Varicocelectomy to “upgrade” semen quality to allow couples to use less invasive forms of assisted reproductive technology

Objective

To determine the magnitude of improvement in semen parameters after a varicocelectomy and the fraction that have improvements such that couples needing IVF or IUI are “upgraded” to needing less invasive assisted reproductive technology (ART).

Design

Retrospective review of prospectively collected data.

Setting

Academic medical centers.

Patient(s)

Men presenting for a fertility evaluation with a clinical varicocele.

Intervention(s)

Varicocele repair (surgical or embolization).

Main Outcome Measure(s)

Total motile sperm count (TMSC) before and after repair, and the proportion of men considered candidates for: natural pregnancy (NP) >9 million, IUI 5–9 million, or IVF < 5 million.

Result(s)

A total of 373 men underwent varicocele repair. The TMSC increased from 18.22 ± 38.32 to 46.72 ± 210.92 (P=.007). The most pronounced increase was with baseline TMSC <5 million, from 2.32 ± 1.50 to 15.97 ± 32.92 (P=.0000002); 58.8% of men were upgraded from IVF candidacy to IUI or NP. For baseline TMSC 5–9 million, the mean TMSC increased from 6.96 ± 1.16 to 24.29 ± 37.17 (P=.0004), allowing 64.9% of men to become candidates for NP. For baseline TMSC of >9 million, TMSC increased from 36.26 ± 52.08 to 81.80 ± 310.83 (P=.05).

Conclusion(s)

Varicocele repair has an important role in the treatment of infertility. Even for low TMSCs, a varicocelectomy may reduce the need for IVF. Varicocele repair (by embolization or microsurgery) potentially reduces the need for IVF and IUI.