Varicocelectomy improves intrauterine insemination success rates in men with varicocele

Purpose: We determined whether varicocele treatment before intrauterine ins emination significantly affects intrauterine insemination success rates. Materials and Methods: A total of 58 infertile couples, of whom the women h ad normal evaluations and men had abnormal semen analyses and a history of varicocele, were included in this study. They were identified after reviewi ng the charts of all women undergoing intrauterine insemination for male fa ctor infertility at our center, Of the men 24 participated in 63 intrauteri ne insemination cycles without varicocele treatment, while in the remaining 34 varicocele was treated before a total of 101 intrauterine insemination cycles, Variables associated with pregnancy or live birth were analyzed usi ng repeat measures logistic regression with generalized estimating equation was performed without including varicocele treatment status. Subsequently varicocele treatment status and the significant associated factors were inc luded in analysis, The semen characteristics of untreated and treated varic ocele groups were compared with repeat measures analysis of variance. Results: On pre-wash semen analysis patients with untreated varicocele had significantly higher mean motility plus or minus standard error than patien ts whose varicoceles were treated (48.6% +/- 2.3% versus 38.1% +/- 1.8%, p = 0.02). However, no statistically significant difference was noted in the mean post-wash total motile sperm count in the treated and untreated groups (7.2 +/- 1.0 versus 14.8 +/- 2.6, p = 0.1). Despite these findings the pre gnancy and live birth rates per cycle were significantly higher in patients in whom varicocele was treated than in those without varicocele treatment (11.8% versus 6.3%, p = 0.04 and 11.8% versus 1.6%, p = 0.007, respectively ) Conclusions: Varicocele treatment may not improve semen characteristics in all men but it appears to improve pregnancy and live birth rates among coup les under going intrauterine insemination for male factor infertility, A fu nctional factor not measured on routine semen analysis may affect pregnancy rates in this setting. Men should be screened for varicocele before. intra uterine insemination is initiated for male factor infertility.