title: [Surgical treatment of varicocele improves fertility and facilitates medically assisted procreation].
abstract: OBJECTIVE
  To assess the effect of varicocelectomy in sperm quality and natural pregnancy and to determine if it can change couple candidacy for assisted reproductive technology (ART) procedures.
  
  
  METHODS
  We performed a retrospective study about 164 infertile men with varicocele associated to sperm abnormalities. We divided our patients into four groups, according to the total motile sperm count (TMC). Group 1 includes 21 azoospermic men, group 2 includes 62 patients who had a TMC strictly less than 1.5x10(6), group 3 includes 22 patients who had a TMC between 1.5 and 5x10(6) and group 4 includes 59 patients who had a TMC strictly greater than 5x10(6). All patients underwent surgical or percutaneous embolisation to repair varicocele.
  
  
  RESULTS
  After treatment, the mean spermatozoid concentration and motility were significantly increased, respectively from 24.8 to 29.2x10(6)spermatozoids per millilitre and 14.4 to 23.2%. Spontaneous pregnancy was observed in 59 couples (35.9%). Concerning the couples who had no pregnancies (105), 51 (48.5%) showed increase of the TMC, which allowed them to change the foreseen preoperative ART by an other one more simple.
  
  
  CONCLUSIONS
  Varicocelectomy has a significant potential not only to improve sperm quality and natural pregnancy, but also to downstage the level of ART needed to male infertility management.
authors.affiliation: Service d'urologie, CHU Habib Bourguiba, 3029 Sfax, Tunisie. hichemjallouli@yahoo.fr
authors.forename: H
authors.initials: H
authors.lastname: Jallouli
authors.forename: M
authors.initials: M
authors.lastname: Hadj Slimen
authors.forename: A
authors.initials: A
authors.lastname: Sahnoun
authors.forename: S
authors.initials: S
authors.lastname: Kechou
authors.forename: S
authors.initials: S
authors.lastname: Ben Amar
authors.forename: Ali
authors.initials: A
authors.lastname: Bahloul
authors.forename: M N
authors.initials: MN
authors.lastname: Mhiri