Comparison of Effects of General Versus Spinal Anesthesia on Spermiogram Parameters and Pregnancy Rates After Microscopic Subinguinal Varicocelectomy Surgery: Retrospective Cohort Analysis

<i>Background and Objectives:</i> The association between different anesthesia modalities and spermiogram parameters and reproductive outcomes in patients undergoing microscopic subinguinal varicocelectomy (MSV) remains unclear. In this retrospective cohort study, we aimed to compare spermiogram parameters and pregnancy rates between patients receiving general anesthesia (GA) versus spinal anesthesia (SA) for MSV with 2-year follow-up data. <i>Materials and Methods:</i> Male patients aged between 18-50 years, with ASA physical scores between I-III, who underwent unilateral or bilateral primary MSV, were included in the study. To minimize selection bias and balance the baseline characteristics between the GA group and SA group, we employed a propensity score matching approach, matching all 38 SA patients with 380 GA patients selected from a larger pool. Patients with complete 24-month follow-up data were included in the final analysis. The primary outcome of our study was determined as evaluating sperm count changes. Secondary outcomes included other sperm parameters (motility, morphology and semen volume), natural pregnancy rates, perioperative complications and recovery parameters. <i>Results:</i> The final analysis included 418 patients who met all inclusion criteria and completed the follow-up period. The study population comprised 380 patients in the GA group and 38 in the SA group. No significant difference was found between the groups in terms of sperm count. Greater improvement in sperm motility was observed in the SA group starting from the third month onwards (<i>p</i> = 0.027). Natural pregnancy was achieved in 16/38 (42.1%) of SA patients versus 125/380 (32.9%) of GA patients (<i>p</i> = 0.031). In addition, better results were obtained in terms of recovery parameters in the SA group. Other results were comparable between the groups. <i>Conclusions:</i> Spinal anesthesia for MSV was associated with greater improvement in sperm motility and higher natural pregnancy rates compared to general anesthesia, despite comparable sperm count improvements. These associations warrant further investigation in prospective randomized trials.