Researchers in Germany found that a simple and minimally invasive outpatient treatment for varicoceles, a common cause of male infertility that affects about 1 in 10 men, can significantly improve sperm function and pregnancy rates.
The study came from the University of Bonn Medical School and is published in the August issue of Radiology.
Lead author Dr Sebastian Flacke and colleagues found that the level of sperm motility present before having the treatment was also an important predictor of pregnancy success.
Flacke is now an associate professor of radiology at the Tufts University School of Medicine, director of noninvasive cardiovascular imaging and vice chair for research and development in the department of radiology at the Lahey Clinic in Burlington, Massachusetts.
He said that:
"Venous embolization, a simple treatment using a catheter through the groin, can help to improve sperm function in infertile men."
"With the patients' improved sperm function, more than one-quarter of their healthy partners were able to become pregnant," added Flacke.
Varicoceles is a condition like varicose veins where the blood vessels in the scrotum become tangled and swollen. Normally the blood flows from the testicles back to the heart via small veins that have a non-return valve to stop the blood flowing backwards to the testicles. But if these valves stop working, then the blood backs up, fails to leave the testicles properly and causes the vessels to bulge and swell.
Varicoceles is a common condition that generally has no symptoms or harmful side effects and affects between 10 and 15 per cent of adult men in the US. Figures from the National Institutes of Health suggest it mostly affects young men between 15 and 25. Occasionally the condition results in pain, shrinkage, or fertility problems.
Until recently, men with problematic varicoceles were treated with open surgery to remove the affected blood vessels, but now there is a minimally invasive procedure called catheter embolization which a man can have as an outpatient. Catheter embolization is where the radiologist inserts a small tube or catheter through a tiny cut in the groin, and using x-ray imaging, guides the catheter to the affected blood vessel and then blocks it using a platinum coil and a few millillitres of a liquid agent. The patient recovers quickly and is usually well enough to go back to work in 24 hours.
For this study, in order to identify what might affect pregnancy rates in couples where the man was infertile before undergoing varicocele embolization, Flacke and colleagues recruited 223 infertile men aged between 18 and 50 who had been diagnosed with at least one varicocele and who underwent embolization. All the men had healthy partners with whom they had been trying to conceive.
Before and after the procedure, all participants underwent a clinical exam (with ultrasound test), gave a semen specimen, and had their hormone levels tested.
The results showed that:226 of the patients' 228 varicoceles were successfully treated with embolization.
Follow up data was successfully obtained for 173 patients, and in these, three months after the procedure, the average sperm motility and sperm count was found to be significantly improved.
Six months later, 45 couples (26 per cent of the 173 followed up), reported a pregnancy.
The only significant pre-treatment predictor of post-treatment pregnancy success was sperm motility.
Other measures such as hormone levels, clinical grading of varicoceles, Doppler ultrasound findings, and other semen parameters did not reach statistical significance.
Flacke said:
"Embolization of varicoceles in infertile men may be considered a useful adjunct to in-vitro fertilization."
"Embolization of Varicocles: Pretreatment Sperm Motility Predicts Later Pregnancy in Partners of Infertile Men."
Sebastian Flacke, Michael Schuster, Attila Kovacs, Marcus von Falkenhausen, Holger M. Strunk, Gerhard Haidl, and Hans H. Schild.
Radiology 2008 248: 540-549.
Volume 248, Issue 2, August 2008
DOI: 10.1148/radiol.2482071675.
