Abstract
To study the effect of high grade varicocele treatment in infertile patients. Seventy-five patients were selected by the following criteria: infertility persisting for more than 1 year; abnormal semen parameters; no other infertility-related disease; no obvious causes of infertility in the subject's partner; basal eco-color Doppler ultrasound demonstrating continuous reflux in the spermatic vein. All patients considered for the study had at least a six months period from the diagnosis to the surgery due to waiting list, choice of the patient or time needed to complete diagnostic evaluation of the couple. The surgical procedure was performed through an inguinal approach. All enrolled patients were counseled to have unprotected intercourse during the ovulation period in order to maximize the probability of pregnancy within the 6-month preoperative period. The achievement of pregnancy and semen parameters were recorded during the preoperative and postoperative period. Two of the seventy-five patients were excluded because of persistent varicocele after surgery. The preoperative pregnancy rate was 1.3% (1 couple). The postoperative pregnancy rate was 42.5%. The stratification of pregnancies by semester showed a significantly higher rate in the first postoperative period (p = 0.0012). Mean time to conception was 13.5 months. Mean preoperative sperm count was 17.6x10(6)/mL compared to 19.7x10(6)/mL in the postoperative period (p < 0.0001). Mean percentage of progressive sperm motility was 13.7%, compared to 17.6% in the postoperative period (p < 0.0001). Mean percentage of normal sperm morphology was 7.6%, compared to 15.2% postoperatively (p < 0.0001). Surgical treatment of high grade varicocele proved to effectively treat associa¬ted infertility by improving seminal parameters and pregnancy rate in our patient cohort.
Highlights
Varicocele is a common scrotal condition characterized by the elongation and enlargement of the network of veins leaving the testis that join to form the testicular vein.The incidence is reported to be as high as 20-24% in the adult male population [1] with a higher prevalence in the left side
The exact association between reduced male fertility and varicocele is not known because prospective randomized studies on varicocele treatment in adults have given conflicting results [4,5,6,7,8]
From January 2006 to February 2011, we studied 75 patients with high grade left varicocele who presented with infertility
Summary
Varicocele is a common scrotal condition characterized by the elongation and enlargement of the network of veins leaving the testis that join to form the testicular vein.The incidence is reported to be as high as 20-24% in the adult male population [1] with a higher prevalence in the left side. The condition is more common in men in infertile marriages, in which it affects 25-40% of men with abnormal semen analysis [2,3]. The exact association between reduced male fertility and varicocele is not known because prospective randomized studies on varicocele treatment in adults have given conflicting results [4,5,6,7,8]. The largest study indicated a benefit [8,9], whereas meta-analysis of most of the prospective randomized trials did not [10]. It would be probable that a lower grade of varicocele does not affect fertility as well as the quality of seminal parameters, and a significant bias might exist
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