COMPARISON OF LAPAROSCOPIC VERSUS MICROSURGICAL VERICOCELECTOMY IN TERMS OF SPERM COUNT

Abstract

Background: Infertility affects nearly 15% of couples of reproductive age, with male factors contributing to 40–50% of cases. Varicocele, an abnormal dilation of the pampiniform plexus veins, is one of the most common reversible causes of male infertility, observed in approximately 16–21% of men presenting to infertility clinics. It impairs spermatogenesis through testicular hyperthermia and venous congestion, leading to poor semen quality. Surgical correction through varicocelectomy remains the mainstay of treatment, with microscopic and laparoscopic techniques being the most widely practiced.

Objective: To compare the improvement in sperm count following laparoscopic and microscopic sub-inguinal varicocelectomy in infertile males diagnosed with varicocele.

Methods: This randomized controlled trial was conducted at the Department of Urology, Hayatabad Medical Complex, Peshawar, from January 1, 2025, to June 30, 2025. A total of 80 males aged 18–40 years with Doppler-confirmed unilateral varicocele were enrolled and randomly divided into two equal groups. Group A (n=40) underwent microscopic sub-inguinal varicocelectomy, while Group B (n=40) underwent laparoscopic varicocelectomy. Semen analyses were performed preoperatively and at four months postoperatively. Data were analyzed using SPSS version 22, applying paired t-tests for within-group and independent t-tests for between-group comparisons, with a p-value <0.05 considered significant.

Results: The mean preoperative sperm count in the microscopic group was 13.68 ± 4.77 million/mL, increasing to 23.86 ± 6.14 million/mL postoperatively (t = −20.03, p < 0.001). In the laparoscopic group, counts rose from 15.25 ± 3.79 million/mL to 21.55 ± 4.42 million/mL (t = −13.84, p < 0.001). The between-group comparison showed a near-significant difference (t = 1.91, p = 0.061), suggesting a trend favoring the microscopic approach.

Conclusion: Both microscopic and laparoscopic varicocelectomy significantly improved sperm counts, confirming varicocelectomy as an effective surgical treatment for varicocele-related male infertility. The microscopic technique showed a slight advantage in enhancing spermatogenesis, though larger multicenter trials are needed to validate this difference.