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Forum Name: Urology Topics

Question: Varicocele repair surgery


 AXLeon - Fri Feb 05, 2010 9:25 am

Hello,

My name is Alex. I am a 34 ear old, healthy male that found out I had a Varicocele causing infertility. I had that surgery, by my Urologist, 7 months ago. I have been working hard to achieve a pregnancy with my wife of 3 years. What are my chances after this type of surgery? I have done a S/A at 3 months and my count is good except I still show Abnormal sperm. Please help me. How can I improve those Abnormalities and achieve conception?

Please help.
 Dr.M.Aroon kamath - Sat Feb 13, 2010 8:18 am

User avatar Hi,
Whether the improvements in semen parameters, often seen (in about 80% of men) post-varicocelectomy, actually translate into improved pregnancy rates has been a matter of ongoing controversy.

One view is that correcting a varicocele often does not improve the semen quality enough to change the therapy that will be required to result in pregnancy for the couple.

Several other studies have shown that varicocele surgery can improve sperm counts, morphology or motility but randomized and controlled trials do not consistently show improved pregnancy rates.

Some recent studies employing non-operated control groups appear to indicate that varicocelectomy does improve pregnancy rates [sponteneous as well as following IVF(in vitro fertilization)/ICSI (intracytoplasmic sperm injection)].

These often contradicting & confusing conclusions stem from a number of factors such as...
- the variability of the type of surgical procedures(artery-sparing vs non artery-sparing)
- bilateral vs unilateral procedures
- age groups
- small number of cases in some studies(which do not reach statistical significance)
- absence of control groups in some studies for meaningful comparisons
- the grades(severity) of the varicoceles Etc.

As far as infertility is concerned, male related factors (male factor infertility) account for roughly 40% & female related factors contribute 40% as well.

Differences in fertility potential exist among men, even though all may exceed the accepted criteria for normal semen quality.

As 7 months have passed since surgery, and you say that the counts are good (you have not mentioned the percentages of motile forms & abnormal spermatozoa),you may have to keep trying. Another crucial factor is that one should address any female realated factors as well.

Generally if pregnancy is not achieved within 6-9 months after the surgery, the other treatment options such as IVF and ICSI may need to be considered.As mentioned earlier, chances of successful IVF/ICSI also have been shown to improve following varicocelectomy.
Best wishes!

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