Paternity Rates and Time to Conception in Adolescents with Varicocele Undergoing Microsurgical Varicocele Repair vs Observation Only: A Single Institution Experience with 408 Patients

Purpose: We compared paternity rates and time to conception between adolescents with varicocele undergoing microsurgical varicocele repair and patients who did not undergo surgery and were followed conservatively. Materials and Methods: The study included 408 males 12 to 19 years old at presentation with clinical palpable varicocele. Of the patients 286 underwent microsurgical subinguinal or inguinal varicocele repair and 122 did not undergo varicocele surgery and were followed conservatively. Only men who desired conception were included in the study. We compared postoperative paternity rates, time to conception, administration of fertility treatment, and difference in sperm parameters and serum hormone levels in all men. Results: The paternity rate was 77.3% (221 of 286 patients) in the microsurgical varicocele repair group and 48.4% (59 of 122) in the control group, revealing a highly significant difference (OR 3.63, p < 0.005). Mean +/- SD time to conception was significantly shorter in the microsurgical varicocele repair group (11.18 +/- 6.5 months) than in the control group (16.85 +/- 6.9 months, p < 0.005). Respective percentages of patients with significant increase in sperm concentration and motility were significantly higher (53.8% and 62.2%) in the microsurgical varicocele repair group compared to the control group (43.4% and 46.7%, p < 0.05 for both). Conclusions: Microsurgical varicocele repair in adolescents with varicocele significantly increases paternity rates and decreases time to conception post-operatively. Patients with varicocele who underwent microsurgical varicocele repair had increased sperm parameters and 3.63 times greater odds of paternity than controls who did not undergo varicocele surgery.