title: Subinguinal microsurgical varicocelectomy for male factor subfertility: ten-year experience.
abstract: OBJECTIVE
  To investigate the impact of subinguinal microsurgical varicocelectomy on semen parameters and pregnancy outcomes in couples with male factor subfertility.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Male Infertility Clinic in an academic institution in Hong Kong.
  
  
  METHODS
  The clinical records of 42 consecutive subfertile male patients who had subinguinal microsurgical varicocelectomy (from January 2000 to December 2009) were retrospectively reviewed. All the patients had a known history of subfertility and abnormalities in one or more semen parameters. Female subfertility factors were not addressed. Only grade 2 or higher clinically palpable varicoceles were operated on.
  
  
  METHODS
  Preoperative and postoperative semen analyses based on the World Health Organization criteria; the outcome measures included changes in semen parameters and whether a pregnancy ensued.
  
  
  RESULTS
  The mean age of patients and their spouses were 38 and 33 years, respectively. The mean duration of infertility was 4 years; 37 patients had primary infertility and five had secondary infertility. The mean (± standard deviation) sperm concentration improved from 12 ± 19 million/mL to 23 ± 29 million/mL following varicocelectomy (P<0.001), the mean sperm motility improved from 26% ± 16% to 32% ± 18% (P<0.001), and the mean normal morphology increased from 5% ± 7% to 6% ± 6% (P<0.001). Postoperatively, 23 (55%) of the patients achieved pregnancy, 11 (26%) being spontaneous, 1 (2%) by intrauterine insemination, and 11 (26%) by in-vitro fertilisation. Among 20 patients with severe preoperative oligospermia (<5 million/mL), statistically significant improvements occurred in postoperative mean sperm concentration, motility and morphology (all P<0.001), and five (25%) of them achieved a spontaneous pregnancy. There was one intra-operative injury to the testicular artery with immediate repair and no testicular atrophy. Five (12%) of the patients had recurrences. No preoperative factors appeared predictive of a pregnancy ensuing.
  
  
  CONCLUSIONS
  In couples with male infertility due to varicoceles, subinguinal microsurgical varicocelectomy was shown to improve sperm concentrations, motility and morphology, and the likelihood of a pregnancy. Spontaneous pregnancy was achieved in 25% of the couples in which the man had severe oligospermia.
authors: Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
authors: L
authors: L
authors: Leung
authors: K L
authors: KL
authors: Ho
authors: P C
authors: PC
authors: Tam
authors: M K
authors: MK
authors: Yiu
mesh_terms: D000328:Adult; D005260:Female; D006723:Hong Kong; D006801:Humans; D007248:Infertility, Male / Q000209:etiology / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D009845:Oligospermia / Q000209:etiology / Q000601:surgery*; D011247:Pregnancy; D018873:Pregnancy Rate; D012008:Recurrence; D012189:Retrospective Studies; D013076:Sperm Count; D013081:Sperm Motility; D016896:Treatment Outcome; D014646:Varicocele / Q000150:complications / Q000601:surgery*; D055815:Young Adult
keywords: Azoospermia; Infertility, male; Microsurgery; Oligospermia; Varicocele