Effect of Varicocele Treatment on Natural Pregnancy Outcomes

Abstract

Natural conception is always favoured over assisted reproduction by the patients and the caregivers, and has been shown to be safer for both the mother and the child. While various studies and meta-analysis have shown the encouraging effects of varicocelectomy on semen parameters in infertile men, improvement in the natural pregnancy rate is more controversial. One of the first studies addressing this topic showed a significant improvement in natural pregnancy rates following varicocelectomy, but these results could not be reproduced by others, and the Cochrane Collaboration meta-analyses performed three consecutive times (2001, 2004, 2008) concluded that varicocelectomy does not improve the natural pregnancy rates. However, these meta-analyses included men with normozoospermia, subclinical varicoceles, and inappropriate interventions and thus faced significant criticism. Subsequent meta-analyses with better selection criteria, namely, including only men with clinical varicoceles and abnormal semen parameters, showed a statistically significant effect of varicocelectomy in improving the natural pregnancy rates. Multiple factors such as age of both the partners, body mass index of the male partner, grade of varicocele, presence of testicular atrophy, pre-operative and post-operative sperm counts, pre-operative serum FSH levels and various other factors have been shown to affect the natural pregnancy rates in men undergoing varicocelectomy. Of the various procedures described, microsurgical varicocelectomy results in highest natural pregnancy rates. Thus, varicocelectomy in couples with normal female partner evaluation with palpable varicoceles and oligozoospermia improves the chances of natural pregnancy.