VARICOCELE

Most common identifiable pathology in infertile men.

Affects 35% - 40% of men presenting for infertility evaluation.

Management of male-factor infertility with clinical varicocele and abnormal semen parameters:Varicocele repair

Assisted Reproductive Technologies (ARTs)○ Intrauterine Insemination (IUI)○ In Vitro Fertilization with Intracytoplasmic

Sperm Injection (IVF/ICSI)

Observation

OBJECTIVES

Assess pregnancy outcomes of two cohorts of infertile men with bilateral varicoceles:

Bilateral varicocelectomy

No surgery

Retrospective review of 610 consecutive infertile couples with clinical varicoceles.

All men had:one year or more of infertilitybilateral clinically palpable varicocele (examined by

same investigator – AZ)abnormal semen parameters

Couples with subclinical or unilateral clinical varicoceles, tubal obstruction or ovulatory failure excluded.

Couples counseled about treatment options (observation, varicocelectomy & ARTs)

All microsurgical varicocelectomies performed by same surgeon (AZ).

Outcome measures: Pregnancy rates (natural and assisted)

Changes in semen parameters

Utilization of ARTs

Total of 610 consecutive infertile men with a clinical varicocele

238 (39%) infertile men with bilateral clinical varicoceles

157 (66%) chose bilateral varicocelectomySurgical (SUR) group

81 (34%) men chose not to have surgeryNon-surgical (NON-SUR) group.

MEAN (±SD) BASELINE CLINICAL PARAMETERS

MEAN (±SD) BASELINE CLINICAL PARAMETERS

MEAN (± SD) SUR GROUP SEMEN PARAMETERS

Pregnancy outcome and ART utilization data available for:

67.5% (106/157) of SUR group

64% (52/81) of NON-SUR group.

MEAN (±SD) BASELINE CLINICAL PARAMETERS IN COUPLES WITH

PREGNANCY OUTCOME DATA

PREGNANCY & ART UTILIZATION RATES IN COUPLES WITH

PREGNANCY OUTCOME DATA

Bilateral varicocele repair, when compared to non-surgical management, was associated with:

Significant improvements in semen parameters

Significant increase in natural pregnancy rate

Significantly less overall ART utilization

For bilateral clinical varicoceles, microsurgical repair is a favourable option for treating couples with male factor infertility.