Bilateral varicocelectomy improves odds of pregnancy

Atlanta-Men whose infertility is due to varicocele may be able to improve the likelihood of achieving impregnation by undergoing bilateral, rather than unilateral varicocelectomy, when indicated. This was the conclusion of the authors of a Canadian study presented here at the AUA annual meeting.

"When the desired outcome is pregnancy, these men have a chance to improve sperm parameters and improve their chances of conception," said lead author Jamie Libman, MD, a fellow in male infertility at St. Mary's Hospital, Montreal, working with Armand Zini, MD.

Researchers reviewed data from 369 consecutive varicocelectomies performed by Dr. Zini between July 1996 and July 2002 that were intended to reverse male factor infertility. Of these, 157 men (43%) underwent bilateral varicocelectomy and an additional 212 men (57%) had unilateral left varicocelectomies. Study endpoints included changes in postoperative semen parameters, rates of assisted and unassisted pregnancy, and use of in utero insemination, in vitro fertilization, and intracytoplasmic sperm injection. Ages of the men and their female partners, overall health, comorbidities, and baseline semen parameters were comparable between the two groups prior to surgery.

The improvement in the concentration of sperm in the bilateral group also was greater than the men in the unilateral group, but the difference was not significant.

"While this result was expected, the degree of difference between the two groups was greater than expected," Dr. Libman said. "It illustrates the dose-dependent relationship between varicocele and sperm production."

He added that varicocelectomy is a cost-effective surgery for men seeking fatherhood because varicocele repair is covered by Medicare in Canada, whereas assisted reproduction is not. However, it may be more difficult in men who have had previous surgery in that area of the body.

Comparable use of in utero insemination, in vitro fertilization, and intracytoplasmic sperm injection was seen in both groups (35.5% vs. 40.5%, p>.05). All pregnancies in the bilateral group resulted in normal births.