CONTROLLED TRIAL OF HIGH SPERMATIC VEIN LIGATION FOR VARICOCELE IN INFERTILE MEN

Objective: To determine whether high ligation is an effective treatmen t for infertile men with clinical varicocele. Design: A randomized, co ntrolled trial of high spermatic vein ligation was carried out. The pa tients were treated and observed for 3 years. Setting: Infertility tre atment clinic and andrology laboratory in a hospital. Patients: Infert ile men with abnormal semen analysis because of varicocele only. Inter vention: High ligation I year postrecruitment (group A) and at the beg inning of the study (group B). Results: Among the 20 couples in group A, 2 pregnancies (10%) were achieved within the Ist year of observatio n period. During the year after high ligation, there were 8 pregnancie s (44.4%), and during the 2nd year after high ligation, there were 4 m ore pregnancies (22.2%). In group B, 15 pregnancies (60%) occurred wit hin the Ist year after operation. Three pregnancies (12%) and 1 pregna ncy (4%) occurred during the 2nd and 3rd year, respectively. After ope ration in all patients of both groups, there was significant improveme nt in semen parameters, regardless of pregnancy occurrence. The differ ence in pregnancy rate (PR) between the operated group B and nonoperat ed group A during the Ist year of study was found to be highly signifi cant. Conclusions: It is concluded that in a population of infertile m en presenting varicocele as the only demonstrable factor of infertilit y, the varicocele is clearly associated with infertility and reduced t esticular function, and its correction by ligation improves sperm para meters and fertility rate. Furthermore, the highest PR in both groups occurred during the Ist year postoperation.