Serum reproductive hormone profiles and semen characteristics of infertile men with clinical varicocoeles before and after varicocoelectomy in Lagos, Nigeria: A prospective cohort study

Abstract

Background: Varicocoeles have been shown to affect fertility by inducing Leydig cell and Sertoli cell dysfunction in the testes, leading to abnormal reproductive hormone values and impairment of spermatogenesis. Varicocoeles are a significant risk factor for androgen deficiency and infertility. This study aimed to evaluate the early effects of open subinguinal varicocoelectomy on serum hormonal levels and semen parameters in infertile men.

Methods: Forty-five infertile men with varicocoeles had serum hormone levels and seminal fluid analysed preoperatively, as well as at 3 and 6 months after varicocoelectomy.

Results: The mean age was 34.6±3.1 years. The known duration of inability to achieve conception ranged from 1 to 7 years, with a median interval of 3 years (interquartile range, 2-4 years). Most of the patients (n=37, 82.2%) had primary infertility. Thirty-three men (73.3%) had bilateral varicocoeles. Although the reproductive hormone levels were all within normal limits, the testosterone levels significantly increased at 6 months after varicocoelectomy (P<0.001). A significant increase in the testosterone level was found in males with low-normal testosterone levels (<4 ng/mL). There was a significant decrease in serum follicle-stimulating hormone after varicocoelectomy (P<0.001). Sperm concentration and progressive motility increased significantly 6 months after varicocoelectomy (P<0.001 respectively). Neither the preoperative varicocoele laterality nor the grade was associated with changes in serum reproductive hormone levels or semen characteristics.

Conclusions: Open subinguinal varicocoelectomy was associated with significantly increased serum testosterone, particularly among men with preoperative low-normal testosterone levels. Varicocoelectomy also improved the spermatogenic function of the testes.