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Effect of Varicocele Treatment on Natural Pregnancy Outcomes

  • Siddharth Yadav
  • Rajeev KumarEmail author
Chapter

Abstract

Natural conception is always favoured over assisted reproduction by the patients and the caregivers, and has been shown to be safer for both the mother and the child. While various studies and meta-analysis have shown the encouraging effects of varicocelectomy on semen parameters in infertile men, improvement in the natural pregnancy rate is more controversial. One of the first studies addressing this topic showed a significant improvement in natural pregnancy rates following varicocelectomy, but these results could not be reproduced by others, and the Cochrane Collaboration meta-analyses performed three consecutive times (2001, 2004, 2008) concluded that varicocelectomy does not improve the natural pregnancy rates. However, these meta-analyses included men with normozoospermia, subclinical varicoceles, and inappropriate interventions and thus faced significant criticism. Subsequent meta-analyses with better selection criteria, namely, including only men with clinical varicoceles and abnormal semen parameters, showed a statistically significant effect of varicocelectomy in improving the natural pregnancy rates. Multiple factors such as age of both the partners, body mass index of the male partner, grade of varicocele, presence of testicular atrophy, pre-operative and post-operative sperm counts, pre-operative serum FSH levels and various other factors have been shown to affect the natural pregnancy rates in men undergoing varicocelectomy. Of the various procedures described, microsurgical varicocelectomy results in highest natural pregnancy rates. Thus, varicocelectomy in couples with normal female partner evaluation with palpable varicoceles and oligozoospermia improves the chances of natural pregnancy.

Keywords

Male infertility natural pregnancy outcomes review varicocelectomy 

References

  1. 1.
    Jackson RA, Gibson KA, Wu YW, Croughan MS. Perinatal outcomes in singletons following in vitro fertilization: a meta-analysis. Obstet Gynecol. 2004;103:551–63.CrossRefGoogle Scholar
  2. 2.
    de Mouzon J, et al. Assisted reproductive technology in Europe: results generated from European registers by ESHRE. Hum Reprod. 2010;25:1851–62.CrossRefGoogle Scholar
  3. 3.
    Mantikou E, et al. Embryo culture media and IVF/ICSI success rates: a systematic review. Hum Reprod Update. 2013;19:210–20.CrossRefGoogle Scholar
  4. 4.
    Ochsenkühn R, et al. Pregnancy complications, obstetric risks, and neonatal outcome in singleton and twin pregnancies after GIFT and IVF. Arch Gynecol Obstet. 2003;268:256.CrossRefGoogle Scholar
  5. 5.
    Schieve LA, Ferre C, Peterson HB, Macaluso M, Reynolds MA, Wright VC. Perinatal outcome among singleton infants conceived through assisted reproductive technology in the United States. Obstet Gynecol. 2004;103:1144–53.CrossRefGoogle Scholar
  6. 6.
    Katalinic A, Rösch C, Ludwig M. Pregnancy course and outcome after intracytoplasmic sperm injection: a controlled, prospective cohort study. Fertil Steril. 2004;81:1604–16.CrossRefGoogle Scholar
  7. 7.
    Blickstein I. Estimation of iatrogenic monozygotic twinning rate following assisted reproduction: pitfalls and caveats. Am J Obstet Gynecol. 2005;192:365–8.CrossRefGoogle Scholar
  8. 8.
    Glazebrook C, Sheard C, Cox S, Oates M, Ndukwe G. Parenting stress in first-time mothers of twins and triplets conceived after in vitro fertilization. Fertil Steril. 2004;81:505–11.CrossRefGoogle Scholar
  9. 9.
    Meng MV, Greene KL, Turek PJ. Surgery or assisted reproduction? A decision analysis of treatment costs in male infertility. J Urol. 2005;174:1926–31.CrossRefGoogle Scholar
  10. 10.
    Thomson F, Shanbhag S, Templeton A, Bhattacharya S. Obstetric outcome in women with subfertility. Br J Obstet Gynecol. 2005;112:632–7.CrossRefGoogle Scholar
  11. 11.
    Draper ES, Kurinczuk JJ, Abrams KR, Clarke M. Assessment of separate contributions to perinatal mortality of infertility history and treatment: a case-control analysis. Lancet. 1999;353:1746–9.CrossRefGoogle Scholar
  12. 12.
    Li TC, Makris M, Tomsu M, Tuckerman E, Laird S. Recurrent miscarriage: aetiology, management and prognosis. Hum Reprod Update. 2002;5:43–81.CrossRefGoogle Scholar
  13. 13.
    Sakkas D, Mofatt O, Manicardi GC, Mariethoz E, Tarozzi N, Bizzaro D. Nature of DNA damage in ejaculated human spermatozoa and the possible involvement of apoptosis. Biol Reprod. 2002;66:1061–7.CrossRefGoogle Scholar
  14. 14.
    Saleh RA, Agarwal A, Sharma RK, Said TM, Sikka SC, Thomas AJ Jr. Evaluation of nuclear DNA damage in spermatozoa from infertile men with varicocele. Fertil Steril. 2003;80:1431–6.CrossRefGoogle Scholar
  15. 15.
    Cocuzza M, Cocuzza MA, Bragais FM, Agarwal A. The role of varicocele repair in the new era of assisted reproductive technology. Clinics (Sao Paulo). 2008;63:395–404.CrossRefGoogle Scholar
  16. 16.
    Mostafa T, Anis TH, El-Nashar A, Imam H, Othman IA. Varicocelectomy reduces reactive oxygen species levels and increases antioxidant activity of seminal plasma from infertile men with varicocele. Int J Androl. 2001;24:261–5.CrossRefGoogle Scholar
  17. 17.
    Mansour Ghanaie M, Asgari SA, Dadrass N, Allahkhan A, Iran-Pour E, Safarinejad MR. Effects of varicocele repair on spontaneous 1st trimester miscarriage: a randomized clinical trial. Urol J. 2012;9:505–13.Google Scholar
  18. 18.
    Gleicher N, Vander Laan B, Pratt D, Karande V. Background pregnancy rates in an infertile population. Hum Reprod. 1996;11:1011–2.CrossRefGoogle Scholar
  19. 19.
    Tiseo BC, Esteves SC, Cocuzza MS. Summary evidence on the effects of varicocele treatment to improve natural fertility in subfertile men. Asian J Androl. 2016;18:239–45.CrossRefGoogle Scholar
  20. 20.
    Tulloch WS. Consideration of sterility; subfertility in the male. Edinb Med J. 1952;59:29–34.Google Scholar
  21. 21.
    Madgar I, Weissenberg R, Lunenfeld B, Karasik A, Goldwasser B. Controlled trial of high spermatic vein ligation for varicocele in infertile men. Fertil Steril. 1995;63:120–4.CrossRefGoogle Scholar
  22. 22.
    Yamamoto M, Hibi H, Hirata Y, Miyake K, Ishigaki T. Effect of varicocelectomy on sperm parameters and pregnancy rate in patients with subclinical varicocele: a randomized prospective controlled study. J Urol. 1996;155:1636–8.CrossRefGoogle Scholar
  23. 23.
    Nieschlag E, Hertle L, Fischedick A, Abshagen K, Behre HM. Update on treatment of varicocele: counselling as effective as occlusion of the vena spermatica. Hum Reprod. 1998;13:2147–50.CrossRefGoogle Scholar
  24. 24.
    Evers JL, Collins JA, Vandekerckhove P. Surgery or embolisation for varicocele in subfertile men. Cochrane Database Syst Rev. 2001;(1):CD000479.Google Scholar
  25. 25.
    Breznik R, Vlaisavljevic V, Borko E. Treatment of varicocele and male fertility. Arch Androl. 1993;30:157–60.CrossRefGoogle Scholar
  26. 26.
    Nilsson S, Edvinsson A, Nilsson B. Improvement of semen and pregnancy rate after ligation and division of the internal spermatic vein: fact or fiction? Br J Urol. 1979;51:591–6.CrossRefGoogle Scholar
  27. 27.
    Marmar J, Benoff S. New scientific information related to varicoceles. J Urol. 2003;170:2371–3.CrossRefGoogle Scholar
  28. 28.
    Unal D, Yeni E, Verit A, Karatas OF. Clomiphene citrate versus varicocelectomy in treatment of subclinical varicocele: a prospective randomized study. Int J Urol. 2001;8:227–30.CrossRefGoogle Scholar
  29. 29.
    Krause W, Muller HH, Schafer H, Weidner W. Does treatment of varicocele improve male fertility? results of the ‘Deutsche Varikozelenstudie’, a multicentre study of 14 collaborating centres. Andrologia. 2002;34:164–71.Google Scholar
  30. 30.
    Evers JL, Collins JA. Surgery or embolisation for varicocele in subfertile men. Cochrane Database Syst Rev. 2004;(3):CD000479.Google Scholar
  31. 31.
    Evers JH, Collins J, Clarke J. Surgery or embolisation for varicoceles in subfertile men. Cochrane Database Syst Rev. 2008;(3):CD000479.Google Scholar
  32. 32.
    Evers JH, Collins J, Clarke J. Surgery or embolisation for varicoceles in subfertile men. Cochrane Database Syst Rev. 2009;(1):CD000479.Google Scholar
  33. 33.
    Ficarra V, et al. Treatment of varicocele in subfertile men: the Cochrane review – A contrary opinion. Eur Urol. 2006;49:258–63.CrossRefGoogle Scholar
  34. 34.
    Marmar JL, et al. Reassessing the value of varicocelectomy as a treatment for male subfertility with a new meta-analysis. Fertil Steril. 2007;88:639–48.CrossRefGoogle Scholar
  35. 35.
    Mehta A, Goldstein M. Microsurgical varicocelectomy: a review. Asian J Androl. 2013;15:56–60.CrossRefGoogle Scholar
  36. 36.
    Abdel-Meguid TA, Al-Sayyad A, Tayib A, Farsi HM. Does varicocele repair improve male infertility? An evidence-based perspective from a randomized, controlled trial. Eur Urol. 2011;59:455–61.CrossRefGoogle Scholar
  37. 37.
    Baazeem A, et al. Varicocele and male factor infertility treatment: a new meta-analysis and review of the role of varicocele repair. Eur Urol. 2011;60:796–808.Google Scholar
  38. 38.
    Kroese AC, de Lange NM, Collins J, Evers JL. Surgery or embolization for varicoceles in subfertile men. Cochrane Database Syst Rev. 2012;(10):CD000479.Google Scholar
  39. 39.
    Kim KH, Lee YJ, Kang DH, Lee H, Seo JT, Cho KS. Impact of surgical varicocele repair on pregnancy rate in subfertile men with clinical varicocele and impaired semen quality: a meta-analysis of randomized clinical trials. Korean J Urol. 2013;54:703–9.CrossRefGoogle Scholar
  40. 40.
    Samplaski MK, Jarvi KA. Prognostic factors for a favourable outcome after varicocele repair in adolescents and adults. Asian J Androl. 2016;18:217–21.CrossRefGoogle Scholar
  41. 41.
    Marks JL, McMahon R, Lipshultz LI. Predictive parameters of successful varicocele repair. J Urol. 1986;136:609–12.CrossRefGoogle Scholar
  42. 42.
    Hassanzadeh-Nokashty K, Yavarikia P, Ghaffari A, Hazhir S, Hassanzadeh M. Effect of age on semen parameters in infertile men after varicocelectomy. Ther Clin Risk Manag. 2011;7:333–6.PubMedPubMedCentralGoogle Scholar
  43. 43.
    Abdalla A, Amin M, Hamdy A, Nandy M. Spontaneous pregnancy outcome after surgical repair of clinically palpable varicocele in young men with abnormal semen analysis. Afr J Urol. 2011;7:115–21.Google Scholar
  44. 44.
    Zorba UO, Sanli OM, Tezer M, Erdemir F, Shavakhabov S, Kadioglu A. Effect of infertility duration on postvaricocelectomy sperm counts and pregnancy rates. Urology. 2009;73:767–71.CrossRefGoogle Scholar
  45. 45.
    Steckel J, Dicker AP, Goldstein M. Relationship between varicocele size and response to varicocelectomy. J Urol. 1993;149:769–71.CrossRefGoogle Scholar
  46. 46.
    Libman J, Jarvi K, Lo K, Zini A. Beneficial effect of microsurgical varicocelectomy is superior for men with bilateral versus unilateral repair. J Urol. 2006;176:2602–5.CrossRefGoogle Scholar
  47. 47.
    Baazeem A, Boman JM, Libman J, Jarvi K, Zini A. Microsurgical varicocelectomy for infertile men with oligospermia: differential effects of bilateral and unilateral varicocele on pregnancy outcomes. BJU Int. 2009;104:524–8.CrossRefGoogle Scholar
  48. 48.
    Zheng YQ, Gao X, Li ZJ, Yu YL, Zhang ZG, Li W. Efficacy of bilateral and left varicocelectomy in infertile men with left clinical and right subclinical varicoceles: a comparative study. Urology. 2009;73:1236–40.CrossRefGoogle Scholar
  49. 49.
    Kamal KM, Jarvi K, Zini A. Microsurgical varicocelectomy in the era of assisted reproductive technology: influence of initial semen quality on pregnancy rates. Fertil Steril. 2001;75:1013–6.CrossRefGoogle Scholar
  50. 50.
    Matkov TG, Zenni M, Sandlow J, Levine LA. Preoperative semen analysis as a predictor of seminal improvement following varicocelectomy. Fertil Steril. 2001;75:63–8.CrossRefGoogle Scholar
  51. 51.
    O’Brien JH, Bowels B, Kamal KM, Jarvi K, Zini A. Microsurgical varicocelectomy for infertile couples with advanced female age: natural history in the era of ART. J Androl. 2004;25:939–43.CrossRefGoogle Scholar
  52. 52.
    Lundy SD, Sabanegh ES. Varicocele management for infertility and pain: a systematic review. Arab J Urol. 2017;16:157.  https://doi.org/10.1016/j.aju.2017.11.003.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Al-Said S, et al. Varicocelectomy for male infertility: a comparative study of open, laparoscopic and microsurgical approaches. J Urol. 2008;180:266–70.CrossRefGoogle Scholar
  54. 54.
    Al-Kandari AM, Shabaan H, Ibrahim HM, Elshebiny YH, Shokeir AA. Comparison of outcomes of different varicocelectomy techniques: open inguinal, laparoscopic, and subinguinal microscopic varicocelectomy: a randomized clinical trial. Urology. 2007;69:417–20.CrossRefGoogle Scholar
  55. 55.
    Bou Nasr E, Binhazzaa M, Almont T, Rischmann P, Soulie M, Huyghe E. Subinguinal microsurgical varicocelectomy vs percutaneous embolization in infertile men: prospective comparison of reproductive and functional outcomes. Basic Clin Androl. 2017;27(11).Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Urology and Renal TransplantVardhaman Mahavir Medical College & Safdarjung HospitalNew DelhiIndia
  2. 2.Department of UrologyAll India Institute of Medical SciencesNew DelhiIndia

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