Embolization of varicocles: pretreatment sperm motility predicts later pregnancy in partners of infertile men.
OBJECTIVE
To identify predictors of future pregnancy in partners of infertile men undergoing embolization of varicoceles.


METHODS
This study was conducted within local institutional review board guidelines, and written informed consent was obtained. In 223 clinically infertile men (age range, 18-50 years) with varicoceles and associated oligoteratoasthenospermia, endovascular embolization of the spermatic veins was performed with distal coil embolization and sclerotherapy. Additional anti-inflammatory treatment was initiated if required. Baseline clinical examination, semen specimen, and hormone level findings were compared to follow-up data. Posttreatment pregnancy rate of their healthy female partners was assessed with a standardized questionnaire. Unconditioned logistic regression was used to identify factors among all available clinical and laboratory data predicting treatment success (sired pregnancy during follow-up).


RESULTS
A total of 226 of 228 varicoceles in 223 patients were successfully treated. Resolution of varicoceles at clinical examination and ultrasonography (US) was observed in 206 patients (92.4%). Three-month follow-up semen analysis in these patients showed significant improvement in sperm motility (P < .001) and sperm count (P < .001); however, average values remained in the abnormal range (World Health Organization guidelines). In 173 patients, follow-up data were successfully obtained, with pregnancy reported in 45 (26%). Baseline sperm motility was identified as the only significant pretreatment factor (standardized regression coefficient beta = 3.285, t = 7.560, P = .006) predicting sired pregnancy. Hormone levels, clinical grading of varicoceles, Doppler US findings, and other semen parameters did not reach statistical significance.


CONCLUSIONS
Sperm motility prior to varicocele treatment in infertile men is an important predictor of later pregnancy.
Flacke
Sebastian
S
Department of Radiology, University of Bonn Medical School, Bonn, Germany. Sebastian.Flacke@lahey.org
Schuster
Michael
M
Kovacs
Attila
A
von Falkenhausen
Marcus
M
Strunk
Holger M
HM
Haidl
Gerhard
G
Schild
Hans H
HH
D000293:Adolescent; D000328:Adult; D003287:Contrast Media; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D007248:Infertility, Male / Q000209:etiology / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D000077423:Polidocanol; D011092:Polyethylene Glycols; D011237:Predictive Value of Tests; D011247:Pregnancy; D015641:Radiography, Interventional; D012597:Sclerosing Solutions; D013076:Sperm Count; D013081:Sperm Motility; D018709:Statistics, Nonparametric; D014646:Varicocele / Q000150:complications / Q000628:therapy*
D003287:Contrast Media; D012597:Sclerosing Solutions; D000077423:Polidocanol; D011092:Polyethylene Glycols