Factors Associated with Improved Semen Characteristics Following Microsurgical Sub-inguinal Varicocelectomy among Infertile Men in Tamale, Ghana

Aims: To determine factors associated with improved semen characteristics post microsurgical sub-inguinal varicocelectomy.

Study Design: An interventional study design

Place and Duration of Study: Department of Surgery (Urology Unit), Tamale Teaching Hospital (TTH), Ghana, between September 2017 to August 2021

Methodology: A total of 127 oligozoospermic patients with varicoceles requiring varicocelectomy were recruited. Patients were categorized into two groups; ‘responders’ and ‘non-responders’. Patients who showed significant improvement in semen characteristics (sperm count, concentration, motility, and morphology) 12 months after varicocelectomy were grouped as responders, whereas those who showed no improvement 12 months after surgery were considered non-responders. The predictive factors considered were; age, body mass index, varicocele grade, testicular hemodynamic, follicle-stimulating hormone (FSH), luteinizing hormone (LH), and semen characteristics. These factors were assessed using logistic regression analysis at an alpha value of 0.05.

Results: The men were aged between 31.0 and 67.0 years old. Among the 127 patients, sperm concentration significantly (p < 0.0001) improved from 7.86 ± 3.876 to 32.87 ± 15.57 x 106/mL and sperm motility increased from 34.40 ± 5.134 to 62.41 ± 12.93 x 106/mL in 69 patients (54.3%). In the logistic regression analysis, pre-operative serum FSH (aOR = 0.494; 95% CI: 0.267-0.913; p = 0.02), total testosterone (aOR = 3.618; 95% CI: 1.325 - 9.879; p = 0.01) and resistive index (L_RI cap) on the left capsular arteries (aOR = 0.452; 95% CI: 0.211 – 0.969; p = 0.045) were predictors of improved sperm concentration.

Conclusion: Microsurgical sub-inguinal varicocelectomy improved sperm characteristics. The predicting factors associated with improved semen characteristics post varicocelectomy are high testosterone, low serum FSH, and low left capsular resistive index (L_RI cap).