(PNM-49) Subinguinal microsurgical varicocelectomy and fertility: real-world evidence of hormonal and reproductive benefit in a cohort of 47 infertile men

Abstract Introduction and Objective Varicocele is the most common identifiable cause of male infertility, and microsurgical varicocelectomy is considered the gold standard treatment. This retrospective cohort study aimed to assess the effects of subinguinal microsurgical varicocelectomy on semen parameters, serum testosterone levels, and pregnancy outcomes in infertile men. Maternal age was also analyzed to contextualize reproductive results. Methods We analyzed 47 men who underwent subinguinal microsurgical varicocelectomy between January 2016 and March 2024 at a university hospital in Rio de Janeiro, all presenting with infertility. Pre- and postoperative semen parameters were assessed according to the 2021 WHO criteria. Serum testosterone and semen analyses were collected before and 3 to 6 months after surgery. Pregnancy outcomes were evaluated through follow-up interviews, and maternal age was recorded when available. Results The procedure resulted in a significant increase in mean serum testosterone, from 365.8 ng/dL before surgery to 439.5 ng/dL postoperatively (mean delta of +73.7 ng/dL). Median sperm motility improved from 13% to 28%, and median sperm concentration rose from 8 to 15.4 million/mL. Azoospermia was present in 8 patients (17.0%) preoperatively and decreased to 3 patients (6.4%) postoperatively. Among the 47 couples, 24 achieved pregnancy following surgery. Maternal age was a mean of 30.6 years (range: 19–42). Varicocele grades II and III were the most common in this cohort. No statistically significant association was found between varicocele grade and postoperative pregnancy (p = 0.923). Conclusion Subinguinal microsurgical varicocelectomy significantly improved hormonal and seminal parameters and reduced azoospermia. More than half of the couples achieved pregnancy postoperatively. No association was observed between varicocele grade and likelihood of pregnancy in this cohort. Financing No conflict.