A nomogram of testicular volume, follicle-stimulating hormone, and inhibin B for predicting live birth after varicocelectomy.

Abstract

To evaluate the incidence of natural pregnancy (NP) and subsequent live birth following microsurgical varicocelectomy (MV) in male infertility patients with varicocele, and to identify potential predictive factors for successful outcomes. This prospective cohort study included 360 male infertility patients diagnosed with clinically palpable varicocele. Participants were followed for 2 years after undergoing MV. The primary outcomes were NP and subsequent live birth, with secondary outcomes including miscarriage rates, infant health, and surgical complications. Cox regression analyses was applied to select predictive factors, and nomograms were constructed to establish prediction models. Within 2 years after MV, 40.89% had live births following NP. Significant improvements were observed in sperm concentration, total motility, progressive motile sperm count, and morphology after MV. Multivariate Cox analysis confirmed that larger testicular volume, lower follicle-stimulating hormone, and higher inhibin B were independent predictors for live birth. The nomogram incorporating these three variables demonstrated good discrimination and favourable calibration. Decision curve analysis confirmed the model's clinical utility across a wide range of threshold probabilities. These findings provide strong evidence to guide andrologists in counselling patients about the benefits of MV and help determine whether MV is necessary for achieving live birth in male infertility associated with varicocele.