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Varicocele repair improves male infertility

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – When infertile men with palpable varicoceles have them repaired, their semen parameters improve and their partners are more likely to become pregnant spontaneously, a new study shows.

Although varicocelectomy is common for this indication, not much evidence supports it, the team at King Abdulaziz University Medical City in Jeddah, Saudi Arabia led by Dr. Taha A. Abdel-Meguid, notes in European Urology published online December 21, 2010.

Dr. Abdel-Meguid’s group randomly assigned 150 married, healthy men ages 20 to 39 who had been infertile for at least a year to varicocelectomy (73 who completed the 1-year follow-up) or to observation (72 completers). Wives were less than 35 years old and fertile.

All subjects had palpable unilateral or bilateral varicoceles (grades 1-3) and at least one impairment in semen quality (sperm concentration < 20 million/mL, progressively motile sperm < 50%, or morphologically normal sperm < 30%). Researchers excluded men with subclinical or recurrent varicoceles, normal semen parameters, or azoospermia.

Varicocelectomies were performed with a subinguinal microsurgical approach, with arterial and lymphatic sparing.

During the following year, 32.9% of treated men got their wives pregnant (the primary endpoint), vs 13.9% of the control group (odds ratio 3.04, p = 0.01).

The authors report that the number needed to treat to achieve an extra spontaneous pregnancy within 1 year was 5.27.

Mean sperm concentration rise from 18.1 million/mL at baseline to 32.2 million/mL at follow-up in the varicocelectomy group; motility climbed from 25.3% to 41.0%, and normal morphology increased from 31.2 % to 39.1% (p < 0.0001 for all three parameters).

By contrast, none of the semen parameters improved significantly in the observation group.

Dr. Abdel-Meguid and colleagues conclude that “our study provided an evidence-based endorsement (level 1b evidence) of the superiority of varicocele repair over observation in infertile men with palpable varicoceles and impaired semen quality.”

The investigators received no outside funding for their study.


Does Varicocele Repair Improve Male Infertility? An Evidence-Based Perspective From a Randomized, Controlled Trial

Eur Urol 2010.