Will repairing a grade 2 varicocele (varicose vein in the scrotum) significantly improve elevated Follicle-Stimulating Hormone (FSH) levels of 10.3 and low sperm count of 5 million per milliliter (m/ml)?

Varicocele Repair for Grade 2 Varicocele with Low Sperm Count and Elevated FSH

Varicocele repair is likely to improve your sperm count but is unlikely to significantly improve your FSH level of 10.3, which suggests underlying testicular dysfunction that may limit the degree of improvement you can expect. 1, 2

Key Prognostic Factors

Your specific parameters indicate a mixed prognosis:

Favorable factors for improvement:

• Grade 2 varicocele is palpable/clinical and meets treatment criteria - guidelines strongly recommend repair for men with clinical varicoceles and abnormal semen parameters 1, 3
• Larger varicoceles (grade 2-3) show greater improvements in sperm parameters after repair compared to grade 1 4

Unfavorable factors limiting expected improvement:

• Your FSH of 10.3 IU/L is elevated - FSH >7.6 IU/L indicates spermatogenic failure or testicular dysfunction beyond just the varicocele itself 1
• FSH >11.7 mIU/mL predicts poor fertility outcomes after varicocelectomy - your level of 10.3 is approaching this threshold 2
• Elevated FSH in varicocele patients should prompt evaluation for primary testicular dysfunction, as the varicocele alone doesn't typically cause FSH elevation to this degree 1

Expected Improvements and Timeline

Sperm count improvements:

• You should expect some improvement in sperm count from your baseline of 5 million/mL, as men with lower baseline counts can still show meaningful improvements 4
• Improvements typically take 3-6 months (two spermatogenic cycles) to manifest 1, 3, 5
• Natural pregnancy, if it occurs, typically happens 6-12 months post-surgery 3

FSH changes:

• FSH may decrease modestly after varicocelectomy, but the decrease is typically not dramatic 6, 7
• One study showed decreased FSH levels post-varicocelectomy, but this was more pronounced in patients with normal baseline FSH 7
• Your elevated FSH suggests the varicocele is not the sole cause of your fertility issues 1

Critical Caveats

Important considerations before proceeding:

• If your female partner has limited ovarian reserve, time spent waiting for sperm recovery (6-12 months) may negatively impact overall fertility outcomes - consider proceeding directly to assisted reproduction in this scenario 1
• After 6 months post-surgery, if sperm parameters remain inadequate, proceed to assisted reproductive technology rather than waiting longer 5
• The quality of evidence for varicocele treatment in severe oligospermia is generally low 1

Recommendation Algorithm

Proceed with varicocelectomy if:

• Your female partner is young (<35 years) with normal ovarian reserve
• You prefer attempting natural conception before ART
• You understand improvements may be modest given your elevated FSH

Consider skipping directly to ART if:

• Female partner age >35 or has diminished ovarian reserve
• Time to pregnancy is critical
• You want the highest probability of pregnancy in the shortest timeframe

Do not pursue varicocelectomy if:

• Ultrasound shows the varicocele is subclinical (non-palpable) - though you state grade 2, which should be palpable 1, 3

1, 3, 6, 5, 4, 7, 2