Prognosis of Subfertility in Men with Corrected or Uncorrected Varicocele

Abstract

To evaluate whether correction of varicocele improves fertility, pregnancy rates were compared in 115 varicocele patients consulting for infertility and having oligozoospermia, asthenospermia, or teratozoospermia, in any combination, and FSH levels within the normal range. Ninety of these patients had corrected, and 25 had uncorrected varicoceles, respectively. The value of clinical and seminal parameters for predicting the eventuality of pregnancy for varicocele patients was also studied. Although both groups were comparable in terms of duration of infertility, mean age, sperm density, motility or fertility index, cumulative pregnancy rates over 12 months were similar, whether or not the varicocele was corrected. The value of clinical or seminal parameters, in any combination, for the prediction of outcome for varicocele patients was poor. The prognosis was poor for men with less than 15% of spermatozoa with normal morphology, FSH levels higher than the mean + 3 SD of those values found in young fathers, and a fertility index below 3. In subjects who achieved pregnancy within one year, pretreatment sperm characteristics were similar in both the corrected and uncorrected groups. Correction of varicocele slightly improved sperm characteristics. It seems likely that in most men with subfertility and varicocele, other factors besides venous reflux are responsible for their infertility.

Treatment of Varicocele and Male Fertility

“…As regards pregnancy, the success was similar in both groups. Similar results were also observed later [8], in a larger group of patients with varicocele treated primarily by embolization. Similar to the results of our own study, several authors also observed that varicocele correlation slightly improves the seminal fluid characteristics.…”

Radiological treatment of male varicocele: technical, clinical, seminal and dosimetric aspects

“…Despite the encouraging results obtained in the seminal parameters (significantly increased sperm concentration and motility), fertility of the patients treated cannot be guaranteed [18][19][20][21][22][23]; as demonstrated by numerous studies, this depends on several female and male variables related to spermatogenesis and ovulation. Finally, it may be hypothesised that any significant morphological changes of germ cells are only appreciable over longer follow-up periods.…”

“…Gli incoraggianti risultati seminali ottenuti (significativo incremento di concentrazione e motilità degli spermatozoi) non ci consentono tuttavia di fare sicure valutazioni circa la fertilità dei pazienti trattati [18][19][20][21][22][23]; essa infatti, così come dimostrato da numerosi studi, dipende da molte variabili maschili e femminili che influenzano la spermatogenesi e l'ovulazione.…”

Results of Varicocelectomy in Patients with Isolated Teratozoospermia

“…While some studies support the defective effect of varicocele on sperm concentration, motility and morphology [3,4,16,19] , others suggest that there are no such effects [20][21][22] . However, the effect of varicocelectomy in patients with isolated sperm morphology defects according to Kruger's strict criteria remains unclear.…”