The study aimed to determine the effect of microsurgical sub-inguinal varicocelectomy on semen parameters among men seeking infertility treatment in Ghana. This was an intervention study conducted at Tamale Teaching Hospital in the Tamale Metropolis from September 2017 to August 2021. The study involves two groups; the surgery group (n = 75) and the observed group (n = 63). Duplicate semen samples (mean values adopted) were collected at the onset and assessed according to the criteria established by World Health Organization (WHO), 2010. Varicocelectomy was performed for the surgery group and no intervention was given to the observed group. The two groups were followed for 180 days and repeated semen samples were collected and analyzed. The data was computed using GraphPad Prism (v8.0) at an alpha of 0.05. All the men had varicocele and were aged between 46.0 and 67.0 years old. There was no difference between semen parameters among the two groups before the surgery. However, after 180 days of follow-up, all of the semen parameters significantly improved in the surgery group (p < 0.0001), while sperm concentration (p = 0.0068), progressive motility (p = 0.0281), and normal sperm morphology (p = 0.0015) decreased in the observed group. The surgery group had an overall percent increase in total sperm count (840.7%; p = 0.0197), sperm concentration (582.1%; p = 0.0125), total viable sperms (155.2%; p < 0.0001), and normal sperm morphology (110.9%; p < 0.0001) while immotile sperms (-51.71%; p < 0.0001) reduced. A pregnancy rate of 25.3% (19/75) was reported among the surgery group but none was reported among the observed group after 180 days. Microsurgical sub-inguinal varicocelectomy improves semen parameters and hence effective treatment of infertile men with a clinically palpable varicocele. It is recommended to use this choice for similar patients, however, further studies with a larger sample size are needed to provide more evidence to recommend this therapy.
Agarwal, A., Sharma, R., Harlev, A. and Esteves, S.C. (2016) Effect of Varicocele on Semen Characteristics According to the New 2010 World Health Organization Criteria: A Systematic Review and Meta-Analysis. Asian Journal of Andrology, 18, 163-170. https://doi.org/10.4103/1008-682X.172638
Bertolotto, M., Freeman, S., Richenberg, J., Belfield, J., Dogra, V., Huang, D.Y., et al. (2020) Ultrasound Evaluation of Varicoceles: Systematic Literature Review and Rationale of the ESUR-SPIWG Guidelines and Recommendations. Journal of Ultrasound, 23, 487-507. https://doi.org/10.1007/s40477-020-00509-z
Clavijo, R.I., Carrasquillo, R. and Ramasamy, R. (2017) Varicoceles: Prevalence and Pathogenesis in Adult Men. Fertility and Sterility, 108, 364-369. https://doi.org/10.1016/j.fertnstert.2017.06.036
Jarow, J.P., Coburn, M. and Sigman, M. (1996) Incidence of Varicoceles in Men with Primary and Secondary Infertility. Urology, 47, 73-76. https://doi.org/10.1016/S0090-4295(99)80385-9
Nashan, D., Behre, H., Grunert, J. and Nieschlag, E. (1990) Diagnostic Value of Scrotal Sonography in Infertile Men: Report on 658 Cases [Der diagnostische Wert der Sonographic der Skrotal-organe bei infertilen Männern: Untersuchung a 658 Patienten]. Andrologia, 22, 387-395. https://doi.org/10.1111/j.1439-0272.1990.tb02013.x
Choi, W.S. and Kim, S.W. (2013) Current Issues in Varicocele Management: A Review. The World Journal of Men’s Health, 31, 12-20. https://doi.org/10.5534/wjmh.2013.31.1.12
Xue, J., Yang, J., Yan, J., Jiang, X., He, L.-Y., Wu, T., et al. (2012) Abnormalities of the Testes and Semen Parameters in Clinical Varicocele. Journal of Southern Medical University, 32, 439-442.
Kadioglu, T.C., Aliyev, E. and Celtik, M. (2014) Microscopic Varicocelectomy Significantly Decreases the Sperm DNA Fragmentation Index in Patients with Infertility. BioMed Research International, 2014, Article ID: 695713. https://doi.org/10.1155/2014/695713
Shiraishi, K., Matsuyama, H. and Takihara, H. (2012) Pathophysiology of Varicocele in Male Infertility in the Era of Assisted Reproductive Technology. International Journal of Urology, 19, 538-550. https://doi.org/10.1111/j.1442-2042.2012.02982.x
Inci, K. and Gunay, L.M. (2013) The Role of Varicocele Treatment in the Management of Non-Obstructive Azoospermia. Clinics, 68, 89-98. https://doi.org/10.6061/clinics/2013(Sup01)10
Seidel, G. (2015) Maintaining the Integrity of Germline DNA: Individuals Age, Species Do Not. Reproduction, Fertility and Development, 27, 865-871. https://doi.org/10.1071/RD14514
Agarwal, A., Mulgund, A., S. Alshahrani, Assidi, M., Abuzenadah, A.M., Sharma, R., et al. (2014) Reactive Oxygen Species and Sperm DNA Damage in Infertile Men Presenting with Low-Level Leukocytospermia. Reproductive Biology and Endocrinology, 12, Article No. 126. https://doi.org/10.1186/1477-7827-12-126
Zini, A., Blumenfeld, A., Libman, J. and Willis, J. (2005) Beneficial Effect of Microsurgical Varicocelectomy on Human Sperm DNA Integrity. Human Reproduction, 20, 1018-1021. https://doi.org/10.1093/humrep/deh701
Krause, W., Müller, H.H., Schäfer, H. and Weidner, W. (2002) Does Treatment of Varicocele Improve male Fertility? Results of the ‘Deutsche Varikozelenstudie’, a Multicentre Study of 14 Collaborating Centres. Andrologia, 34, 164-171. https://doi.org/10.1046/j.1439-0272.2002.00494.x
Breznik, R., Vlaisavuevic, V. and Borko, E. (1993) Treatment of Varicocele and Male Fertility. Archives of Andrology, 30, 157-160. https://doi.org/10.3109/01485019308987750
Rageth, J., Unger, C., DaRugna, D., Steffen, R. Stucki, D., Barone, C., et al. (1992) Long-Term Results of Varicocelectomy. Urologia International, 48, 327-331.
Nallella, K.P., Sharma, R.K., Aziz, N. and Agarwal, A. (2006) Significance of Sperm Characteristics in the Evaluation of Male Infertility. Fertility and Sterility, 85, 629-634. https://doi.org/10.1016/j.fertnstert.2005.08.024
Dubin, L. and Amelar, R.D. (1970) Varicocele Size and Results of Varicocelectomy in Selected Subfertile Men with Varicocele. Fertility and Sterility, 21, 606-609. https://doi.org/10.1016/S0015-0282(16)37684-1
Marsman, J. and Schats, R. (1994) The Subclinical Varicocele Debate. Human Reproduction, 9, 1-8. https://doi.org/10.1093/oxfordjournals.humrep.a138294
Hussein, A.F. (2006) The Role of Color Doppler Ultrasound in the Prediction of the Outcome of Microsurgical Subinguinal Varicocelectomy. The Journal of Urology, 176, 2141-2145. https://doi.org/10.1016/j.juro.2006.07.009
Mittal, B.V. and Singh, A.K. (2010) Hypertension in the Developing World: Challenges and Opportunities. American Journal of Kidney Diseases, 55, 590-598. https://doi.org/10.1053/j.ajkd.2009.06.044
World Health Organization (2010) World Health Statistics 2010. World Health Organization, Geneva.
Elder, K. and Dale, B. (2020) In-Vitro Fertilization. Cambridge University Press, Cambridge. https://doi.org/10.1017/9781108611633
Marmar, J.L., DeBenedictis, T.J. and Praiss, D. (1985) The Management of Varicoceles by Microdissection of the Spermatic Cord at the External Inguinal Ring. Fertility and Sterility, 43, 583-588. https://doi.org/10.1016/S0015-0282(16)48501-8
Agarwal, A., Deepinder, F., Cocuzza, M., Agarwal, R., Short, R.A., Sabanegh, E., et al. (2007) Efficacy of Varicocelectomy in Improving Semen Parameters: New Meta-Analytical Approach. Urology, 70, 532-538. https://doi.org/10.1016/j.urology.2007.04.011
Nagler, H., Luntz, R. and Martinis, F. (1997) Varicocele. In: Lipshultz, L.I. and Howards, S.S., Eds., Infertility in the Male, Mosby, St. Louis, 336-359.
Witt, M.A., and Lipshultz, L.I. (1993) Varicocele: A Progressive or Static Lesion? Urology, 42, 541-543. https://doi.org/10.1016/0090-4295(93)90268-F
Cooper, T.G., Noonan, E., Von Eckardstein, S., Auger, J., Baker, H., Behre, H.M., et al. (2010) World Health Organization Reference Values for Human Semen Characteristics. Human Reproduction Update, 16, 231-245. https://doi.org/10.1093/humupd/dmp048
Scott, L.S. and Young, D. (1962) Varicocele: A Study of Its Effects on Human Spermatogenesis, and of the Results Produced by Spermatic Vein Ligation. Fertility and Sterility, 13, 325-334. https://doi.org/10.1016/S0015-0282(16)34563-0
Glover, T. (1955) Some Effects of Scrotal Insulation on the Semen of Rams. Society for the Study of Fertility, 7, 66-75.
Williams, D.H., Karpman, E. and Lipshultz, L.I. (2006) Varicocele: Surgical Techniques in 2005. Canadian Journal of Urology, 13, 13-17. https://doi.org/10.1016/j.fertnstert.2004.03.028
Grober, E.D., Chan, P.T., Zini, A. and Goldstein, M. (2004) Microsurgical Treatment of Persistent or Recurrent Varicocele. Fertility and Sterility, 82, 718-722. https://doi.org/10.1159/000019772
Barbalias, G.A., Liatsikos, E.N., Nikiforidis, G. and Siablis, D. (1998) Treatment of Varicocele for Male Infertility: A Comparative Study Evaluating Currently Used Approaches. European Urology, 34, 393-398.
Khan, M., Khan, S., Pervez, A., Nawaz, H., Ahmed, S. and Tareen, S. (2003) Evaluation of Low Ligation and High Ligation Procedures of Varicocele. Journal of the College of Physicians and Surgeons—Pakistan, 13, 280-283.
Masson, P. and Brannigan, R.E. (2014) The Varicocele. Urologic Clinics of North America, 41, 129-144. https://doi.org/10.1016/j.ucl.2013.08.001
Guzick, D.S., Overstreet, J.W., Factor-Litvak, P., Brazil, C.K., Nakajima, S.T., Coutifaris, C., et al. (2001) Sperm Morphology, Motility, and Concentration in Fertile and Infertile Men. New England Journal of Medicine, 345, 1388-1393. https://doi.org/10.1056/NEJMoa003005
Nilsson, S., Edvinsson, A. and Nilsson, B. (1979) Improvement of Semen and Pregnancy Rate after Ligation and Division of the Internal Spermatic Vein: Fact or Fiction? British Journal of Urology, 51, 591-596. https://doi.org/10.1111/j.1464-410X.1979.tb03609.x
Madgar, I., Weissenberg, R., Lunenfeld, B., Karasik, A. and Goldwasser, B. (1995) Controlled Trial of High Spermatic Vein Ligation for Varicocele in Infertile Men. Fertility and sterility, 63, 120-124. https://doi.org/10.1016/S0015-0282(16)57306-3
Evers, J.L. and Collins, J. (2004) Surgery or Embolization for Varicocele in Subfertile Men. Cochrane Database of Systematic Reviews, No. 3, Article No. CD000479. https://doi.org/10.1002/14651858.CD000479.pub2
Czaplicki, M., Bablok, L. and Janczewski, Z. (1979) Varicocelectomy in Patients with Azoospermia. Archives of Andrology, 3, 51-55. https://doi.org/10.3109/01485017908985048
Lenzi, A., Gandini, L., Bagolan, P., Nahum, A. and Dondero, F. (1998) Sperm Parameters after Early Left Varicocele Treatment. Fertility and Sterility, 69, 347-349. https://doi.org/10.1016/S0015-0282(97)00474-3
Maiwald, M., Widmer, A.F., Shaw, D. and Coventry, B.J. (2014) Surgical Infection. In: Coventry, B., Ed., General Surgery Risk Reduction, Springer, London, 107-132. https://doi.org/10.1007/978-1-4471-5391-7_3