title: Efficacy of spermatic vein ligation in patients affected by high grade left varicocele.
abstract: OBJECTIVE
  To study the effect of high grade varicocele treatment in infertile patients.
  
  
  METHODS
  Seventy-five patients were selected by the following criteria: infertility persisting for more than 1 year; abnormal semen parameters; no other infertility-related disease; no obvious causes of infertility in the subject's partner; basal eco-color Doppler ultrasound demonstrating continuous reflux in the spermatic vein. All patients considered for the study had at least a six months period from the diagnosis to the surgery due to waiting list, choice of the patient or time needed to complete diagnostic evaluation of the couple. The surgical procedure was performed through an inguinal approach. All enrolled patients were counseled to have unprotected intercourse during the ovulation period in order to maximize the probability of pregnancy within the 6-month preoperative period. The achievement of pregnancy and semen parameters were recorded during the preoperative and postoperative period.
  
  
  RESULTS
  Two of the seventy-five patients were excluded because of persistent varicocele after surgery. The preoperative pregnancy rate was 1.3% (1 couple). The postoperative pregnancy rate was 42.5%. The stratification of pregnancies by semester showed a significantly higher rate in the first postoperative period (p = 0.0012). Mean time to conception was 13.5 months. Mean preoperative sperm count was 17.6x10(6)/mL compared to 19.7x10(6)/mL in the postoperative period (p < 0.0001). Mean percentage of progressive sperm motility was 13.7%, compared to 17.6% in the postoperative period (p < 0.0001). Mean percentage of normal sperm morphology was 7.6%, compared to 15.2% postoperatively (p < 0.0001).
  
  
  CONCLUSIONS
  Surgical treatment of high grade varicocele proved to effectively treat associa¬ted infertility by improving seminal parameters and pregnancy rate in our patient cohort.
authors.affiliation: Department of Urology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Grasso
authors.affiliation: Department of Urology, University Vita-Salute San Raffaele, Milan, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Lania
authors.affiliation: Department of Urology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Blanco
authors.affiliation: Department of Urology, Desio Hospital, Desio, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Confalonieri
authors.affiliation: Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan (AACG), Milan, Italy.
authors.forename: Angelica A C
authors.initials: AA
authors.lastname: Grasso
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007248:Infertility, Male / Q000601:surgery*; D008026:Ligation / Q000379:methods; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011247:Pregnancy; D018873:Pregnancy Rate; D015203:Reproducibility of Results; D013076:Sperm Count; D013081:Sperm Motility; D013737:Testis / Q000098:blood supply*; D016896:Treatment Outcome; D014646:Varicocele / Q000601:surgery*; D014680:Veins / Q000601:surgery; D055815:Young Adult