Effectiveness of Microsurgical Varicocelectomy in Male Infertility: A Randomized Controlled Study from India

Anil Kumar Sah* and Vineet Malhotra

Introduction: Varicocele is a common and potentially correctable cause of male infertility. Although several randomized trials suggest improvement in semen parameters following varicocelectomy, its effect on spontaneous pregnancy remains debated, particularly in diverse populations. This randomized controlled trial evaluated the impact of microsurgical varicocelectomy on semen quality and natural conception in infertile Indian men with clinical varicocele.

Methods: This prospective randomized controlled study was conducted at VNA Hospital, New Delhi, from January 2024 to December 2025. A total of 364 infertile men with clinically palpable varicocele and abnormal semen parameters were randomized into two groups: microsurgical subinguinal varicocelectomy (n=182) and observation with counseling (n=182). Operative interventions were completed between January and December 2024, and follow-up continued until December 2025. The primary outcome was spontaneous pregnancy rate at 6 and 12 months. Secondary outcomes included changes in semen parameters and complication rates.

Results: At 12 months, spontaneous pregnancy occurred in 41.8% of the surgery group compared with 21.4% in the observation group (p<0.001). Significant improvements were observed in sperm concentration, progressive motility, total motile sperm count, and sperm DNA fragmentation index, with progressive benefits over time in the intervention arm. Unlike prior studies, improvement in pregnancy rates continued beyond 12 months. Complication rates were low, with hydrocele in 2.1% and recurrence in 1.6%.

Conclusions: Microsurgical varicocelectomy significantly improves semen parameters and spontaneous pregnancy rates in infertile men with clinical varicocele. Benefits appear progressive over time, supporting early surgical intervention in appropriately selected patients.

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Published on: Aug 19, 2026 Pages: 8-16

Full Text PDF Full Text HTML DOI: 10.17352/2455-2968.000171
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