Microscopic versus Non-Microscopic Subinguinal Varicocelectomy for Treatment of Male Subfertility, A Randomized Controlled Study

Abstract Objective To compare the outcomes of subinguinal microscopic versus non-microscopic varicocelectomy in the treatment of male subfertility, particularly regarding perioperative complications, effects on semen parameters, and fertility. Methods This prospective study included 128 patients with primary infertility associated with varicocele. The patients were randomly assigned into two equal groups, which included subinguinal microscopic and non-microscopic varicocelectomy. We analyzed the following variables: age, laterality, grade of varicocele, semen parameters prior to and 3 months after surgery, pain relief, postoperative complications, and pregnancy rate at one year. Results Both groups had similar age, BMI, mean infertility duration, and varicocele grade. More veins were ligated in microscopic vs macroscopic varicocelectomy (p < 0.001). The rate of testicular artery identification and preservation was significantly higher in microscopic vs macroscopic varicocelectomy (92% vs 30%, p < 0.001). The rates of infection, hematoma, and hydrocele were similar among both groups. Baseline semen parameters were similar among both groups. Microscopic varicocelectomy was associated with higher increase in semen volume (1.45 vs 1.35 ml, p < 0.001), sperm count (138 vs 97 million/ml, p = 0.007), progressive sperm motility (29.5 vs 24%, p < 0.001) and reduction of abnormal forms (-37.5 vs -26.5%, p = 0.008) at 3 months postoperatively. The conception rate was higher at one year among patients who underwent microsurgical versus macroscopic varicocelectomy (45.6% vs 23.4%, respectively, p = 0.018) Conclusion Microscopic subinguinal varicocelectomy can preserve more internal spermatic arteries, ligate more veins, better improve semen parameters, and eventually improve fertility outcomes compared to non-microscopic subinguinal varicocelectomy for the treatment of male subfertility.