Clinical outcomes of intracytoplasmic sperm injection in infertile men with treated and untreated clinical varicocele

Abstract

OBJECTIVE: Our aim was to evaluate the impact of varicocelectomy on intracytoplasmic sperm injection (ICSI) outcomes in a group of infertile men with clinical varicoceles. DESIGN: Retrospective analysis of clinical data. MATERIALS AND METHODS: This study involved 242 infertile men with a history of clinical varicoceles who underwent ICSI from January 2000 to August 2008. Eighty men had a prior successful varicocelectomy (group 1) and 162 men had any grade of varicocele (group 2) at the time of ICSI. Baseline semen parameters in groups 1 (before surgery) and 2 were matched. For group 1, semen analysis values were compared before and after surgery using a paired Student's T test. Clinical pregnancy rates were compared between groups using Pearson's Chi-square test, and a logistic regression analysis was performed to verify if surgical correction of the varicoceles increased the odds of clinical pregnancy or decreased the odds of abortion. Only the first ICSI cycle of each patient was included for analysis. Throughout the study, a p-value of less than 5% was considered significant. RESULTS: Mean FSH level, testicular volume, duration of infertility, male and female partners' ages and the proportion of female factor problems were not different between goups. The distribution of varicocele grade within the treated and untreated groups was not different. Improvement in sperm concentration (14.1x10 pre, 34.9x10 post; p=0.026) and reduction in sperm defect score (2.2 pre, 1.9 post; p=0.013) were observed after varicocele repair in group 1. Clinical pregnancy rates after ICSI were higher in the treated group (60.3% in group 1, 45.0% in group 2, p=0.031). Also, the chance of miscarriage after obtaining a pregnancy by ICSI were reduced if the varicocele had been treated (OR=0.433; 95% confidence interval 1.05 to 6.60; p=0.012). CONCLUSIONS: Our data suggest that varicocelectomy improves clinical pregnancy rates by ICSI. Also, the chance of miscarriage may be reduced if the varicocele is treated before assisted reproduction.