title: Microsurgical varicocelectomy in the era of assisted reproductive technology: influence of initial semen quality on pregnancy rates.
abstract: OBJECTIVE
  To evaluate the natural history of infertile couples in whom the man underwent varicocelectomy.
  
  
  METHODS
  Retrospective study.
  
  
  METHODS
  University infertility clinic.
  
  
  METHODS
  159 infertile couples.
  
  
  METHODS
  Microsurgical varicocelectomy.
  
  
  METHODS
  Standard semen parameters and pregnancy rates (assisted and unassisted).
  
  
  RESULTS
  Postoperative sperm concentration and motility increased significantly compared to before the varicocelectomy (28.9 +/- 3.0 vs. 22.5 +/- 2.1 x 10(6)/mL and 33.9 +/- 1.9 vs. 22.1 +/- 1.3%, respectively). Overall, 48% (76/159) of the couples achieved a spontaneous pregnancy at the mean of 30 months' follow-up. An additional 10% (16/159) and 11% (18/159) of couples achieved a pregnancy following intrauterine insemination and in vitro fertilization/intracytoplasmic sperm injection, respectively. Significantly higher spontaneous pregnancy rates were observed in couples in whom the man's initial sperm concentration was greater than or equal to 5 million sperm per milliliter compared to those in whom the man's initial sperm concentration was less than 5 million sperm per milliliter (61% vs. 8%, respectively).
  
  
  CONCLUSIONS
  Our data demonstrate that, in couples in whom the man undergoes varicocelectomy for treatment of varicocele, close to 70% achieve a pregnancy. The initial sperm concentration is predictive of unassisted pregnancy outcome in this population.
authors.affiliation: Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: K M
authors.initials: KM
authors.lastname: Kamal
authors.forename: K
authors.initials: K
authors.lastname: Jarvi
authors.forename: A
authors.initials: A
authors.lastname: Zini
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007248:Infertility, Male / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000379:methods; D008875:Middle Aged; D011247:Pregnancy; D018873:Pregnancy Rate; D012099:Reproductive Techniques; D012189:Retrospective Studies; D012661:Semen / Q000166:cytology / Q000502:physiology; D013076:Sperm Count; D013081:Sperm Motility / Q000502:physiology*; D014646:Varicocele / Q000473:pathology / Q000601:surgery*