Role of varicocelectomy on altering the (ART)‎ options available for management of male infertility

Abstract EN

Purpose : This was a prospective randomized controlled study to assess how varicocelectomy alters semen quality in a large group of infertile men and determined whether it can change patient chance for ART.

PATIENTS AND METHODS: A group of 80 infertile men with clinical varicocele underwent microsurgical varicocelectomy and were followed up to 1 and 2 years postoperatively for alterations in semen quality and conception, respectively.

Preoperatively &postoperatively the total motile sperm count was calculated in all semen analyses, based on total motile sperm count valuens, patients were divided into 4 groups according to the type of ART for which they qualified, those with count < 1.

5 million, were candidate for intracytoplasmic sperm injection (ICSI), those with count 1.

5 to 5 million were candidate for in vitro fertilization(IVF& ET), those with count 5 to less than 20million candidate for intrauterine insemination(IUI) & those with count > = 20 million were left for spontaneous pregnancy.

Preoperative and postoperative semen quality was compared among individuals in these groups to determine the shifts in assisted reproductive technology care that are possible after varicocelectomy.

RESULTS :Mean patient age was 26.

3 years (range 17 to 45).Microsurgical varicocelectomy was bilateral in 60 patients(75 %),on the left side in 20 (25 %)patients.

A positive response to varicocelectomy, defined as a greater than 50 % increase in total motile sperm count , was observed in 40patients(50 %).

An overall spontaneous pregnancy rate of 35% was achieved after varicocelectomy with a mean time to conception of 7 months of preoperative.

In vitro fertilization and intra cytoplasmic sperm injection candidates 31 % became intrauterine insemination or spontaneous' pregnancy candidates after varicocelectomy .Of intrauterine insemination candidates 42 % gained the potential for spontaneous pregnancy.

CONCLUSION: Varicocelectomy has significant potential not only to obviate the need for assisted reproductive technology, but also to down stage or shift the level of assisted reproductive technology needed for management of male factor infertility.