Varicocelectomy and male fertility: comparison of semen quality and recurrence of varicocele following varicocelectomy by two techniques.

Abstract

Two hundred thirty-eight infertile men aged between 20 and 50 years suffering from left varicocele underwent ligation of the internal spermatic vein. The patients were operated on using Ivanissevich technique IT (210 patients) or the Bernardi technique BT (28 patients). In the BT group recurrences were found in 7.1% as against 28% in the IT group. The low rate of recurrence found in the BT group might be due to the fact that the patients were under local anaesthesia and collaborated with the surgeon. Varicocelectomy was followed by significant improvement in sperm quality 3 to 9 months after operation. Improvement among the fertile men was more rapid than among the infertile men. Sperm concentration improved significantly in 50% of the cases. Sperm motility improved in 37% of the cases, while morphology improved only in 29% of the cases. Sperm vitality was identical in response to that of motility. Varioocelectomy did not cause any change in the seminal plasma constituents (volume, pH, fructose). Improvement in sperm quality was identical in the IT and BT groups, as was the impregnation rate. 94 couples reported pregnancies 39.5%), which occurred within 2 years after operation (12 +/- 1.5 months mean +/- SEM). No correlation was found between size of varicocele and improvement in sperm quality and fertilizing capacity.