Left spermatic vein reflux after varicocele repair predicts pregnancies and live births in subfertile couples

  • S. D’AndreaEmail author
  • A. Barbonetti
  • C. Castellini
  • L. Nolletti
  • A. Martorella
  • E. Minaldi
  • A. V. Giordano
  • S. Carducci
  • S. Necozione
  • F. Francavilla
  • S. Francavilla
Original Article



Varicocele repair (VR) is proposed to improve fertility in subfertile couples with a poor semen quality. We explored whether the disappearance of a left continuous spermatic venous reflux (SVR) at scrotal colour-Doppler ultrasound (CDUS), an objective evidence for a VR, is predictive for improved fertility outcome in subfertile couples.


VR was performed by left internal spermatic vein sclero-embolisation in 88 males seeking a consultation for subfertility. Semen analysis and scrotal CDUS were evaluated before and 6 months after VR. Serum levels of FSH and total testosterone (TT) were obtained at baseline. Telephone interview was used to obtain information about fertility outcome. Significant predictors of pregnancy and live births, selected by univariate analyses, were included into multiple logistic regression models to assess independent associations.


At the adjusted model, independent significant predictors of pregnancy after VR were a disappeared SVR at CDUS (OR = 5.5, 97.5% CI 2.01–15.4; p = 0.0009) and an improved sperm total motile count (TMC) (OR = 5.5, 97.5% CI 1.4–27.9; p = 0.02). Even live births were independently associated with both disappeared left SVR at CDUS (OR = 4.3, 97.5% CI = 1.6–11.8; p = 0.003) and improved TMC after VR (OR = 4.8, 97.5% CI 1.3–24.2; p = 0.02).


The still controversial effect of varicocele repair on fertility in subfertile couples may reside on the undefined objective methods to document a successful VR and its effect on couple fertility. The disappearance of a continuous left SVR at CDUS after VR was the objective best predictor for subsequent improved fertility in subfertile couples.


Varicocele Fertility Pregnancy Live birth Ultrasound Semen analysis 


Author contributions

SD acquisition of data, drafting the article, analysis and interpretation of data. AM acquisition of data, drafting the article, analysis and interpretation of data. AB, LN, CC acquisition, analysis and interpretation of data. AVG, SG, EM, AM, SN statistical analysis and interpretation of data. FF critical revision for important intellectual content. SF conception and design, analysis and interpretation of data, critical revision for important intellectual content, final approval of the version to be published.

Financial support

This work was supported by Ministero dell’Università e della Ricerca Scientifica, Italy.

Compliance with ethical standards

Conflict of interest

The authors have no potential conflicts of interest to disclosure.

Ethical approval

The local ethics committee approved the study protocol.

Informed consent

Informed consent was obtained from all individuals included in the study.


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Copyright information

© Italian Society of Endocrinology (SIE) 2019

Authors and Affiliations

  • S. D’Andrea
    • 1
    Email author
  • A. Barbonetti
    • 1
  • C. Castellini
    • 1
  • L. Nolletti
    • 1
  • A. Martorella
    • 1
  • E. Minaldi
    • 1
  • A. V. Giordano
    • 2
  • S. Carducci
    • 2
  • S. Necozione
    • 3
  • F. Francavilla
    • 1
  • S. Francavilla
    • 1
  1. 1.Andrology Unit, Department of Life, Health and Environment SciencesUniversity of L’AquilaL’AquilaItaly
  2. 2.Interventional Radiology UnitUniversity Hospital San SalvatoreL’AquilaItaly
  3. 3.Epidemiology Division, Department of Life, Health and Environment SciencesUniversity of L’AquilaL’AquilaItaly

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