Studies on Varicocele and Subfertility

Abstract

Forty cases of varicocele were treated with high division of the internal spermatic vein(s). The reason for the operation was subfertility in 35 cases and local complaints in 5 cases. The semen was analyzed before and after the operation in all cases.

Postoperative examination of the scrotum in 37 cases showed persistent varicocele in two of them. A second, successful operation was performed in one case.

The sperm density was increased after the operation in 62.5 per cent of the cases and the sperm motility was increased in 50 per cent. Cases with azoospermia (crypto-spermia) showed no significant improvement. At the end of the observation period conception has occurred in 17 per cent of the infertile marriages in the series.

Testicular biopsy was performed in 30 patients with varicocele. The histologic findings varied from an overall normal parenchyma with complete spermatogenesis to widespread and severe atrophy. In cases with severe tubular damage there was also interstitial and peritubular fibrosis.

The correlation between the histologic picture and the sperm density was fairly good on the whole. In some cases, however, the sperm density was poor although spermatogenesis was largely normal; the reverse was also found. Testicular damage may thus be of focal nature and consequently testicular biopsy is not always representative.

The investigation shows that varicocele deserves due attention as a contributory factor in male subfertility and should therefore be surgically corrected. Improved fertility can be expected in at least half of the cases after the operation. The investigation further suggests that in sterile marriages factors other than varicocele may be concomitantly operative in both partners.