Varicocele Surgery: Is It the Right Choice for Male Infertility?

Varicocele surgery

Hello Doctor, my husband and I have been married for two years and have been trying to conceive for about a year and a half without success.
We went to a fertility clinic for testing, and the female side showed no issues.
However, my husband's semen analysis revealed that only 1% of the sperm morphology was normal (according to Kruger's strict criteria), with a sperm count of 145.2 million, motility at 67% (but only 14% with progressive motility).
He underwent a scrotal ultrasound at the urology department, which showed bilateral varicocele.
The doctor informed us that the varicocele condition is considered quite severe, but also mentioned that even with surgery, there is no guarantee that the semen quality will improve.
I would like to ask the doctor if, given my husband's situation, surgery is generally recommended? Thank you.

Ming, 20~29 year old female. Ask Date: 2016/03/08

Dr. Fu Shizhang reply Urology

In general, varicocele is associated with poor sperm quality, and approximately 60% of patients experience improvement after surgery.
Although improvement cannot be guaranteed, given your husband's condition, it is still recommended that he undergo surgical treatment for the best outcome.

Reply Date: 2016/03/08

More Info

Varicocele surgery is a topic of significant interest, especially for couples facing infertility challenges. In your case, the presence of bilateral varicocele, particularly when classified as severe, raises important considerations regarding male fertility.
Varicocele refers to the enlargement of veins within the scrotum, similar to varicose veins that can occur in the legs. This condition is relatively common and is known to affect sperm production and quality. The mechanism behind this is thought to involve increased temperature in the testicular area due to impaired blood flow, which can negatively impact spermatogenesis (the process of sperm production).
In your situation, the semen analysis indicates a low percentage of normal sperm morphology (only 1% meeting Kruger's strict criteria), a total sperm count of 145.2 million, and a motility rate of 67%, with only 14% showing progressive motility. These factors suggest that while the sperm count is adequate, the quality, particularly in terms of morphology and motility, may be a concern.
The decision to proceed with varicocele surgery (varicocelectomy) often hinges on several factors, including the severity of the varicocele, the results of the semen analysis, and the overall fertility goals of the couple. While surgery can potentially improve sperm quality and fertility outcomes, it is important to note that not all patients experience significant improvements post-surgery. Studies have shown that varicocelectomy can lead to improved sperm parameters in some men, but the success rates can vary widely.

Given that your wife's fertility has been ruled out as a factor, addressing the male side of the equation becomes crucial. If the varicocele is indeed severe, surgical intervention may be recommended, especially if there is a desire to improve sperm quality before considering assisted reproductive technologies (ART) such as in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI).
However, it is essential to have a thorough discussion with a urologist specializing in male fertility. They can provide insights into the potential benefits and risks of the surgery, as well as alternative options if surgery is not pursued. Additionally, they may suggest lifestyle modifications or medical treatments that could also help improve sperm quality.

In summary, while varicocele surgery can be a viable option for improving male fertility, it is not a guaranteed solution. The decision should be made collaboratively with your healthcare provider, considering all factors, including the severity of the varicocele, the specific sperm quality issues, and your overall fertility goals. It may also be beneficial to explore other fertility treatments concurrently, depending on the timeline and urgency of your desire to conceive.

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