Effect of varicocelectomy on sperm parameters and pregnancy rate in patients with subclinical varicocele: a randomized prospective controlled study. Does varicocele repair improve male infertility? An evidence-based perspective from a randomized, controlled trial. Does treatment of varicocele improve male fertility? results of the 'Deutsche Varikozelenstudie', a multicentre study of 14 collaborating centres. Treatment of varicocele and male fertility. Controlled trial of high spermatic vein ligation for varicocele in infertile men. Clomiphene citrate versus varicocelectomy in treatment of subclinical varicocele: a prospective randomized study. Treatment of varicocele: counselling as effective as occlusion of the vena spermatica. Improvement of semen and pregnancy rate after ligation and division of the internal spermatic vein: fact or fiction?
We assessed whether subclinical varicocele ligation improves fertility and/or semen parameters.
                A total of 85 patients with a subclinical varicocele diagnosed by scrotal thermography presented with infertility. Patients were randomly assigned to groups 1 (high ligation of the internal spermatic vein) and 2 (followed without any treatment). At least 3 semen samples were obtained at study entry and 1 year later in both groups.
                The pregnancy rate in group 1 was 6.7% compared to 10% in group 2, and the difference was not statistically significant. Group 1 had significantly higher levels of sperm density and total motile sperm count at 1 year. There were no significant differences between groups 1 and 2 regarding change in seminal volume, sperm motility and abnormal sperm morphology.
                Subclinical varicocelectomy has some effect on spermatogenesis but no beneficial effect on pregnancy rate. Randomized controlled trials (RCTs) addressing varicocele treatment are scarce and have conflicting outcomes.
                To determine whether varicocele treatment is superior or inferior to no treatment in male infertility from an evidence-based perspective.
                A prospective, nonmasked, parallel-group RCT with a one-to-one concealed-to-random allocation was conducted at the authors' institution from February 2006 to October 2009. Married men 20-39 yr of age who had experience infertility ≥1 yr, had palpable varicoceles, and with at least one impaired semen parameter (sperm concentration <20 million/ml, progressive motility <50%, or normal morphology <30%) were eligible. Exclusions included subclinical or recurrent varicoceles, normal semen parameters, and azoospermia. Sample size analysis suggested 68 participants per arm.
                Participants were randomly allocated to observation (the control arm [CA]) or subinguinal microsurgical varicocelectomy (the treatment arm [TA]). Semen analyses were obtained at baseline (three analyses) and at follow-up months 3, 6, 9, and 12. The mean of each sperm parameter at baseline and follow-ups was determined.
                We measured the spontaneous pregnancy rate (the primary outcome), changes from baseline in mean semen parameters, and the occurrence of adverse events (AE-the secondary outcomes) during 12-mo follow-up; p<0.05 was considered significant.
                Analysis included 145 participants (CA: n=72; TA: n=73), with a mean age plus or minus standard deviation of 29.3±5.7 in the CA and 28.4±5.7 in the TA (p=0.34). Baseline characteristics in both arms were comparable. Spontaneous pregnancy was achieved in 13.9% (CA) versus 32.9% (TA), with an odds ratio (OR) of 3.04 (95% confidence interval [CI], 1.33-6.95) and a number needed to treat (NNT) of 5.27 patients (95% CI, 1.55-8.99). In CA within-arm analysis, none of semen parameters revealed significant changes from baseline (sperm concentration [p=0.18], progressive motility [p=0.29], and normal morphology [p=0.05]). Conversely, in TA within-arm analysis, the mean of all semen parameters improved significantly in follow-up versus baseline (p<0.0001). In between-arm analysis, all semen parameters improved significantly in the TA versus CA (p<0.0001). No AEs were reported.
                Our RCT provided level 1b evidence of the superiority of varicocelectomy over observation in infertile men with palpable varicoceles and impaired semen quality, with increased odds of spontaneous pregnancy and improvements in semen characteristics within 1-yr of follow-up.
                Copyright © 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved. Treatment of varicocele is suggested in infertile men if sperm parameter values are abnormal. The effectiveness of the treatment with respect to fertility remains to be clarified. A multicentre, prospective randomized study on varicocele treatment in infertile men to demonstrate the superiority of sclerotization of the varicocele in preventing persistence, was started in 1995 with the collaboration of 15 German andrological centres. The primary endpoint was the incidence of pregnancy 1 year after randomisation. The number of cases needed to achieve the goal of the study was calculated at 460. However, three years after starting the study, only 67 patients had been randomized. Different reasons contributed to the poor recruitment. There was no significant increase in pregnancy rate in the treated group, compared to the controls, the confidence interval being 20.8% to 15.7%. The authors would like to encourage further collaborative study groups to start another prospective, randomized study with the aim of avoiding the costs and risks of varicocele treatment when its success remains unclear. Ninety-six patients with varicocele were followed for 4 years in a prospective randomized study. Seventeen patients were excluded from the study in accordance with exclusion criteria. In 26 patients varicocele was treated surgically and 12 patients were treated either by sclerosation or embolization. Forty-one patients with varicocele had no therapy. In 54 patients oligoasthenozoospermia and in 25 normozoospermia was certified. In the group of patients without treatment, the pregnancy rate in the women was higher (22/41, or 53.7%) than in the group receiving treatment (13/38, or 34.2%). The difference was not statistically significant. After therapy, sperm concentration increased and sperm motility improved also. The differences were not statistically significant. The study showed that varicocele therapy bears no influence on male fertility. To determine whether high ligation is an effective treatment for infertile men with clinical varicocele.
                A randomized, controlled trial of high spermatic vein ligation was carried out. The patients were treated and observed for 3 years.
                Infertility treatment clinic and andrology laboratory in a hospital.
                Infertile men with abnormal semen analysis because of varicocele only.
                High ligation 1 year postrecruitment (group A) and at the beginning of the study (group B).
                Among the 20 couples in group A, 2 pregnancies (10%) were achieved within the 1st year of observation period. During the year after high ligation, there were 8 pregnancies (44.4%), and during the 2nd year after high ligation, there were 4 more pregnancies (22.2%). In group B, 15 pregnancies (60%) occurred within the 1st year after operation. Three pregnancies (12%) and 1 pregnancy (4%) occurred during the 2nd and 3rd year, respectively. After operation in all patients of both groups, there was significant improvement in semen parameters, regardless of pregnancy occurrence. The difference in pregnancy rate (PR) between the operated group B and nonoperated group A during the 1st year of study was found to be highly significant.
                It is concluded that in a population of infertile men presenting varicocele as the only demonstrable factor of infertility, the varicocele is clearly associated with infertility and reduced testicular function, and its correction by ligation improves sperm parameters and fertility rate. Furthermore, the highest PR in both groups occurred during the 1st year postoperation. The purpose of the study was to compare the effect of varicocelectomy with that of clomiphene citrate on seminal improvement and pregnancy rates in patients with subclinical varicocele.
                A total of 42 infertile men with left subclinical varicocele were randomized to group I (21 patients, surgery) and group II (21 patients, medical therapy). The patients in group I were treated with varicocelectomy and those in group II with clomiphene citrate, 50 mg/day, orally. Sperm parameters (sperm density, motility and morphology) were recorded before and 6 months after beginning the treatment and pregnancy rates were estimated. In statistical analysis, paired and independent-samples t-tests, Kaplan-Meier and Log rank tests and Fisher's exact test were used.
                Mean +/- SD age of the series was 32.7 +/- 6.1 years, that of group I was 32.2 +/- 5.5 years and that of group II was 33.1 +/- 6.7 years (P = 0.680). All seminal parameters increased after both surgical and medical treatment, but only increases in sperm density and motility following varicocelectomy were statistically significant. Changes in seminal parameters between groups I and II were statistically insignificant. Pregnancy was seen in two cases in group I and in one in group II (P = 0.500). The cumulative pregnancy rates were 12.5% in group I and 6.7% in group II (P = 0.589).
                Clomiphene citrate did not increase sperm density and motility as effectively as subclinical varicocelectomy, but there was no statistically significant difference between surgical and medical therapy methods in terms of seminal improvement and pregnancy rate. Occlusion of the spermatic vein by surgical or angiographic techniques is generally accepted as the treatment of choice in infertile patients with varicocele. We have recently demonstrated that surgical ligation and radiological embolization are equally effective in terms of pregnancies following treatment. Since, however, it remains unclear whether any treatment is more effective than no treatment, we initiated a controlled, randomized prospective study to address this question. Infertile patients with varicocele were investigated twice using Doppler sonography, ultrasonography of the scrotal contents, semen analysis according to World Health Organization guidelines and serum follicle stimulating hormone, luteinizing hormone and testosterone measurements. Other causes of male infertility were excluded. The patients' wives were free of obvious causes of infertility such as anovulation or tubal blockage. Subjects fulfilling the admission criteria were randomly allocated to groups receiving ligation, embolization or no treatment. Thereafter, all patients were investigated and counselled every 3 months for a period of 1 year. In all, 47 couples in the treatment group (23 ligations and 24 embolizations) and 48 in the non-treatment group concluded the study. When entering the study, there were no significant differences in semen analysis and hormonal parameters between the two groups, nor between the subgroups undergoing treatment. While no significant changes in semen parameters occurred in the non-treatment group, the sperm concentration increased significantly (P = 0.008) in the treated patients from 16.5 +/- 2.5 x 10(6)/ml (mean +/- SE) before to 25.1 +/- 4.1 x 10(6)/ml at the end of the study.(ABSTRACT TRUNCATED AT 250 WORDS) Male partners with left-sided varicoceles of 96 infertile couples were studied. Fifty-one patients were submitted to ligation of the testicular veins and 45 individuals were randomised as controls. During an observation period of 53 months (range 36 to 74 months) we found no statiscally significant improvement in the semen crude variables, the morphology or the progressive motility in the series of men submitted to surgery. The pregnancy rate was lower in those who had an excision of varicocelle.