Introduction. The mechanism of impaired spermatogenesis in case of varicocele is still unknown, and the connection between male infertility and varicocele is based only on the statistical data, which gives not always unambiguous results. Nevertheless, the presence of male infertility is a defining indication for varicocele surgical treatment. At the same time, the surgical treatment of varicocele itself can in 28% cases have a depressing effect on spermatogenesis in men. The available reports observing patients with varicocele without surgical treatment show the long-term duration of reproductive function in these patients.
Aim. To assess the long-term reproductive function dynamics in patients with varicocele with or without surgical treatment.
Materials and methods. We observed 198 men aged 19-24 years, in whom varicose veins of the spermatic cord on the left were detected by palpation during a preventive examination, or during their active visit to a urologist for varicocele. Ejaculate analyzes were assessed in the laboratory, according to the 1987 WHO recommendations, the results of which were statistically processed using MicrosoftExcel 7.0 and Statisticafor Windows 6.0 software. Depending on the degree of varicose veins, the patients were divided into three groups, which were compared with each other to assess the effect of the varicocele severity on spermogram indices.
Results. The results obtained indicate the absence of any connection between impaired spermatogenesis in case varicocele and the severity of the spermatic cord varicose veins. Changes in spermograms were the same for different degrees of varicocele. Dynamic monitoring for more than 15 years of the reproductive function state in patients with varicocele revealed a gradual decrease in the main indicators of sperm fertility in all patients with varicocele. However, in men from the group of operated patients, these changes occurred much earlier and were significantly more pronounced than in the group of non-operated patients. The frequency of pregnancies ending with elective delivery during the observation period in the group of unoperated patients with varicocele was noted in 35 (68.8%) of 51 married couples, while in the group of operated patients out of 63 married couples, the delivery was recorded in 18 cases (28 ,8%).
Conclusions. Varicose veins of the spermatic cord are not a determining factor in impaired spermatogenesis and is not an absolute indication for surgical treatment as a prevention of spermatogenesis disorders. A progressive deterioration of spermogram parameters in patients with varicocele without surgery for the period of time more than 5 years was noted in only 10.6% of patients, while in the group of operated patients, these disorders were detected in 23.9%. In addition, non-operated patients had a higher birth rate for the entire follow-up period compared to patients from the operated group (68.8% versus 28.6%).