VARICOCELE LIGATION WITH IMPROVED FERTILITY

Summary. Seminal changes following fifty-five high ligations of different sizes of varicocele have been compared with those following ligation of the spermatic vein in the absence of a varicocele. The criteria for selection of cases for operation have been discussed and it has been shown that even very small varicoceles are worthy of ligation. An initial depression of the sperm count is generally followed by a gradual increase for as long as 15 months after operation. Depressed sperm motility associated with an adequate sperm count is a strong indication for operation but good results can also be antici¬ pated when there is complete necrospermia. Approximately 75 % of cases with low sperm counts can be expected to return to normal levels. Congenital or pathological changes in the testes — other than those produced by a varicocele — are a contra-indication to operation. In a previous communication (Scott, 1958), the results of seminal and histological studies in patients with different sizes of varicocele were presented and it was noted that all grades of varicocele appeared to play a definite part in the production of male subfertility. That particular study was undertaken to make possible the more accurate selection of cases for operation; the present study sets out to justify these criteria for elective surgery based on the seminal changes following ligation of the different sizes of varicocele. In the past 4 years, over a hundred subfertile men have had their varicoceles ligated by Mr W. S. Mack or myself at the Male Infertility Clinic of the Western Infirmary, Glasgow. This study covers fifty-five consecutive cases in which the author carried out both the operation and the clinical assessment of the size of the varicocele. Fifty-three of these cases had left-sided varicoceles of varying sizes and two had large right-sided varicoceles. To serve as 'controls', * Read at the Annual Conference, 1959, of the Society for the Study of Fertility.