Defining Improvement After Varicocele Ligation
Treatment of clinically palpable varicoceles for infertility has been shown to improve semen parameters and pregnancy rates. However, there is no established definition for "significant improvement" after varicocelectomy. We sought to further investigate the correlation of improvement in semen parameters and pregnancy rates after varicocele ligation (VL), for the purpose of better defining significant improvement.
Following IRB approval, we retrospectively evaluated all patients seen at a single academic Reproductive Medicine Center from January 2006 to April 2016. Inclusion criteria were sub-fertile patients undergoing microscopic subinguinal varicocelectomy for clinically palpable varicoceles, with at least one abnormal parameter on pre-operative SA, a post-operative SA and with at least 12 months postoperative pregnancy data. Post-operative SA was performed at 3 and/or 6 months post-operatively. Natural pregnancy rates were evaluated. Exclusion criteria were pregnancies conceived within 2 months of surgery, patients with non-obstructive azoospermia, or with female factor infertility secondary to tubal obstruction. We defined significant improvement as >50% increase in total progressively motile sperm count (TPMC) on postoperative semen analysis. Patients were divided into two cohorts based on whether they experienced significant improvement after VL. Natural pregnancy rates were then compared between the two cohorts, using Student's T-test. Statistical significance was defined as p <0.05.</p>
During this study period 244 patients underwent VL, of which 133 patients met inclusion criteria. Eighty-four patients (64.1%) experienced >50% improvement in TPMC after VL. Patients who experience improvement after varicocele ligation had a significantly higher natural pregnancy rate than those who did not (50% vs 17.1%, p<0.01).</p>
After varicocele ligation, >50% improvement in TPMC is associated with significantly higher natural pregnancy rates.