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Feasibility of Loupe Assisted Subinguinal Varicocelectomy in Treatment of Male Infertility

Saurabh Kale*, Thaha Rashid, Dineshan KM, Felix Cardoza

Objectives: To study the impact of loupe assisted subinguinal varicocelectomy on semen quality, serum testosterone level, and spontaneous pregnancy rate.

Methods: The data were prospectively collected for 102 infertile men with clinical varicoceles. The preoperative values of semen analysis parameters and serum testosterone level were compared with postoperative values at 6 months. Spontaneous pregnancy was assessed at 6 months.

Results: The mean age of patients was 31.56 ± 4.31 years. Primary infertility was reported in 86 patients, while 16 had secondary infertility. Bilateral varicoceles were seen in 79 patients while 23 had unilateral varicoceles. The total sperm concentration (x106/ml) before and after varicocelectomy was 12.82 ± 3.91 and 20.06 ± 2.13 respectively (p<0.0001). The total sperm motility (%) before and after varicocelectomy was 37.67 ± 7.23 and 55.46 ± 4.51 respectively (p<0.0001). The sperm morphology (Kruger/Strict morphology criteria %) before and after varicocelectomy was 3.11 ± 0.80 and 3.70 ± 0.78 respectively (p<0.0001). The serum testosterone level (ng/dl) before and after varicocelectomy was 323.90 ± 67.81 and 396.74 ± 40.88 respectively (p<0.0001). The Spontaneous pregnancy rate in couples with primary and secondary infertility was 18.60% and 31.25% respectively. The difference in their rates was not significant (p=0.251). The overall spontaneous pregnancy rate was 20.5 %.

Conclusion: Loupe-assisted subinguinal varicocelectomy is effective in treating male infertility. It leads to significant improvement in semen quality and serum testosterone level. Despite the absence of definitive studies on the impact of varicocelectomy and fertility outcomes, it is reasonable to consider it as an option in selective varicocele patients with semen abnormalities.