Older Age Is Associated With Similar Improvements in Semen Parameters and Testosterone After Subinguinal Microsurgical Varicocelectomy

TLDR

Men with palpable varicocele are at risk for progressive declines in fertility and testosterone, and while varicocelectomy is believed to improve or preserve testicular function, its effectiveness in older men remains controversial. This study aimed to determine whether microsurgical subinguinal varicocelectomy improves semen parameters and testosterone in men of different ages, especially those 40 years or older. The authors retrospectively reviewed demographics, questionnaires, operative notes, charts, testosterone, and semen analyses of 272 men undergoing microsurgical subinguinal varicocelectomy, grouping them into <30, 30–39, and ≥40 years. Across all age groups, microsurgical varicocelectomy produced significant increases in sperm concentration, total sperm count, and testosterone, with comparable magnitude in men 40 years or older, supporting its use for infertility and hypogonadism in older men.

Abstract

It is generally accepted that men with clinically palpable varicocele are at high risk for a progressive decrease in fertility and testosterone levels with time. Varicocelectomy is thought to improve testicular function or at least halt the accelerated decrease in testicular function associated with varicocele. Substantial controversy exists as to whether varicocelectomy is effective in older men, possibly due to irreversible testicular damage or limited potential for recovery from varicocele induced damage.We retrospectively reviewed the records of men who underwent microsurgical subinguinal varicocelectomy, as done by a single surgeon. Demographics, patient questionnaires, operative notes, charts, testosterone and semen analysis were reviewed. Patients were divided into 3 groups based on age at surgery, including less than 30, 30 to 39 and 40 years or greater.A total of 272 men met study inclusion criteria. In all 3 age groups we noted similar testosterone and baseline semen analysis parameters. There were significant increases in sperm concentration and total sperm count in all age groups. When analysis was restricted to men with baseline testosterone 400 ng/dl or less, there was a mean 110, 133 and 136 ng/dl increase in 21 men who were 40 years old or older, in 30 who were 30 to 39 years old and in 21 who were younger than 30 years, respectively.Microsurgical varicocelectomy resulted in significant increases in sperm concentration, total sperm count and testosterone in all age groups studied, including men in the fifth and sixth decades of life. Microsurgical varicocelectomy should be offered to older men for infertility and/or hypogonadism.