Varicocele Repair and Semen Volume
Varicocele repair can improve semen volume in men with clinical varicoceles and abnormal semen parameters. 1, 2
Effect of Varicocele Repair on Semen Parameters
- Varicocele repair is associated with improvements in multiple semen parameters, including semen volume, in men with clinical varicoceles and preoperative abnormal sperm quality 1, 3
- After varicocele repair, the average time to improvement in semen parameters is approximately two spermatogenic cycles (3-6 months) 1, 3
- Studies have demonstrated significant increases in mean left and total testicular volume after varicocele repair, which correlates with improvements in semen volume and other parameters 2
- Embolization treatment for varicocele has also been shown to significantly improve semen parameters, including sperm concentration per ejaculate, which reflects improved semen volume 4
Clinical Considerations for Varicocele Treatment
- Varicocele is present in approximately 15% of the normal male population, but this percentage increases to 25% in men with abnormal semen analysis and 35-40% in men presenting with infertility 1, 3
- Only clinical (palpable) varicoceles should be treated, as treatment of subclinical (non-palpable) varicoceles is not associated with improvement in either semen parameters or fertility rates 1, 3
- The mechanism behind varicocele-induced fertility issues includes higher scrotal temperature, testicular hypoxia, and reflux of toxic metabolites that can cause testicular dysfunction through increased DNA damage 3
- Varicocele repair appears to have the most beneficial effects in men with impaired semen parameters and palpable varicoceles 5
Treatment Options and Outcomes
- The main procedures for varicocele repair include microsurgical subinguinal or inguinal varicocelectomy, laparoscopic varicocelectomy, and radiological percutaneous embolization 5
- Microsurgical varicocelectomy is generally considered the optimal treatment in most cases 5
- Spontaneous pregnancy typically occurs between 6 and 12 months after varicocelectomy in couples where varicocele was the primary cause of infertility 1, 3
- Varicocele repair may also improve outcomes in men undergoing assisted reproductive technologies 3
Special Considerations
- In some cases of azoospermia with spermatogenic failure, varicocele repair has resulted in the appearance of sperm in the ejaculate, particularly in men with severe hypospermatogenesis or maturation arrest at the spermatid stage 6
- Higher varicocele grade and older age are associated with more significant impairment of semen parameters, suggesting these patients may benefit more from repair 1
- Careful patient selection for treatment based on couple fertility status, varicocele grade, and semen quality is critical for achieving subsequent pregnancy 7