title: Varicocelectomy does not impact pregnancy outcomes following intracytoplasmic sperm injection procedures.
abstract: There are many studies in the literature suggesting an acquired, apparently  progressive infertility due to varicocele. In fact, varicocelectomy has become  the most commonly performed male infertility surgery. Assisted reproductive  technologies such as intracytoplasmic sperm injection (ICSI) are also  important for couples with male factor infertility associated with varicocele.  Therefore, the aim of this study was to evaluate the effect of varicocelectomy  on sperm quality and pregnancy rate with ICSI. Data were analyzed from 248  patients who had varicocele or underwent a previous varicocelectomy and were  treated with ICSI between 2000 and 2008. Patients with varicocele were divided  into two groups: men with clinical varicocele (group 1, n = 79) and men who  underwent varicocelectomy before ICSI (group 2, n = 169). In all cases, female  infertility was not detected. We evaluated and compared the two groups' semen  characteristics as defined by the World Health Organization and Tygerberg's  strict criteria: the female partner's age; the number of oocytes retrieved;  and the fertilization, implantation, pregnancy, and miscarriage rates. We used  the Wilcoxon signed rank test or the Mann-Whitney test for these analyses. No  differences were detected in the age of the female partners between group 1  (33.0 ± 0.46 years) and group 2 (33.8 ± 0.38 years; P =  .1872). Semen volume was higher in group 1 (3.3 ± 0.3 mL) than it was  in group 2 (2.5 ± 0.14; P = .0043). No differences were  detected between groups 1 and 2 with regard to sperm concentration (30.08  ± 4.01 million/mL and 24.1 ± 2.42 million/mL, respectively;  P = .138), sperm motility (38.2% ± 2.69% and 38.7% ±  2.08%, respectively; P = .881), and morphology according to  Tygerberg's strict criteria (2.6% ± 0.44% and 2.4% ± 0.37%,  respectively; P = .7202). Also, no differences were detected in the  number of oocytes retrieved between group 1 (14.8 ± 1.74) and group 2  (14.9 ± 1.04; P = .9515). The fertilization rate was higher in  group 1 (73.2%) than it was in group 2 (64.9%; P = .0377); however,  no differences were detected in the pregnancy rates (31.1% vs 30.9%;  P = .9806), implantation rates (22.1% vs 17.3%; P = .5882),  or miscarriage rates (21.7% vs 23.9%; P = .8401) between groups 1 and  2. Although a varicocelectomy should always be performed before assisted  reproduction is pursued, this surgery does not increase pregnancy rates or  decrease miscarriage rates following ICSI.
authors.affiliation: Fertility-Assisted Fertilization Center, Av Brigadeiro Luís Antônio, São Paulo, SP 01401-002, Brazil. fabio@conception-rs.com.br
authors.forename: Fabio F
authors.initials: FF
authors.lastname: Pasqualotto
authors.forename: Daniela P A F
authors.initials: DP
authors.lastname: Braga
authors.forename: Rita C S
authors.initials: RC
authors.lastname: Figueira
authors.forename: Amanda S
authors.initials: AS
authors.lastname: Setti
authors.forename: Assumpto
authors.initials: A
authors.lastname: Iaconelli
authors.forename: Edson
authors.initials: E
authors.lastname: Borges
mesh_terms: D000022:Abortion, Spontaneous / Q000209:etiology; D000328:Adult; D001938:Brazil; D048430:Cell Shape; D010064:Embryo Implantation; D005260:Female; D006801:Humans; D007248:Infertility, Male / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D008297:Male; D054315:Oocyte Retrieval; D010062:Ovulation Induction; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D012189:Retrospective Studies; D013076:Sperm Count; D020554:Sperm Injections, Intracytoplasmic / Q000009:adverse effects; D013081:Sperm Motility; D013094:Spermatozoa / Q000473:pathology; D016896:Treatment Outcome; D013521:Urologic Surgical Procedures, Male / Q000009:adverse effects; D014646:Varicocele / Q000150:complications / Q000473:pathology / Q000601:surgery*