الملخص

Background: Clinically varicocele (VCL) is defined as tortious dilation of the pampiniform venous plexus. Anatomically it includes the area between the testis and the final venous drainage which comprises pampiniform plexus, inguinal, and testicular veins. An important complication of advanced VCL is male infertility in 15-20% of cases. VCL is a correctible cause of male infertility. Pathophysiological consequences of VCL on the testes are variable from one person to another in deteriorating quantity, motility, and morphology of sperms. Aim: In this study, VCL complication consequences on sperm motility had been studied and concentrated as one of the most important fertilizing factors, in order to set a correct reversing time for the VCL effects on the testes.  Material and methods: This clinical study was carried out in 3 years, from march 2016 to April of 2019, In which (86) male varicocele-related infertility cases were collected in whom (54) primary and (32) secondary infertility cases. Seminal fluid analyses were performed intervalley every three months pre and postoperatively. Hormonal assays included serum (FSH, LH, Testosterone, Prolactin, and TSH). The VCL patients were grouped according to VCL dependent infertility duration into three groups: 1st group or early (less than one year). 2nd group or middle stage (less than two but more than one year). 3rd group or late stage (more than two years). All had been managed by operations (laparoscopic or open inguinal) and ± supplementary antioxidant medicines. Follow-up then continued for 18 months after treatment. Results: overall response of conceiving was 39.5%, in Group 1, while 56% of the response was recorded in Group 2, and 31.42% in Group 3. Subclinical group got 50% of the recovery. In the laparoscopic class, 20% bilateral varicocele was observed during the operation. In 8 (9.4%) patients of G2 and G3, subnormal testosterone levels were observed to reverse after the operation. Conclusion: The presence of varicocele is directly associated with congestion and a back-pressure effect on the testes, and the longer duration of varicocele with the majority of spermatic veins is associated with epididymal destructive changes moreover to testicular tissues. Consequently, more irreversible bad spermatic parameters were observed due to more aggressive testicular and epididymal endothelial damage.