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Bilateral microsurgical varicocele repair versus the non-surgical approach for male-factor infertility is associated with a higher pregnancy rate and lower ART utilization. INTRODUCTION. VARICOCELE. Most common identifiable pathology in infertile men. - PowerPoint PPT Presentation

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Page 1: INTRODUCTION
Page 2: INTRODUCTION
Page 3: INTRODUCTION

VARICOCELE Most common identifiable pathology in

infertile men.

Affects 35% - 40% of men presenting for infertility evaluation.

Page 4: INTRODUCTION

Management of male-factor infertility with clinical varicocele and abnormal semen parameters:Varicocele repair

Assisted Reproductive Technologies (ARTs)○ Intrauterine Insemination (IUI)○ In Vitro Fertilization with Intracytoplasmic

Sperm Injection (IVF/ICSI)

Observation

Page 5: INTRODUCTION

OBJECTIVES Assess pregnancy outcomes of two

cohorts of infertile men with bilateral varicoceles:

Bilateral varicocelectomy

No surgery

Page 6: INTRODUCTION
Page 7: INTRODUCTION

Retrospective review of 610 consecutive infertile couples with clinical varicoceles.

All men had:one year or more of infertilitybilateral clinically palpable varicocele (examined by

same investigator – AZ)abnormal semen parameters

Couples with subclinical or unilateral clinical varicoceles, tubal obstruction or ovulatory failure excluded.

Page 8: INTRODUCTION

Couples counseled about treatment options (observation, varicocelectomy & ARTs)

All microsurgical varicocelectomies performed by same surgeon (AZ).

Page 9: INTRODUCTION

Outcome measures: Pregnancy rates (natural and assisted)

Changes in semen parameters

Utilization of ARTs

Page 10: INTRODUCTION
Page 11: INTRODUCTION

Total of 610 consecutive infertile men with a clinical varicocele

238 (39%) infertile men with bilateral clinical varicoceles

157 (66%) chose bilateral varicocelectomySurgical (SUR) group

81 (34%) men chose not to have surgeryNon-surgical (NON-SUR) group.

Page 12: INTRODUCTION

MEAN (±SD) BASELINE CLINICAL PARAMETERS

Page 13: INTRODUCTION

MEAN (±SD) BASELINE CLINICAL PARAMETERS

Page 14: INTRODUCTION

MEAN (± SD) SUR GROUP SEMEN PARAMETERS

Page 15: INTRODUCTION

Pregnancy outcome and ART utilization data available for:

67.5% (106/157) of SUR group

64% (52/81) of NON-SUR group.

Page 16: INTRODUCTION

MEAN (±SD) BASELINE CLINICAL PARAMETERS IN COUPLES WITH

PREGNANCY OUTCOME DATA

Page 17: INTRODUCTION

PREGNANCY & ART UTILIZATION RATES IN COUPLES WITH

PREGNANCY OUTCOME DATA

Page 18: INTRODUCTION
Page 19: INTRODUCTION

Bilateral varicocele repair, when compared to non-surgical management, was associated with:

Significant improvements in semen parameters

Significant increase in natural pregnancy rate

Significantly less overall ART utilization

Page 20: INTRODUCTION

For bilateral clinical varicoceles, microsurgical repair is a favourable option for treating couples with male factor infertility.

Page 21: INTRODUCTION

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