Varicocele affects approximately 15% of men and up to 40% of those seeking treatment for infertility. Among the various therapeutic approaches, subinguinal microsurgery is now recognized in international journals as the gold standard technique.
Overview of the latest data from meta-analyses published in the medical literature (source: Pubmed)
1. A clear improvement in sperm parameters. Recent studies confirm the direct benefit of this intervention on the spermogram:
- Sperm count and motility: a significant increase in the number and progressive motility of sperm is observed from 3 to 6 months after the procedure.
- Sperm DNA fragmentation: microsurgery reduces intratesticular oxidative stress, which significantly decreases the DNA fragmentation index, a key parameter for promoting natural pregnancy or optimizing the chances of success in ART (IVF/ICSI).
2. Increased pregnancy rates
- Spontaneous pregnancy rates at 12 months are significantly higher in couples where the partner has undergone surgery.
- In assisted reproductive technology (ART) procedures, varicocele correction improves embryo quality and live birth rates.
3. The lowest rate of recurrence and complications. The use of the operating microscope provides millimeter precision impossible to achieve with the naked eye or by other approaches:
- A minimal recurrence rate: between 0.5% and 2% only, compared to 4% to 11% for embolization and up to 15% for conventional open surgery. High-magnification visualization allows for the connection of all the spermatic and collateral veins responsible for relapses.
- A near absence of hydrocele: the risk remains below 1%, because the lymphatic microvessels are perfectly identified and preserved.
- Maximum arterial safety: the testicular artery is identified and spared to preserve the vascularization of the testicle.
4. A benefit on testosterone levels In men with a biological decrease in testosterone associated with a clinical varicocele, publications show a significant increase in testosterone levels after the operation, by freeing Leydig cells from scrotal hyperthermia.
In conclusion, the scientific literature demonstrates that subinguinal microsurgery offers the optimal combination: the best results for male fertility with the lowest risk of recurrence. It is the procedure of choice for effectively treating a clinical varicocele.
Dr. Davy Benarroche — Urologist and andrologist surgeon, specialist in male fertility in Paris.