Microsurgical varicocelectomy for isolated asthenospermia.
OBJECTIVE
Varicocele represents the most common cause of male infertility, and most reports indicate that varicocelectomy has a beneficial effect on male fertility and pregnancy outcome. We evaluated the clinical outcomes of infertile couples with varicocele and isolated asthenospermia who chose to undergo varicocelectomy as well as those who chose not to undergo the procedure.


METHODS
We performed a retrospective review of 118 consecutive infertile couples in whom the man presented with clinical varicocele and isolated asthenospermia (less than 50% motile sperm). All couples were presented with possible treatment options (observation, varicocelectomy, assisted reproductive technologies). The clinical characteristics and outcomes of 2 subgroups of men--those who elected to undergo surgery (varicocelectomy, 69) and those who did not (49)--were examined and compared.


RESULTS
Mean male and female patient age, duration of infertility and baseline total motile sperm count were not significantly different in the control and surgery groups. The mean total motile sperm count increased significantly after varicocelectomy (29.6 million preoperatively vs 39.0 million postoperatively, p <0.05). The spontaneous pregnancy rate was significantly higher in the surgery group compared to the control group (65% vs 32%, respectively, p <0.01). The combined spontaneous and intrauterine insemination pregnancy rate was also significantly higher in the surgery group compared to the control group (74% vs 36%, respectively, p <0.01). Use of in vitro fertilization/intracytoplasmic sperm injection was significantly higher in the control group compared to the surgery group (32% vs 11%, respectively, p <0.05).


CONCLUSIONS
Our data support the practice of varicocelectomy for the treatment of clinical varicocele and isolated asthenospermia.
Boman
Jason M
JM
Division of Urology, Department of Surgery, McGill University, Montreal, Quebec, Canada. jboman21@hotmail.com
Libman
Jamie
J
Zini
Armand
A
D000328:Adult; D053627:Asthenozoospermia / Q000175:diagnosis* / Q000209:etiology; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007248:Infertility, Male / Q000175:diagnosis / Q000601:surgery; D008297:Male; D008866:Microsurgery / Q000379:methods*; D011182:Postoperative Care; D011247:Pregnancy; D018873:Pregnancy Rate / Q000639:trends*; D011300:Preoperative Care; D011336:Probability; D012016:Reference Values; D018570:Risk Assessment; D013076:Sperm Count / Q000706:statistics & numerical data; D013081:Sperm Motility; D016896:Treatment Outcome; D013521:Urologic Surgical Procedures, Male / Q000379:methods*; D014646:Varicocele / Q000150:complications / Q000175:diagnosis / Q000601:surgery*