Microsurgical and nonmagnified subinguinal varicocelectomy for infertile men: a comparative study

Objective: To compare semen parameters, pregnancy, recurrence, and complication rates after microsurgical and nonmagnified subinguinal varicocelectomy for infertile men. Design: Prospective, randomized study. Setting: Ghodran General Hospital, Kingdom of Saudi Arabia. Patient(s): One hundred sixty-two infertile male patients with varicocele. Intervention(s): Eighty-two patients were treated by microsurgical subinguinal varicocelectomy (MSSIV) (group I), whereas 80 patients were treated by conventional, nonmagnified subinguinal varicocelectomy (NMSIV) (group II). Main Outcome Measure(s): The patients were postoperatively evaluated by physical examination and semen analysis after 4 and 12 months. Pregnancy rate was monitored during the follow-up period. Result(s): Postoperatively, mean sperm count and motility improved significantly in both groups: 42.7% and 67.1% of the MSSIV group and 23.7% and 33.8% of the NMSIV group showed >= 50% improvement in sperm count and motility after 1 year. Patients having bilateral varicocele showed significantly better improvement of sperm count than those with unilateral varicocele after both MSSIV and NMSIV. The pregnancy rate at the end of the follow-up period reached 37.8% in the MSSIV group and 21.2% in the NMSIV group. The recurrence rate was zero in the MSSIV group and 11.3% in the NMSIV group. The rate of hydrocele formation was 1.2% in the MSSIV group and 8.7% in the NMSIV group. Conclusion(s): Microsurgical subinguinal varicocelectomy has a better improving effect on sperm count and motility, higher spontaneous pregnancy rates, and lower postoperative recurrence and hydrocele formation than conventional subinguinal varicocelectomy in infertile men. (Fertil Steril (R) 2010; 94: 2600-3. (C) 2010 by American Society for Reproductive Medicine.)