Abstract
BACKGROUND: Varicocele is a common, correctable cause of male infertility, often associated with impaired spermatogenesis. Microsurgical subinguinal varicocelectomy is considered the gold standard for varicocele repair, with documented benefits on semen quality, particularly sperm count. OBJECTIVE: The objective of this study was to evaluate the effect of microsurgical varicocelectomy on sperm count in infertile men diagnosed with clinical varicocele. METHODOLOGY: This prospective observational study was conducted at the Institute of Kidney Diseases, Hayatabad Medical Complex, Peshawar, Pakistan, over six months (October 1, 2024, to March 31, 2025). A total of 100 male patients aged between 20 to 45 years with clinical Grade I-III varicocele and abnormal semen parameters were enrolled. Patients underwent microsurgical subinguinal varicocelectomy after baseline semen analysis. A follow-up semen analysis was performed three months postoperatively. Pre- and postoperative sperm counts were compared using paired t-tests. Subgroup analysis was performed based on varicocele grade and laterality. RESULTS: The mean preoperative sperm count was 12.5 ± 6.8 million/mL, which significantly increased to 20.2 ± 8.1 million/mL postoperatively (p < 0.001). Patients with Grade III varicocele showed the highest improvement (22.6 ± 9.1 million/mL, p = 0.003). No significant difference was observed based on laterality (p = 0.087). CONCLUSION: Microsurgical varicocelectomy significantly improves sperm count in men with clinical varicocele, particularly in higher-grade cases. It should be considered an effective first-line intervention in the management of varicocele-associated male infertility.