Pregnancy rates following varicocele repair without seminal improvement.

Amy E.T. Sparks; J I Sandlow; P C Fretz; J Blaine; J Milleman

doi:10.1016/S0015-0282(03)01528-0

Objective: Nearly one-third of patients fail to improve following varicocele repair. However, there have not been any reports to date as to the outcome of these couples. Therefore, our objective was to determine the pregnancy rate in patients who have undergone varicocele repair without subsequent improvement in seminal parameters. Design: Retrospective chart review of patients undergoing varicocele repair. Materials and Methods: Following IRB approval, follow up was obtained from patients who underwent varicocele repair from 7/95 through 3/02. Only clinically significant varicoceles (no subclinical) were repaired. Data was gathered from chart review, mail survey, and patient self-report. Patients without pre and postoperative seminal fluid analyses (SFA), as well as pregnancy follow up, were excluded. Follow up of at least one year was required to be included in pregnancy data, unless pregnancy was achieved earlier. Significant seminal improvement was defined as at least a 50% increase in any of the following: motile sperm/ml, sperm/ml, or % motility. Results: A total of 285 patients underwent varicocele repair in the defined study period. Complete follow up was available for 133 patients. A total of 89 (67%) of these patients had a significant improvement in at least one of their seminal parameters and 44 (33%) did not. Of the 133 patients, 49 (37%) achieved natural conception and 84 (63%) did not. Of those 84, 59 went on to in vitro fertilization, with 36 (61%) achieving pregnancy. However, of the 44 patients who did not demonstrate significant improvement in at least one of the above parameters, 10 (23%) achieved natural conception. There were no significant differences in male or female ages between the groups with and without improvement. Conclusion: Repair of clinically significant varicoceles results in a reasonable chance of natural conception, even in patients who do not demonstrate significant improvements in their postoperative seminal parameters. This rate is higher than previously reported pregnancy rates of approximately 15% for untreated varicoceles. Therefore, couples should be counseled to continue attempts at conception following repair, despite lack of seminal improvement, unless time is of the essence.

Pregnancy rates following varicocele repair without seminal improvement.

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