Does age matter? Impact of age on testicular function and pregnancy outcomes following microsurgical varicocelectomy in patients with grade 3 varicocele

Objective: To evaluate the effects of age on semen and hormonal parameters following microsurgical varicocelectomy among patients with grade 3 varicocele, and to compare fertility outcomes between younger (<40 years) and older (≥40 years) men. Methods: Retrospective cohort study of infertile patients with clinical left grade 3 varicocele who underwent microsurgical subinguinal varicocelectomy (MV). Patients meeting the inclusion criteria (N = 550) were divided into two groups based on their age at the time of MV: <40 (n = 441) and ≥40 years (n = 109). Preoperative semen analysis and hormonal profiles were collected, and follow-up data including pregnancy outcomes were gathered at 3 and 6 months post-surgery. Results: Post-surgery, the younger group showed significant improvements in sperm count and total motility (p < 0.001 for each) as well as progressive motility (p = 0.005), while older men exhibited a significant increase in progressive motility (p = 0.002). For each group, there were no significant changes in hormonal levels post-surgery. Comparative analysis across the two age groups showed no significant differences in the postoperative extent of semen improvements or pregnancy. Conclusion: MV is a viable option for older infertile patients as it is for younger infertile men with grade 3 varicocele, and both groups can achieve similarly high rates of pregnancy outcomes.