Varicocele in Oligospermic Patients: Pathophysiology and Results After Ligation and Division of the Internal Spermatic Vein

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Abstract
A total of 51 oligospermic patients with varicoceles who underwent high ligation and division of the left spermatic vein were followed for up to 32 mo. Of these patients, 59.9% had improvement in total sperm count, 47.1% in sperm motility and 42.1% in the morphological pattern of the spermatozoa. Pregnancies were reported by 13 patients. Improvement in sperm motility occurred first, followed by improvement in morphology. The last improvement was in total sperm count. The observation period after a varicocele operation should be restricted to 9 mo., in which time about 75% of the expected improvement takes place. A clinical classification for the degree of varicocele is proposed. No correlation between size of the varicocele and treatment results could be observed. A classification of sperm analysis is proposed, using a 3-digital index that might enable better comparison of sperm analysis and better communication among physicians. A specific group of oligospermic patients could not be defined who might benefit more than other groups from a varicocele operation. Pathophysiological pathways leading to impaired spermatogenesis in patients with varicoceles are discussed.