E. Nieschlag et al., TREATMENT OF VARICOCELE - COUNSELING AS EFFECTIVE AS OCCLUSION OF THEVENA SPERMATICA, Human reproduction, 10(2), 1995, pp. 347-353
Occlusion of the spermatic vein by surgical or angiographic techniques
is generally accepted as the treatment of choice in infertile patient
s with varicocele. We have recently demonstrated that surgical ligatio
n and radiological embolization are equally effective in terms of preg
nancies following treatment. Since, however, it remains unclear whethe
r any treatment is more effective than no treatment, we initiated a co
ntrolled, randomized prospective study to address this question. Infer
tile patients with varicocele were investigated twice using Doppler so
nography, ultrasonography of the scrotal contents, semen analysis acco
rding to World Health Organization guidelines and serum follicle stimu
lating hormone, luteinizing hormone and testosterone measurements. Oth
er causes of male infertility were excluded. The patients' wives were
free of obvious causes of infertility such as anovulation or tubal blo
ckage. Subjects fulfilling the admission criteria were randomly alloca
ted to groups receiving ligation, embolization or no treatment. Therea
fter, all patients were investigated and counselled every 3 months for
a period of 1 year. In all, 47 couples in the treatment group (23 lig
ations and 24 embolizations) and 48 in the non-treatment group conclud
ed the study. When entering the study, there were no significant diffe
rences in semen analysis and hormonal parameters between the two group
s, nor between the subgroups undergoing treatment. While no significan
t changes in semen parameters occurred in the non-treatment group, the
sperm concentration increased significantly (P = 0.008) in the treate
d 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. A total of 25 pregnancies w
ere recorded during the 1-year study period, 12 in the treatment group
(25.5 %) and 13 in the non-treatment group (27.1%). This difference w
as not significant. These results challenge the current standard appro
ach of varicocele repair and emphasize the need for properly controlle
d studies in infertility treatment.