Does the type of infertility affect varicocelectomy efficacy?

Introduction. Varicocele is recognized as the most prevalent and treatable factor contributing to both primary (PI) and secondary (SI) male infertility. This condition has been widely studied due to its impact on fertility, and varicocelectomy is a commonly employed surgical intervention aimed at improving reproductive outcomes. Objectives. The purpose of this study was to evaluate and compare the effectiveness of varicocelectomy in men with primary and secondary infertility, focusing on changes in semen parameters post-surgery. Materials and Methods. This prospective single center study included men diagnosed with PI ( n = 22) and SI ( n = 28), who underwent varicocelectomy at the Republican Specialized Scientific-Practical Medical Center of Urology between January 2021 and December 2022. Semen parameters before and after varicocelectomy were assessed in accordance with the WHO 5th (2010) and 6th (2021) manuals. Results. Our analysis demonstrated that patients in group I were significantly younger ( p < 0.001) and experienced a shorter infertility duration ( p < 0.01) compared to those in group II. Key semen parameters showed notable improvement in group I; for instance, sperm concentration rose by 50 %, from 62.2 ± 8.7 to 93.5 ± 10.0 M/ml, while total motile sperm count increased by 113 %, from 76.7 ± 17.1 to 163.4 ± 27.8 M ( p < 0.05). In contrast, group II showed a significant increase only in the percentage of progressive motile sperm (up by 107 %, from 13.5 ± 2.6 to 28.0 ± 5.2 %, p < 0.05). A notable distinction was observed in the improvement of total motile sperm count between groups I and II (113 % vs. 74 %, respectively, p < 0.01). Additionally, a difference was identified between the groups in the correlation coefficient (r) for the initial and post-surgery percentages of progressive motile sperm. Conclusions. Patients with SI presented with a higher mean age and longer infertility duration than those with PI. Varicocelectomy led to significant improvements in key semen parameters in patients with PI, whereas for patients with SI, the procedure primarily enhanced only the percentage of progressive motile sperm. These findings indicate that the type of infertility may influence the effectiveness of varicocelectomy, but only in the context of differences in age and duration of infertility between these groups.

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