Microscopic Subinguinal Internal Spermatic Vein Ligation (Varicocelectomy) with Lymphatic Preservation: Effects on Semen Quality and Pregnancy, with and without Clomiphene Citrate

A cohort of 60 consecutive patients (age range: 29–55 years, average: 36 years) with presumed male factor infertility and clinically apparent varicocele(s) underwent microscopic subinguinal varicocele repair (with lymphatic preservation). All procedures were done under general anesthesia, on an outpatient basis. Depending on preoperative semen parameters, clomiphene citrate was used as an adjunct to surgery. Surgical outcome, semen response and pregnancies were determined. Follow-up was 1 to 5 years (or to pregnancy). Female ages ranged from 22–39 years, average: 32 years.

Overall, postoperative semen parameters (count and/or motility) improved in 60%, with a pregnancy rate of 25%. In patients with preoperative sperm counts less than 10 million per cc (about half the total population), the addition of clomiphene after surgery resulted in semen improvement rates and pregnancy rates equal to those of the patients with preoperative sperm counts greater than 10 million per cc who underwent surgery alone.

There was one minor wound infection, no clinical recurrences, and no postoperative hydroceles. Outpatient microscopic subinguinal internal spermatic vein ligation is a safe and effective treatment for varicocele in patients with male factor infertility. As well, the use of postoperative clomiphene citrate in those cases with very low preoperative sperm counts improved the outcome of that group to the same degree as those with higher preoperative sperm counts.