Impact of varicocoelectomy on male semen parameters: A long-term analysis of sperm quality and outcomes.

Background: Varicocoeles are common in 40% of men presenting with infertility. Semen parameters including sperm motility, low sperm count and sperm morphology are altered by the presence of varicocoeles. Though varicocoelectomy has been associated with improvements in these parameters, studies on long-term outcomes are limited.

Objectives: Analyze pre-operative samples with those collected at multiple post-operative timepoints to assess if sperm parameters continue to improve in the period following varicocoelectomy.  MATERIALS AND METHODS: Adult men who underwent varicocoelectomy under a single surgeon from 2017 to 2023 with at ≥1 post-operative semen analysis (SA) were included. Motile sperm count, progressive motility, round cells, semen volume, sperm concentration, sperm morphology, total motility and viability was collected from each patient's SA. Wilcoxon signed-rank tests were used to compare medians of sperm parameters from pre-operative baseline to 6, 12, 18 and 24 months follow up.

Results: At 6 months, number of motile sperm increased from 4 to 8 million/mL (p < 0.0001), progressive motility increased from 34% to 42% (p < 0.0001), total motility rose from 37% to 45% (p <0.0001), concentration increased from 6.9 mil/mL to 9 mil/mL (p <0.0001), and morphology increased from 1% to 2% (p = .0026). Viability increased from 60% to 62% (p = .0002). At 6-12 months, number of motile sperm (7 mil/mL, p < 0.0001), progressive motility (38.5%, p = 0.0005), sperm concentration (8 mil/mL, p < 0.0001), and total motility (41.5%, p < 0.0001) remained statistically significant compared to baseline. At 12-18 months, significant increases in progressive motility (35%, p = 0.0272) and total motility (37%, p = 0.0022) persisted.

Conclusions: Our retrospective study demonstrates significant short-term improvements across multiple parameters at 6-months after varicocoelectomy. While we note individual improvement in sperm parameters during longer follow-up period, there was variability based on the time frame. Our findings underscore the impact of varicocoelectomies may have on enhancing short-term male fertility. Future, prospective research is needed to validate these findings.