Results

Varicocelectomy results in significant improvement in semen analysis in 60 to 80% of men and natural pregnancy rates of 43% and 69% at one and two years respectively, controlling for female factors. Reported pregnancy rates after varicocelectomy vary from 20 to 60%. A randomized controlled trial of surgery versus no surgery in infertile men with varicoceles revealed a pregnancy rate of 44% at one year in the surgery group versus 10% in the control group. In our series of 1,500 microsurgical operations, 43% of couples were pregnant at one year 59 and 69% at two years when couples with female factors were excluded. Microsurgical varicocelectomy results in return of sperm to the ejaculate in up to 50% of azoospermic men with palpable varicoceles. 

The results of varicocelectomy are also related to the size of the varicocele. Repair of large varicoceles results in a significantly greater improvement in semen quality than repair of small varicoceles. In addition, large varicoceles are associated with greater pre-operative impairment of semen quality than small varicoceles, and consequently overall pregnancy rates are similar regardless of varicocele size. Some evidence suggests that the younger the patient is at the time of varicocele repair, the greater the improvement after repair and the more likely the testis is to recover from varicocele induced injury.66 Varicocele recurrence, testicular artery ligation or post-varicocelectomy hydrocele formation are often associated with poor post-operative results. In infertile men with low serum testosterone levels, microsurgical varicocelectomy alone results in substantial improvement in serum testosterone levels.