Fate of Recurrent or Persistent Varicocele in the Era of Assisted Reproduction Technology: Microsurgical Subinguinal Redo Varicocelectomy Versus Observation

OBJECTIVE To compare sperm parameters, serum hormone levels, and pregnancy and miscarriage rates between the infertile men with recurrent or persistent varicocele who underwent microsurgical subinguinal redo varicocelectomy or had observation only. MATERIALS AND METHODS The study included 217 primary infertile men with recurrent or persistent varicocele. The patients were divided into 2 groups: 120 men underwent microsurgical subinguinal redo varicocelectomy, and 97 had observation only. Differences in total motile sperm count and serum hormone levels, and pregnancy and miscarriage rates were compared between the 2 groups. RESULTS The mean total motile sperm count increased from 20.93 +/- 2.87 to 45.54 +/- 6.28 million in the microsurgical redo varicocelectomy group, and decreased from 16.62 +/- 2.75 to 15.6 +/- 2.81 million in the control group, revealing significant difference between the 2 groups (P =.000). Increase in total testosterone level was significantly higher in the microsurgical redo varicocelectomy group (+1.36 +/- 0.32 ng/mL) than in the control group (-0.23 +/- 0.1 ng/mL) (P =.000). Of the couples, 63 achieved pregnancy in the microsurgical redo varicocelectomy group (52.5%), and 38 had pregnancy in the control group (39.2%) (P < .05). Spontaneous pregnancy rate was significantly higher in the microsurgical redo varicocelectomy group (39.7%) than in the control group (15.8%) (P < .01). Use of assisted reproductive technology to achieve pregnancy was significantly lower in the microsurgical redo varicocelectomy group (60.3%) than in the control group (84.2%) (P < .01). CONCLUSION Microsurgical subinguinal redo varicocele repair improves postoperative sperm parameters, serum total testosterone level, and spontaneous pregnancy rates compared with the controls. It also decreases need for use and level of assisted reproductive technology. (c) 2018 Elsevier Inc.