Ovarian varicocele is a well-known cause of pelvic pain in women (1-3). Surgical or laparoscopic ligation, or retrograde transcatheter embolization is successfully used for treatment of symptomatic cases (l-6).In 1991, Galkin et al. (7) hypothesized that long-lasting ovarian varicocele might cause hypofunction of the ovaries and, similar to testicular varicocele, could be a cause of infertility. This hypothesis is not yet proven in the medical literature. We report two cases of pregnancy in women with infertility after successful transcatheter embolization of ovarian varices.
Case reports Case 1A 43-year-old woman presented with chronic pelvic pain of three years duration. Her pain increased after physical activity and during menses. She had given birth to a full-term baby 20 years prior to presentation. She has not become pregnant since that time, despite a lack of contraception during the last 7 years. Repeated gynecologic examinations including hysterosalpingography did not reveal any source of pelvic pain. No disorder of hormonal milieu was noted on endocrine evaluation.Abdominal ultrasound did not reveal any gynecologic pathology such as leiomyoma, adenomyosis, or endometriosis, but it showed marked dilatation of veins around the left ovary. The diameter of the left ovarian vein trunk was 12 mm.The presence of left ovarian varicocele was confirmed by selective retrograde venography. The right transjugular approach was used, because the patient had several large moles on both groins. A Headhunter 1 catheter (Cordis, Bridgewater, New Jersey, USA) was placed in the left renal vein, and then in the left ovarian vein. Embolization of the dilated left ovarian vein was performed with three long and four short homemade steel coils 10-12 mm in diameter (Fig. 1). The right ovarian vein was not dilated.During the next month, the patient had significant reduction of pelvic pain, which eventually disappeared completely. Ultrasound (US) examination showed occlusion and fibrosis of the left ovarian vein, and disappearance of pelvic varices. Three months after the procedure, the patient became pregnant. The pregnancy was normal, and resulted in an easy delivery.
Case 2A 25-year-old woman was referred to our hospital with a 4-year history of infertility. She had never been pregnant. She complained of periodic mild pelvic pain and dysmenorrhea. Her symptoms were aggravated by standing for a long time, and they increased during sexual activity. No pathological changes were observed on gynecologic examination or en- ABSTRACT We describe two cases of left-sided ovarian varicocele in patients with infertility. Pregnancy occurred in both women after successful retrograde venous embolization. Ovarian varicocele may be associated with infertility in some patients.
INTERVENTIONAL RADIOLOGY