EFFECTS OF SUBINGUINAL VARICOCELE LIGATION ON SPERM CONCENTRATION, MOTILITY AND KRUGER MORPHOLOGY

Purpose: We examined the effects of varicocelectomy on semen parameter s in 30 subfertile men, with emphasis on potential changes in sperm co unt, motility and morphology as measured by Kruger's strict morphologi c criteria. Materials and Methods: A total of 30 patients underwent su binguinal varicocelectomy (25 bilateral and 5 unilateral). Preoperativ e and postoperative sperm density, motility and morphology were analyz ed. Preoperative follicle-stimulating hormone, luteinizing hormone and testosterone levels were measured and compared to those of fertile vo lunteers enrolled in our sperm donation program. Pregnancy rates after varicocelectomy were also examined. The Wilcoxon signed rank test was used to measure levels of statistical significance in all analyses.Re sults: We found that sperm density and motility improved significantly (p <0.05) without concomitant changes in strict morphology (p >0.05) only in men with clinical bilateral varicoceles. No differences were o bserved in values among testosterone, follicle-stimulating hormone and luteinizing hormone levels of the fertile control group and preoperat ive varicocele patients. Of 30 patients 12 (40%) had successful, full- term pregnancies, including 6 via natural cycle intercourse, 5 (43%) b y in vitro fertilization embryo transfer and I by intracytoplasmic spe rm injection. Conclusions: Although sperm morphology as measured by st rict morphologic criteria does not improve after varicocelectomy, ther e were highly significant changes in motility and concentration. Hormo nal differences are not likely to have a role in or be reflective of p athophysiology of varicocele induced male infertility. The recent obse rvation that sperm motility may be an independent or additive predicti ve factor for fertilization and pregnancy supports the need for contin ued varicocele repair independent of the lack of varicocelectomy effec t on Kruger morphology.