IMPROVEMENT OF SPERM COUNT AND MOTILITY AFTER LIGATION OF VARICOCELESDETECTED WITH COLOR DOPPLER ULTRASONOGRAPHY

The debate regarding the efficacy of varicocele ligation for improveme nt of semen parameters and pregnancy rates is ongoing. In addition, no consensus exists as to the benefit of treatment of subclinical varico celes. The aim of this study was to investigate, retrospectively, the effect of high ligation of both subclinical and clinical varicoceles o n sperm count and motility. The value of several factors from history- taking and physical examination for the prediction of successful varic ocelectomy was analysed. A total of 139 patients, operated on for a un ilateral varicocele on the left side, were studied. Varicoceles wee su bclinical in 73 patients, based on colour Doppler ultrasonography, and 66 varicoceles were clinical, based on palpation in addition to ultra sonography. Comparison of semen parameters before and after surgery re vealed a significant improvement. The median sperm count increased fro m 10.0 to 14.7, and from 18.2 to 28.6 million/ejaculate, in patients w ith subclinical and clinical varicoceles, respectively (p < 0.001). Th e percentage improvement in median sperm count in subclinical varicoce les was not statistically different from the improvement in clinical v aricoceles. Mean progressive motility improved significantly after lig ation (p < 0.001). The improvement in motility in subclinical varicoce les, from 16 to 23%, was significantly larger than the 24 to 27% impro vement in clinical varicoceles. The increase in sperm count was relate d positively to testicular volume before surgery (p < 0.05). The incre ase in sperm motility was significantly lower in patients with a histo ry of cryptorchidism (n = 22, p < 0.05). The present data show that li gation of varicoceles detected using Doppler ultrasonography, whether palpable or not, results in an increase in sperm concentration and mot ility.