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Purpose:

Varicocele represents the most common cause of male infertility, and most reports indicate that varicocelectomy has a beneficial effect on male fertility and pregnancy outcome. We evaluated the clinical outcomes of infertile couples with varicocele and isolated asthenospermia who chose to undergo varicocelectomy as well as those who chose not to undergo the procedure.

Materials and Methods:

We performed a retrospective review of 118 consecutive infertile couples in whom the man presented with clinical varicocele and isolated asthenospermia (less than 50% motile sperm). All couples were presented with possible treatment options (observation, varicocelectomy, assisted reproductive technologies). The clinical characteristics and outcomes of 2 subgroups of men—those who elected to undergo surgery (varicocelectomy, 69) and those who did not (49)—were examined and compared.

Results:

Mean male and female patient age, duration of infertility and baseline total motile sperm count were not significantly different in the control and surgery groups. The mean total motile sperm count increased significantly after varicocelectomy (29.6 million preoperatively vs 39.0 million postoperatively, p <0.05). The spontaneous pregnancy rate was significantly higher in the surgery group compared to the control group (65% vs 32%, respectively, p <0.01). The combined spontaneous and intrauterine insemination pregnancy rate was also significantly higher in the surgery group compared to the control group (74% vs 36%, respectively, p <0.01). Use of in vitro fertilization/intracytoplasmic sperm injection was significantly higher in the control group compared to the surgery group (32% vs 11%, respectively, p <0.05).

Conclusions:

Our data support the practice of varicocelectomy for the treatment of clinical varicocele and isolated asthenospermia.

References

  • 1 The influence of varicocele on parameters of fertility in a large group of men presenting to infertility clinics: World Health Organization. Fertil Steril1992; 57: 1289. Google Scholar
  • 2 : Are sperm motion parameters influenced by varicocele ligation?. Fertil Steril1999; 71: 886. Google Scholar
  • 3 : Treatment outcome after varicocelectomy: A critical analysis. Urol Clin North Am1994; 21: 517. Google Scholar
  • 4 : Varicocele and fertility: relationship between testicular volume and seminal parameters before and after treatment. J Androl2006; 27: 548. Google Scholar
  • 5 : Varicocelectomy: 986 cases in a twelve-year study. Urology1977; 10: 446. Google Scholar
  • 6 : Microsurgical inguinal varicocelectomy with delivery of the testis: an artery and lymphatic sparing technique. J Urol1992; 148: 1808. LinkGoogle Scholar
  • 7 : Technical modification of microsurgical varicocelectomy can reduce operating time. Urology2006; 67: 803. Google Scholar
  • 8 : WHO Laboratory Manual for the Examination of Human Semen and Sperm-Cervical Mucus Interaction. Cambridge: Cambridge University Press1992. Google Scholar
  • 9 : Controlled trial of high spermatic vein ligation for varicocele in infertile men. Fertil Steril1995; 63: 120. Crossref, MedlineGoogle Scholar
  • 10 : Update on treatment of varicocele: counselling as effective as occlusion of the vena spermatica. Hum Reprod1998; 13: 2147. Google Scholar
  • 11 : Processed total motile sperm count correlates with pregnancy outcome after intrauterine insemination. Urology2002; 60: 497. Google Scholar
  • 12 : Effect of the total motile sperm count on the efficacy and cost-effectiveness of intrauterine insemination and in vitro fertilization. Fertil Steril2001; 75: 661. Google Scholar
  • 13 : ICSI outcome in patients with transient azoospermia with initially motile or immotile sperm in the ejaculate. Hum Reprod2005; 20: 2584. Google Scholar
  • 14 : Effect of age and grade on surgery for patients with varicocele. Urology2005; 65: 768. Google Scholar
  • 15 : Effects of male age on semen quality and fertility: a review of the literature. Fertil Steril2001; 75: 237. Google Scholar
  • 16 : Effect of male age on fertility: evidence for the decline in male fertility with increasing age. Fertil Steril2003; 79: 1520. Google Scholar
  • 17 : Social determinants of human reproduction. Hum Reprod2001; 16: 1518. Google Scholar
  • 18 : Effect of aging on fertility and pregnancy. Semin Reprod Endocrinol1991; 9: 165. Google Scholar
  • 19 : Microsurgical varicocelectomy in the era of assisted reproductive technology: influence of initial semen quality on pregnancy rates. Fertil Steril2001; 75: 1013. Google Scholar

Division of Urology, Department of Surgery, McGill University, Montreal, Quebec, Canada