Varicocelectomy boosts sperm number and motility, as well as likelihood of pregnancy.


NEW ORLEANS—Varicocelectomy may significantly improve semen parameters such as sperm count, motility, and morphology in infertile men with palpable lesions, according to a new meta-analysis that contradicts the findings of previous studies.

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“We did this study because there is a huge controversy regarding the value of varicocelectomy for the treatment of infertile men rather than just going for ART [assisted reproductive technique],” said lead investigator Ashok Agarwal, PhD, director of the Reproductive Research Center at the Cleveland Clinic’s Glickman Urological Institute in Ohio. Varicocele is a leading cause of male infertility, but some doctors question the value of surgical correction for improving semen parameters or pregnancy outcomes.


Dr. Agarwal’s meta-analysis, which was presented here at the American Society of Reproductive Medicine annual meeting, offers “new perspective” because it uses a “strict” new scoring system that quantifies bias. Moreover, the meta-analysis included studies only with preoperative and postoperative semen data on the same patient, and spontaneous or natural pregnancy rates of female partners following a surgical varicocelectomy.


Data was analyzed from five studies of infertile men with palpable varicocele and at least one abnormal semen parameter. A total of 396 men who underwent the surgery went on to achieve 131 pregnancies (33.0%). There were also 174 control patients who did not un-dergo the procedure who went on to achieve 27 pregnancies (15.5%).


Following surgery, sperm concentration increased by 9.71 3 106/mL and motility increased by about 10%. In addition, sperm concentration increased by 12.03 3 106/mL and motility increased by about 12% after high ligation, the meta-analysis showed. The change in sperm morphology was 3.16% overall. Compared with no treatment for clinical varicocele, men who had a varicocelectomy were nearly threefold more likely to report a “spontaneous” pregnancy, Dr. Agarwal said. He calculated that nearly six men needed to be treated with varicocelectomy to achieve one pregnancy.


“We found that the clinical pregnancy rates were significantly improved, as well as all the important sperm parameters, in the patients treated with this surgical procedure worldwide. This is a very im-portant message and very good news,” Dr. Agarwal said. “Many gynecologists think this procedure is a waste of time. Many urologists, on the other hand, think it is very important, so this has been very controversial. Now, our study provides a scientific basis for clinicians to offer this new approach.”


Robert Visscher, MD, of Holland, Mich., emeritus executive director for ASRM, observed: “This meta-analysis by a reputable researcher appears to be well-done. I think the secret to success with this procedure is choosing the proper male patients with the correct set of variables. If the patient has clinical varicocele and an abnormal semen analysis on at least two occasions, then I think this study affirms that he is an appropriate candidate for a varicocelectomy.”