VARICOCELE
Most common identifiable pathology in infertile men.
Affects 35% - 40% of men presenting for infertility evaluation.
Management of male-factor infertility with clinical varicocele and abnormal semen parameters:Varicocele repair
Assisted Reproductive Technologies (ARTs)○ Intrauterine Insemination (IUI)○ In Vitro Fertilization with Intracytoplasmic
Sperm Injection (IVF/ICSI)
Observation
OBJECTIVES
Assess pregnancy outcomes of two cohorts of infertile men with bilateral varicoceles:
Bilateral varicocelectomy
No surgery
Retrospective review of 610 consecutive infertile couples with clinical varicoceles.
All men had:one year or more of infertilitybilateral clinically palpable varicocele (examined by
same investigator – AZ)abnormal semen parameters
Couples with subclinical or unilateral clinical varicoceles, tubal obstruction or ovulatory failure excluded.
Couples counseled about treatment options (observation, varicocelectomy & ARTs)
All microsurgical varicocelectomies performed by same surgeon (AZ).
Outcome measures: Pregnancy rates (natural and assisted)
Changes in semen parameters
Utilization of ARTs
Total of 610 consecutive infertile men with a clinical varicocele
238 (39%) infertile men with bilateral clinical varicoceles
157 (66%) chose bilateral varicocelectomySurgical (SUR) group
81 (34%) men chose not to have surgeryNon-surgical (NON-SUR) group.
MEAN (±SD) BASELINE CLINICAL PARAMETERS
MEAN (±SD) BASELINE CLINICAL PARAMETERS
MEAN (± SD) SUR GROUP SEMEN PARAMETERS
Pregnancy outcome and ART utilization data available for:
67.5% (106/157) of SUR group
64% (52/81) of NON-SUR group.
MEAN (±SD) BASELINE CLINICAL PARAMETERS IN COUPLES WITH
PREGNANCY OUTCOME DATA
PREGNANCY & ART UTILIZATION RATES IN COUPLES WITH
PREGNANCY OUTCOME DATA
Bilateral varicocele repair, when compared to non-surgical management, was associated with:
Significant improvements in semen parameters
Significant increase in natural pregnancy rate
Significantly less overall ART utilization
For bilateral clinical varicoceles, microsurgical repair is a favourable option for treating couples with male factor infertility.