الفهرس 
Anatomy and histologyOnly 14 pages are availabe for public view
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Abstract
Varicocele is recognized as a clinical problem, since it is very old in the history, and its association with male infertility is well-established (Dubin and Amelar, 1977; and Saypol, 1981).
The importance of varicocele lies in its common presentation in the general public and infertility clinics, with an overall prevalence rate of 35-40% in men with primary infertility, and of 80% in men with secondary infertility (Kamal et al., 2001; and Gat et al., 2004).
The etiology of varicocele is probably multifactorial (Skoog et al., 1997), and its pathophysiology shows us that it can decrease fertility by different mechanisms (Naughton et al., 2001).
The most important methods for diagnosis of varicocele and its impact on male fertility are: clinical diagnosis, scrotal ultrasound, color doppler, and semen analysis. Other less commonly applied methods include venography, testicular biopsy, thermography, perfusion scintigraphy, hormonal profile, and other techniques.
The subinguinal approach of varicocelectomy is one of the common procedures for treating varicocele. It was described by several authors to be simple, safe, and a favourable method for ligation of varicocele (Goldstein et al., 1992; and Marmar and Kim, 1994; and Ammaturo et al., 2005).
The effectiveness of varicocelectomy is still debatable. Yamamoto et al. (1994) and Nieschlag et al. (1995, 1998) found no statistically significant difference in pregnancy rates between treated and non-treated varicocele groups, while other authors reported increased fertility parameters after the operation. Some of these authors studied the effect of varicocelectomy on semen parameters and reported marked improvement (Cayan et al., 2000; and Agarwal et al., 2007). The others, studied its effect on the pregnancy rate postoperatively, and reported an improvement in 20%-60% (Schlesinger et al., 1994).
Our study included 60 varicocele patient with ages ranging between 23 and 57 years old. All the patients underwent subinguinal varicocelectomy and were followed up for one year postoperatively as regards the pregnancy rate and semen analysis at 3, 6, 9, and 12 months.
The results showed that the pregnancy rate was 51.7%, and that the pregnancy occurred within a mean duration of 4.7 months after the operation, and that the improvement in sperm concentration, motility, and sperm morphology was 66.7%, 60%, and 60% in each of them respectively.
Correlation between preoperative parameters, and the pregnancy outcome was made. We found that the outcome was significantly correlated with reflux, bilaterality of varicocele, testicular atrophy, smoking, partner’s menstrual irregularity and partner gynecological problems affecting the fertility. When combining reflux and bilaterality, it was found that this combination has a highly significant effect on the pregnancy outcome.
Other factors were found to be non significantly correlated with the pregnancy outcome, including the internal spermatic vein diameter, patient’s age, type of infertility (primary or secondary), duration of infertility, and partner’s age.
Some researchers considered the outcome after varicocelectomy non-satisfactory, because there still a high percentage of patients that may have a persistant infertility after the operation. Suggested causes for persistent infertility may include hormonal and immunological factors, as well as failure of the operation or recurrence of varicocele, Yq microdeletion, cigarette smoking, and undiagnosed female factors.
Conclusion and recommendations
In spite of the fact that subinguinal technique of varicocelectomy may not be beneficial for some patients, yet it improves pregnancy rate, and semen parameters. Even in patients desiring assisted reproductive techniques, prior varicocelectomy may improve pregnancy outcome of this procedure.
Further studies are recommended to evaluate the effect of corticosteroid administration as an adjuvant therapy after varicocelectomy to improve the fertility of the patient and the pregnancy rate.