Varicocele correction for infertility: which patients to treat?

Abstract

Given the lack of clarity regarding the value of varicocele correction in improving male fertility, we examined whether divergent results in this regard could be attributed to selection of patients, especially with regard to the duration of their infertility or to the length of patients' androgen receptor CAG repeats. In a prospective study, involving all varicocele patients consulted consecutively for infertility, we compared the pregnancy rate (PR) over 1 year produced by patients who opted not to have varicocele correction after extensive information concerning fertility prospects (N = 185), with that by patients who had varicocele correction (N = 137). In the second study involving another smaller group of varicocele subjects (N = 72), we investigated whether CAG repeat length in the androgen receptor gene had any influence on fertility of varicocele-corrected patients. Overall, the PR in corrected and uncorrected varicocele groups did not differ significantly, but when subjects with infertility beyond 2 years were considered, varicocele-corrected subjects had a significantly greater PR than uncorrected varicocele patients (p = 0.025). Together with infertility duration, spermatozoa progressive motility appears the most important predictor of fertility, whereas neither grade of varicocele nor age of the couple (within the age limits of this study) influenced the outcome. Similarly, CAG repeat length did not affect the outcome of varicocele correction. These data suggest that varicocele correction at 1 year of infertility does not result in a significantly higher PR than that achieved by men with uncorrected varicocele. In view of the high spontaneous PR in subjects with an infertility of less than 2 years, varicocele correction aimed at restoring fertility appears to be most appropriate for men whose infertility extends beyond 2 years.

Are varicoceles associated with increased deoxyribonucleic acid fragmentation?

“…In a recent meta-analysis of randomized controlled trials on varicocele repair, Baazeem et al (10) showed that varicocelectomy is moderately superior to observation in men with a clinical varicocele and oligospermia, although the effect was not statistically significant. Additional randomized trials are needed to show that varicocele repair does result in more spontaneous pregnancies, especially in younger couples with infertility duration of at least 2 years (11).…”

Could androgen receptor gene CAG tract polymorphism affect spermatogenesis in men with idiopathic infertility?

“…Androgen receptor polymorphism was assessed as previously described [29]. In brief, CAG triplets repeats number was determined by counting genomic DNA extracted [Microgeno DNA kit (AB Analitica srl, Advance Biomedicine, REF.…”

Varicocele repair for infertility

“…However, when the analysis was restricted to the individuals with infertility beyond 2 years, couples receiving a varicocele repair had a significantly higher pregnancy rate than patients with uncorrected varicocele (26 vs. 13.4%, P ¼ 0.02). According to the results of this study, the correction of varicocele aimed at restoring fertility could be more appropriate for men of couples with infertility longer than 2 years [19]. In a retrospective study analyzing 183 infertile patients with varicocele, Al-Ghazo et al [20] reported a spontaneous pregnancy rate higher in patients with an infertility duration shorter than 3 years (37.3%) in comparison with patients with longer infertility duration (34.9% for the infertility period ranging between 3 and 6 years; 26.3% for infertility longer than 6 years).…”

“…Within a 12-month period, the pregnancy rate was 44.1% in the first group and 19% in the second one (P ¼ 0.003) [18 & ]. In a nonrandomized study comparing 137 patients who received varicocele treatment and 185 who did not receive any varicocele correction, Giagulli and Carbone [19] showed that the overall pregnancy rate in corrected and uncorrected varicocele groups did not differ significantly. However, when the analysis was restricted to the individuals with infertility beyond 2 years, couples receiving a varicocele repair had a significantly higher pregnancy rate than patients with uncorrected varicocele (26 vs. 13.4%, P ¼ 0.02).…”