Comparison of artery-ligating and artery-preserving varicocelectomy: effect on post-operative spermatogenesis

To evaluate the effects of ligature of the internal spermatic artery at varicocelectomy on fertility, we conducted a prospective randomized study for comparison of two surgical methods (artery-ligated and artery-preserved). A total of 66 infertile patients with palpable varicocele was randomly assigned to an artery-ligated or artery-preserved group at varicocelectomy and the change in seminal characteristics and testis volume was prospectively investigated. Sperm density and motility improved significantly in the artery-ligated group. There was significant improvement in sperm density in the artery-preserved group, but motility did not reach the level of statistical significance in this group. The significant change in testis volume was not observed in both groups. Seven (23.3%) of 30 patients in the artery-ligated group and 5 (13.9%) of 36 men in the artery-preserved group managed to impregnate their partners. The difference was not statistically significant. In spite of the advocative advantage of artery preservation, our present study did not show any significant difference between artery-ligating and artery-preserving varicocelectomy when improvements in semen quality and pregnancy rate were assessed. Thus, artery-ligated varicocelectomy is warranted with regard to post-operative fertility in the patients with clinical varicocele.