Microsurgical varicocelectomy for infertile men with oligospermia: differential effect of bilateral and unilateral varicocele on pregnancy outcomes

Abstract

Objectives: To evaluate the pregnancy outcomes of two groups of oligospermic men with varicocele, one having a varicocelectomy (group 1) and the other electing not to have surgery (group 2), as varicocele represents the most common factor associated with male infertility and most reports indicate that varicocelectomy has a beneficial effect on male fertility and pregnancy outcome.

Patients and methods: We retrospectively reviewed consecutive oligospermic men who had microsurgical varicocelectomy (233, group 1) between September 1996 and January 2002 and a consecutive group of oligospermic men with varicoceles who elected not to have surgery (127, group 2). The outcome measures included changes in semen variables, partner pregnancy rates (assisted and unassisted) and use of assisted reproductive technologies (ART).

Results: The mean sperm concentration and motility increased significantly after varicocelectomy (P < 0.05). The natural pregnancy rate in group 1 (38%) was higher than in group 2 (30%). The use of ART was significantly greater in group 2 than group 1. In the subset of couples with bilateral varicocele, the natural pregnancy rate was significantly higher in group 1 than group 2 (48% vs 15%, respectively, P = 0.008).

Conclusions: This study suggests that the natural pregnancy rate is higher after varicocelectomy than in those not having surgery, although the difference was not statistically significant. However, in the subset of couples with bilateral varicocele, the spontaneous pregnancy rates were significantly higher after surgery.