Abstract
Objective
To compare laboratory outcomes and pregnancy rates of infertile couples, in which male partners have treated and untreated clinical varicocele before performing ICSI.
Materials and methods
The data of 306 couples in whom ICSI was performed due to infertility were evaluated retrospectively. All of the males had clinical varicocele, and patients were evaluated in two groups. Group A (n = 168) included patients who underwent successful varicocele repair and Group B (n = 138) included patients with clinical varicocele at the time of ICSI and no history of varicocele repair. Semen analysis, demographic factors and live birth and pregnancy rates were recorded.
Results
There were 168 patients (54.9 %) in group A and 138 patients (45.1 %) group B. Groups were similar for demographic factors. Semen analysis results were significantly better after varicocelectomy. Pregnancy rates were higher in group A (62.5 vs. 47.1 %, p = 0.001). Live birth rates were also higher in group A (47.6 vs. 29.0 %, p = 0.0002). In the logistic regression analysis, varicocelectomy was found to increase the rates of viable pregnancy (OR 2.02, 95 % CI 1.25–3.87; p = 0.032), live births (OR 2.12, 95 % CI 1.26–3.97; p = 0.026).
Conclusion
Performing varicocelectomy improves the pregnancy and live birth rates by ICSI in infertile couples in whom the male partner has clinical varicocele. Varicocelectomy should be offered before ICSI to infertile men with clinical varicocele. However, further prospective randomized studies are needed to confirm benefit of varicocelectomy before ICSI.
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References
World Health Organization (2000) WHO manual for the standardized investigation and diagnosis of the infertile couple. Cambridge University Press, Cambridge
Vital and Health Statistics, series 23, no. 26 (2002) Centers for Disease Control. http://www.cdc.gov. Accessed 28 June 2010
Evers JH, Collins J, Clarke J (2009) Surgery or embolisation for varicoceles in subfertile men. Cochrane Database Syst Rev 21(1):CD000479
Yamamoto M, Hibi H, Hirata Y et al (1996) Effect of varicocelectomy on sperm parameters and pregnancy rates in patients with subclinical varicocele: a randomized prospective controlled study. J Urol 155(5):1636–1638
Grasso M, Lania C, Castelli M et al (2000) Low-grade left varicocele in patients over 30 years old: the effect of spermatic vein ligation on fertility. BJU Int 85(3):305–307
Daitch JA, Bedaiwy MA, Pasqualotto EB et al (2001) Varicocelectomy improves intrauterine insemination success rates among men with varicoceles. J Urol 165:1510
Cayan S, Erdemir F, Ozbey I et al (2002) Can varicocelectomy significantly change the way couple use assisted reproductive technologies? J Urol 167:1749
Estevez SC, Oliveira FV, Bertolla RP (2010) Clinical outcome of intracytoplasmic sperm injection in infertile men with treated and untreated clinical varicocele. J Urol 184(4):1442–1446
Pasqualotto FF, Braga DP, Figueira RC, Setti AS, Iaconelli A Jr, Borges E Jr (2012) Varicocelectomy does not impact pregnancy outcomes following intracytoplasmic sperm injection procedures. J Androl 33(2):239–243
Estevez SC, Glina S (2005) Recovery of spermatogenesis after microsurgical subinguinal varicocele repair in azoospermic men based on testicular histology. Int Braz J Urol 31:541
World Health Organization (1999) WHO laboratory manual for the examination of human semen and sperm-cervical mucus interactions, 4th edn. Cambridge University Press, Cambridge, pp 4–22
Mostafa T, Anis TH, El-Nashar A et al (2001) Varicocelectomy reduces reactive oxygen species levels and increases antioxidant activity of seminal plasma from infertile men with varicocele. Int J Androl 24:261
Zini A, Blumenfeld A, Libman J et al (2005) Beneficial effect of microsurgical varicocelectomy on human sperm DNA integrity. Hum Reprod 20:1018–1021
Van Steirteghem AC, Nagy Z, Joris H, Liu J, Staessen C, Smitz J, Wisanto A, Devroey P (1993) High fertilization and implantation rates after intracytoplasmic sperm injection. Hum Reprod 8:1061–1066
Penson DF, Paltiel AD, Krumholz HM, Palter S (2002) The cost-effectiveness of treatment for varicocele related infertility. J Urol 168:2490–2494
Smit M, Romijn JC, Wildhagen MF, Veldhoven JL, Weber RF, Dohle GR (2010) Decreased sperm DNA fragmentation after surgical varicocelectomy is associated with increased pregnancy rate. J Urol 183:270–274
Inci K, Hascicek M, Kara O et al (2009) Sperm retrieval and intracytoplasmic sperm injection in men with nonobstructive azoospermia, and treated and untreated varicocele. J Urol 182:1500
Marmar JL, Kim Y (1994) Subinguinal microsurgical varicocelectomy: a technical critique and statistical analysis of semen and pregnancy data. J Urol 152(4):1127–1132
Yaman O, Soygur T, Zumrutbas AE, Resorlu B (2006) Results of microsurgical subinguinal varicocelectomy in children and adolescents. Urology 68(2):410–412
Meng MV, Greene KL (2005) Turek PJ surgery or assisted reproduction? A decision analysis of treatment costs in male infertility. J Urol 174(5):1926–1931
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Gokce, M.I., Gülpınar, Ö., Süer, E. et al. Effect of performing varicocelectomy before intracytoplasmic sperm injection on clinical outcomes in non-azoospermic males. Int Urol Nephrol 45, 367–372 (2013). https://doi.org/10.1007/s11255-013-0394-2
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DOI: https://doi.org/10.1007/s11255-013-0394-2