Efficacy of varicocele embolization versus ligation of the left internal spermatic vein for improvement of sperm quality

Abstract

Efficacy of surgical varicocelectomy versus embolization of the spermatic vein was studied in 137 men diagnosed as suffering from left varicocele. The men were divided randomly into three groups according to the methods of treatment: A--embolization of the internal spermatic vein (51 men); B--Ivanissevich technique of high ligation of the spermatic veins (43 men); and C--Bernardi technique of high ligation (43 men). The groups were similar in terms of age, duration of infertility and possessed semen characterized as oligoteratoasthenozoospermia. The fertility of the female partners was evaluated carefully and they were found to be potentially fertile. Varicocele was diagnosed by at least two of the following methods: physical palpation during valsalva manoeuvre, venography, or scrotal scanning using the technetium pertechnetate radioactive method. Semen quality was assessed before treatment and at 3, 6 and 9 months post-treatment. Fecundity was followed-up for 18 months. The major results were: (i) Shrinkage of the varicocele was found in all three groups studied. The same rate of recurrence was recorded in the three groups (24%, 37% and 35% in groups A, B and C, respectively). (ii) Improvement of sperm quality was significant in groups A and B, with better results in group B. (iii) The pregnancy rate was significantly higher in group B, compared with A (38.2% vs. 20.6%; P less than 0.05). Thus, high ligation of the internal spermatic vein yields better results than low ligation or embolization as far as semen quality and pregnancy is concerned.

Subinguinal microsurgical varicocelectomy vs. percutaneous embolization in infertile men: Prospective comparison of reproductive and functional outcomes

“…Therefore, our results fully agree with many studies that both the procedures provide similar increase in sperm quality [28]. Also, studies favoring higher results after SIS than PE only show marginal differences [14]. …”

“…In recent years, a new radiological technique, called percutaneous embolization (PE) was put forward as a non-surgical alternative. However, so far, there is a paucity of comparative studies the literature between these two techniques [13, 14]. Therefore, the question of which procedure (PE or SIS) is more effective remains debated.…”

The great debate: varicocele treatment and impact on fertility

“…Yavetz et al noted the greatest overall improvement in measures of sperm quality with subinguinal approach in comparison to transinguinal approach and embolization (significant improvements in concentration, motility and morphology by six months) 70. Sayfan et al also noted a more measurable improvement in postoperative sperm counts in open approaches as opposed to embolization 71.…”

Reassessing the value of varicocelectomy as a treatment for male subfertility with a new meta-analysis

“…First, we would select only articles that included infertile men with palpable varicoceles who had at least one low semen parameter on three samples. Second, we would limit this study only to surgical repairs because there has been a difference of opinion regarding the outcomes with surgery compared with embolization (25,26). Third, we would include only articles that reported data on the relationship of ''surgical'' varicocelectomies and ''spontaneous or natural'' pregnancy rates.…”