Comparative efficacy of varicocelectomy and intrauterine insemination in varicocoele patients with mild semen abnormalities: An observational study.

Background: Varicocoele is a common cause of male infertility, affecting spermatogenesis through increased testicular temperature, venous stasis, and oxidative stress. Microsurgical subinguinal varicocelectomy improves semen quality, whereas intrauterine insemination is widely used for mild male factor infertility. The comparative efficacy of these treatments in varicocoele patients with mild semen abnormalities remains unclear.

Objectives: To evaluate the efficacy of microsurgical subinguinal varicocelectomy and intrauterine insemination in improving clinical pregnancy and live birth rates in varicocoele patients with mild semen abnormalities and assess post-operative improvements in semen parameters following microsurgical subinguinal varicocelectomy.

Materials and methods: A retrospective cohort study involving 650 microsurgical subinguinal varicocelectomy patients from five medical centers and 700 intrauterine insemination patients from one center was conducted. Inclusion criteria included varicocoele diagnosed via ultrasonography, mild semen abnormalities (total motile sperm count ≥5 million), and at least one abnormal semen parameter. Primary outcomes were clinical pregnancy and live birth rates. Secondary outcomes included sperm concentration, motility, and total motile sperm count changes post-microsurgical subinguinal varicocelectomy. Statistical analyses included chi-square tests and logistic regression.

Results: Microsurgical subinguinal varicocelectomy patients demonstrated significant improvements in sperm concentration (35.2-43.3 × 10⁶/mL), motility (26%-38%), and total motile sperm count (18.8-34.9 × 10⁶, p < 0.001). Clinical pregnancy and live birth rates were higher in the microsurgical subinguinal varicocelectomy group (35.23% and 31.08%) compared to the intrauterine insemination group (29.57% and 24.00%, p < 0.05). Multivariate analysis revealed that microsurgical subinguinal varicocelectomy significantly increased pregnancy (OR = 1.43, 95% CI: 1.12-1.83, p < 0.05) and live birth rates (OR = 1.56, 95% CI: 1.21-2.02, p < 0.05).

Discussion and conclusion: Microsurgical subinguinal varicocelectomy significantly enhances semen quality and achieves superior clinical pregnancy and live birth rates compared to intrauterine insemination for varicocoele patients with mild semen abnormalities. These findings suggest that microsurgical subinguinal varicocelectomy is a more effective treatment option, highlighting the importance of individualized treatment strategies and supporting the preferential use of surgical intervention in this specific patient population.