Natural history of varicocele management in the era of intracytoplasmic sperm injection.
OBJECTIVE
To evaluate the outcomes of infertile couples with varicocele.


METHODS
Retrospective study.


METHODS
University infertility clinic.


METHODS
Six hundred ten consecutive infertile couples in whom the man was found to have a clinical varicocele.


METHODS
Microsurgical varicocelectomy and assisted reproductive technologies (ARTs; intrauterine insemination and intracytoplasmic sperm injection).


METHODS
Clinical characteristics, pregnancy rates, and ART utilization in two subgroups of couples (those who elected to undergo varicocelectomy and those who did not).


RESULTS
Sixty percent of the couples (363/610) opted for varicocele repair. The surgical and nonsurgical groups had comparable ages and duration of infertility. However, sperm concentration and motility were significantly lower in the surgical group, compared with in the observation one. As well, the surgical group had a significantly higher prevalence of primary infertility (80% vs. 71%) and had significantly smaller testicles bilaterally. Utilization of ART was significantly higher in the observation group compared with the surgical group (54% vs. 38%). Overall pregnancy rates (spontaneous + assisted pregnancies) in the observation and surgical group were not significantly different.


CONCLUSIONS
This study suggests that men with poorer baseline characteristics are more likely to opt for varicocele repair. Furthermore, couples electing not to repair the varicocele are more likely to undergo ART procedures to improve their chances of conception.
Zini
Armand
A
Department of Surgery, Division of Urology, McGill University, Montreal, Quebec, Canada. ziniarmand@yahoo.com
Boman
Jason
J
Baazeem
Abdulaziz
A
Jarvi
Keith
K
Libman
Jamie
J
D000328:Adult; D002755:Choice Behavior; D005260:Female; D006801:Humans; D007248:Infertility, Male / Q000209:etiology / Q000628:therapy*; D008297:Male; D010342:Patient Acceptance of Health Care; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies; D013076:Sperm Count; D020554:Sperm Injections, Intracytoplasmic / Q000706:statistics & numerical data; D013081:Sperm Motility; D016896:Treatment Outcome; D013521:Urologic Surgical Procedures, Male / Q000706:statistics & numerical data; D014646:Varicocele / Q000150:complications / Q000601:surgery*