < 0.0001), and normal sperm morphology (110.9%; p < 0.0001) while immotile sperms (-51.71%; p < 0.0001) reduced. A pregnancy rate of 25.3% (19/75) was reported among the surgery group but none was reported among the observed group after 180 days. Microsurgical sub-inguinal varicocelectomy improves semen parameters and hence effective treatment of infertile men with a clinically palpable varicocele. It is recommended to use this choice for similar patients, however, further studies with a larger sample size are needed to provide more evidence to recommend this therapy.
Highlights
Infertility renders spontaneous pregnancy nearly impossible and currently in medical practice, impairment of semen parameters suggests that a varicocele might be present [1]
Varicocelectomy was performed for the surgery group and no intervention was given to the observed group
There was no significant difference between the age (p = 0.3384), body mass index (BMI) (p = 0.2474) visceral fat (p = 0.2621), systolic blood pressure (SBP) (p = 0.5448), and diastolic blood pressure (DBP) (p = 0.3575) of the surgery group compared with the observed group (Table 2)
Summary
Infertility renders spontaneous pregnancy nearly impossible and currently in medical practice, impairment of semen parameters suggests that a varicocele might be present [1]. Several studies have linked the low or poor quality of sperm production to; anatomical anomaly of the varicocele [7] [8], increased scrotal temperature [9], and adrenal hormone, and gonadotoxic metabolite refluxes [10], epigenetic changes [11], and increased production of reactive oxygen species (ROS) in the scrotum which results in sperm DNA damage [12]. These related factors may act individually or synergistically affecting spermatogenesis in varicocele patients
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