Background: Varicocele is known to be associated with impaired semen parameters and male infertility in adults. However, its impact on the adolescent and young adult (AYA) population is less well known.

Objectives: The study aimed to assess the improvement in sperm parameters following varicocelectomy in the AYA population, comparing them to matched adult counterparts, and investigating potential advantages of early intervention.

Methods: A prospective analysis was conducted using a comprehensive database at the University of Miami spanning from 2010 to 2022. We included AYA (under 25 years of age) men who underwent varicocelectomy. To ensure comparability, they were matched with adult patients (over 30 years of age) based on follicle-stimulating hormone (FSH) values, varicocele grade, and laterality (unilateral or bilateral) in a 1:2 ratio. Semen parameters were evaluated before and after surgery, including sperm count, motility, morphology, and overall semen quality.

Results: We included 45 patients in the Adolescents and Young Adults (AYA) category, and matched them with 116 adults based on FSH, varicocele grade and laterality, all of whom underwent microsurgical varicocelectomy. The AYA group exhibited greater improvements post-varicocelectomy compared to the matched cohort. FSH levels in the AYA group were significantly lower than in adults after varicocelectomy, 4.2 and 8.92 respectively (p=0.022). Furthermore, postoperative sperm concentration in the AYA men demonstrated a remarkable increase, with a 1.7-fold increase in mean concentration compared to the adult group (p<0.001) (Table 2). Additionally, motility also displayed significant enhancement among the AYA men, with a final mean total motile sperm count (TMSC) improvement of 2.25-fold compared to the adult cohort (p=0.002).

Conclusion: This study highlights the potential benefits of varicocelectomy as a viable treatment option for adolescents and young adults with varicocele, particularly those with impaired semen parameters. By intervening at an earlier stage of development, patients in this age group can achieve significant improvements in semen quality, as compared to their adult counterparts.