Embolization of Varicoceles May Improve Male Infertility

A new study has found that embolization of varicoceles in men with infertility may be considered a useful adjunct to in vitro fertilization, increasing sperm motility.

Researchers from the University of Bonn (Germany) examined 223 clinically infertile men aged 18-50 with varicoceles and associated oligoteratoasthenospermia who underwent endovascular embolization of the spermatic veins with distal coil embolization and sclerotherapy. If needed, patients started additional anti-inflammatory treatment. Baseline clinical findings, semen analysis, and hormone levels were compared with those obtained at follow-up. Of 228 varicoceles in 223 patients, 226 were successfully treated, and 206 patients (92.4%) had resolution of varicoceles at clinical examination and ultrasonography (US); 3-month follow-up semen analysis showed significant improvement in sperm motility. Unconditioned logistic regression helped determine clinical and laboratory factors predicting treatment success, defined as sired pregnancy during follow-up.

The results showed that of 173 patients with available follow-up data, 26% reported pregnancy in their partners. The only significant pretreatment factor to predict sired pregnancy was baseline sperm motility. Hormone levels, clinical grading of varicoceles, Doppler ultrasonographic findings, and other semen parameters did not reach statistical significance to predict pregnancy. Patients with less impaired sperm motility appeared to benefit the most from the treatment. The study was published in the August 2008, issue of Radiology.

"Retrograde venous embolization improves various semen parameters and leads to sired pregnancies in about one-third of the partners,” concluded lead author Sebastian Flacke, M.D., Ph.D., and colleagues of the department of radiology. "The improved quality of the semen after varicoceles embolization may make this treatment a useful adjunct to in vitro fertilization therapy.”

Varicoceles, which usually affect approximately 15% of otherwise healthy men, consist of dilatated veins in the pampiniform plexus, often visible or palpable as a conglomerate of dilatated vessels. It has been widely accepted that varicoceles are associated with subfertility; however, controversies exist regarding the significance of varicoceles in men with infertility. The American Urological Society and the American Society for Reproductive Medicine stated jointly that correction of varicoceles is indicated for infertile men with palpable lesions and one or more abnormal semen parameters.


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