Clinical and Doppler Ultrasonographic Correlation of Varicocele in Male Infertility

Varicocele is a common, surgically correctable cause of male infertility. Its prevalence, clinical patterns, and impact on semen quality vary among populations, with limited data from India. This study aimed to assess clinical, semen, and ultrasonographic characteristics of infertile men with varicocele compared to infertile men without varicocele at a tertiary referral center in northern India.

This prospective observational study was conducted at Dr. Ram Manohar Lohia Institute of Medical Sciences (Dr. RMLIMS), Lucknow, from September 2023 to August 2024. Ninety infertile men were enrolled: 45 with clinically diagnosed varicocele (cases) and 45 without varicocele (controls). Clinical grading, scrotal Doppler parameters, and semen analyses were recorded. Group differences were analyzed using chi-square and t-tests. Odds ratios (OR) with 95% confidence intervals (CI) were calculated. Binary logistic regression was adjusted for age and type of infertility.

Azoospermia was significantly more frequent in cases (46.7%) than controls (20%) (OR: 3.51; 95% CI: 1.37-9.02; p = 0.007). Oligozoospermia occurred in 60% of cases versus 35.6% of controls (OR: 2.71; 95% CI: 1.12-6.55; p = 0.020). Mean pampiniform plexus diameters were larger in cases (right: 2.15 ± 0.66 mm; left: 2.95 ± 0.72 mm) compared to controls (right: 1.30 ± 0.21 mm; left: 1.47 ± 0.19 mm; p < 0.001 for both). High-grade left varicoceles (grades IV-V) were strongly associated with azoospermia (p = 0.014) and oligozoospermia (p = 0.007). Regression analysis confirmed varicocele as an independent predictor of azoospermia (adjusted OR: 3.23; 95% CI: 1.18-8.82). Post hoc power exceeded 80% for primary outcomes.

In this cohort, varicocele was independently associated with impaired spermatogenesis, particularly azoospermia and oligozoospermia. Ultrasound measurements confirmed clinical findings, with larger pampiniform plexus diameters in affected men. These findings underscore the importance of routine varicocele evaluation in the workup of male infertility in India.