title: Varicocelectomy improves intrauterine insemination success rates in men with varicocele.
abstract: OBJECTIVE
  We determined whether varicocele treatment before intrauterine insemination significantly affects intrauterine insemination success rates.
  
  
  METHODS
  A total of 58 infertile couples, of whom the women had normal evaluations and men had abnormal semen analyses and a history of varicocele, were included in this study. They were identified after reviewing the charts of all women undergoing intrauterine insemination for male factor infertility at our center. Of the men 24 participated in 63 intrauterine insemination cycles without varicocele treatment, while in the remaining 34 varicocele was treated before a total of 101 intrauterine insemination cycles. Variables associated with pregnancy or live birth were analyzed using repeat measures logistic regression with generalized estimating equation techniques. An initial stepwise generalized estimating equation was performed without including varicocele treatment status. Subsequently varicocele treatment status and the significant associated factors were included in analysis. The semen characteristics of untreated and treated varicocele groups were compared with repeat measures analysis of variance.
  
  
  RESULTS
  On pre-wash semen analysis patients with untreated varicocele had significantly higher mean motility plus or minus standard error than patients whose varicoceles were treated (48.6% +/- 2.3% versus 38.1% +/- 1.8%, p = 0.02). However, no statistically significant difference was noted in the mean post-wash total motile sperm count in the treated and untreated groups (7.2 +/- 1.0 versus 14.8 +/- 2.6, p = 0.1). Despite these findings the pregnancy and live birth rates per cycle were significantly higher in patients in whom varicocele was treated than in those without varicocele treatment (11.8% versus 6.3%, p = 0.04 and 11.8% versus 1.6%, p = 0.007, respectively).
  
  
  CONCLUSIONS
  Varicocele treatment may not improve semen characteristics in all men but it appears to improve pregnancy and live birth rates among couples undergoing intrauterine insemination for male factor infertility. A functional factor not measured on routine semen analysis may affect pregnancy rates in this setting. Men should be screened for varicocele before intrauterine insemination is initiated for male factor infertility.
authors.affiliation: Center for Advanced Research in Human Reproduction and Infertility, Urological Institute, Department of Gynecology-Obstetrics and Biostatistics, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Daitch
authors.forename: M A
authors.initials: MA
authors.lastname: Bedaiwy
authors.forename: E B
authors.initials: EB
authors.lastname: Pasqualotto
authors.forename: B N
authors.initials: BN
authors.lastname: Hendin
authors.forename: J
authors.initials: J
authors.lastname: Hallak
authors.forename: T
authors.initials: T
authors.lastname: Falcone
authors.forename: A J
authors.initials: AJ
authors.lastname: Thomas
authors.forename: D R
authors.initials: DR
authors.lastname: Nelson
authors.forename: A
authors.initials: A
authors.lastname: Agarwal
mesh_terms: D005260:Female; D006801:Humans; D007248:Infertility, Male / Q000628:therapy*; D007315:Insemination, Artificial; D008297:Male; D011247:Pregnancy; D013076:Sperm Count; D013081:Sperm Motility; D014646:Varicocele / Q000503:physiopathology / Q000601:surgery*