Functional outcomes of surgical treatment of varicocele in infertile men: Comparison of three techniques. (June 2022) - Ouanes, Yassine
Abstract: Introduction: Among identified causes of male infertility, varicocele holds an important place and is significantly associated with sperm quality deterioration. Surgical management of this condition leads to an improvement in the sperm count and an increase in the spontaneous pregnancy rate. Objective: The goal of this study was to compare different surgical techniques in terms of morbidity and fertility results. Patients and methods: It is a retrospective study of interesting patients followed for infertility related to varicocele between January 2007 and December 2015. Three surgical techniques were compared: open inguinal surgery, antegrade sclerotherapy, and laparoscopy. Morbidity and pregnancy rate were assessed according to different techniques. Results: Post-operative complication rates were comparable (p = 0, 94) between the 3 surgical techniques. An amelioration of sperm parameters has been noted in all operated patients, without statistical difference between the three techniques (p = 0, 29 for the sperm concentration and p = 0, 49 for the progressive mobility). Spontaneous pregnancy was better (p = 0, 03) for patients who have had a varicocelectomy in a sub-inguinal way. Conclusion: All of the three surgical techniques used in this study showed an improvement of sperm parameters in an equal way with similar morbidity. However, the spontaneous pregnancy rate with open surgery was better. Highlights: A varicocele is found in 15% of the male population and in 35% of men with infertility. Surgical treatment of a clinical varicocele improves spermogram parameters as well as the paternity rate. Open surgery should not be abandoned at the expense of sclerotherapy and laparoscopy. This technique was associated with a better paternity rate.