The effect of microsurgical varicocelectomy on serum follicle stimulating hormone, testosterone and free testosterone levels in infertile men with varicocele

Objectives To analyse the effects of varicocelectomy on serum follicle-stim ulating hormone (FSH), testosterone and free testosterone levels, and to in vestigate the interrelationships between seminal and hormonal variables. Patients and methods The records were retrospectively evaluated for 78 infe rtile patients who underwent microsurgical inguinal varicocelectomy, with d ocumented serum FSH, testosterone, free testosterone levels, sperm concentr ation and sperm motility before and after surgery. Left and bilateral varic oceles were detected in 40 and 38 patients, respectively. In addition, seru m hormonal values of 10 fertile men in whom physical examinations and Doppl er ultrasonography revealed no evidence of varicocele were recorded and use d as a control group. Results The mean (sd) serum FSH levels of all patients decreased from 15.21 (3.34) before surgery to 10.82 (2.93) mIU/mL afterward (P=0.01), and serum testosterone levels increased from 5.63 (1.40) to 8.37 (2.2) ng/mL (P=0.01 ), whereas free testosterone levels increased from 23.13 (3.19) to 32.83 (4 .37) pg/mL (P < 0.001). In contrast to the significant difference in sperm motility before and after surgery of all patients (P < 0.01), the differenc e in sperm count was insignificant (P > 0.05). Thirty-six patients with hig h serum FSH levels before surgery had significantly lower levels afterward (P=0.001). In this group, the sperm concentration and motility also increas ed, from 17.66 (4.35) to 20.76 (4.37) million/mL (P=0.05) and from 30.9 (4. 4)% to 37.5 (4.34)%, respectively (P=0.01). In the remaining 42 patients wh o had normal preoperative serum FSH levels, there was a slight decrease aft er surgery (P=0.02). Their sperm concentration increased slightly (P=0.04), and motility also increased (P=0.001). Sixty patients had a significantly higher testosterone level after surgery; in this group the sperm concentrat ion and motility increased (P=0.01). Conclusion Varicocelectomy promotes Sertoli and Leydig cell function. The s ignificant increase in serum free testosterone level results in a significa nt improvement in sperm concentration and motility.