Effect of Varicocele Surgery on FSH Levels
Yes, varicocele surgery does reduce FSH levels in patients with varicocele. The most recent evidence from a 2023 systematic review and meta-analysis demonstrates that varicocele surgical repair decreases serum FSH levels compared to preoperative levels 1.
Mechanism and Hormonal Effects
- Varicocele affects approximately 15% of the general male population but is present in 25% of men with abnormal semen analysis and 35-40% of men presenting with infertility 2.
- The pathophysiology involves higher scrotal temperature, testicular hypoxia, and reflux of toxic metabolites that cause testicular dysfunction and DNA damage 2.
- Varicocelectomy improves testicular function, which leads to:
Clinical Evidence for FSH Reduction
- A 2023 meta-analysis found that after varicocele surgical repair, mean serum FSH levels significantly decreased compared to preoperative levels (p<0.05) 1.
- A 2018 systematic review and meta-analysis demonstrated that serum FSH levels were higher before surgery than after (95% confidence interval 0.19-0.77, P=0.001) 3.
- The decrease in FSH levels following varicocelectomy is believed to reflect improved testicular function and Sertoli cell activity 1, 4.
Timing of Hormonal Changes
- Improvements in hormonal parameters, including FSH reduction, typically occur in parallel with improvements in semen parameters 1.
- After varicocele repair, the average time to improvement in semen parameters is up to two spermatogenic cycles (approximately 3-6 months) 5.
- Spontaneous pregnancy, when it occurs, typically happens between 6 and 12 months after varicocelectomy 5.
Patient Selection Considerations
- Treatment should be targeted to men with clinical (palpable) varicoceles and abnormal semen parameters 2.
- Treatment of subclinical (non-palpable) varicoceles is not effective at increasing chances of spontaneous pregnancy 2.
- Bilateral varicocelectomy for bilateral varicoceles shows comparable improvements in semen parameters to unilateral varicocelectomy for unilateral varicoceles 6.
Pitfalls and Caveats
- Routine use of ultrasonography to identify non-palpable varicoceles is discouraged, as treatment of subclinical varicoceles does not improve fertility outcomes 2.
- The hormonal response to varicocelectomy may vary between individuals, with some studies showing inconsistent results regarding FSH changes 4.
- While FSH levels typically decrease after successful varicocelectomy, this change alone should not be used as the sole marker of treatment success 1.