Objectives: Varicocelectomy could be beneficial in oligospermic patients with varicocele. To investigate predictors of improvement in seminal parameters after varicocelectomy, the intra-testicular microcirculation was assessed before and after varicocelectomy to define suitable candidates for repair. Patients and Methods: This study included 45 oligospermic infertile patients with varicocele (23 with left and 22 bilateral). They were assessed by physical examination, semen analysis, power Doppler ultrasound and hormonal levels. Preoperative intra-testicular hemodynamic parameters were compared with 25 normal fertile controls. All patients underwent inguinal varicocelectomy and were followed-up for at least 6 months. Patients were then further subdivided into responders and non-responders according to improvement in their seminal parameters. Results: Preoperatively, the intra-testicular end diastolic velocity (EDV), resistive index (RI) and pulsatility index (PI) of oligospermic patients with varicocele were significantly different from the controls. Postoperatively, total motile sperm count improved in 27 cases. EDV, RI and PI revealed significant changes between responders and non-responders. Responders had significantly higher preoperative EDV and peak systolic velocity and lower RI, PI, and follicle-stimulating hormone (FSH) versus non-responders. With linear regression analysis, EDV and FSH were the significant predictors of improved total motile sperm count. Conclusion: Varicocelectomy is beneficial in oligospermic patients with high EDV and low FSH level.

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