Varicocelectomy before assisted reproductive technology: are outcomes improved?

Fertil Steril. 2017 Sep;108(3):385-391. doi: 10.1016/j.fertnstert.2017.06.033.

Abstract

Clinical varicoceles have been associated with impaired semen parameters and male-factor infertility. Varicocele repair can improve live birth rates for men with clinical varicocele. Varicocelectomy is often combined with assisted reproductive techniques (ART) such as intrauterine insemination (IUI), in vitro fertilization (IVF), or intracytoplasmic sperm injection (ICSI). Here we review the literature examining varicocelectomy before ART to evaluate whether improved pregnancy outcomes are realized. Although insufficient evidence exists to determine if correcting a varicocele improves IUI outcomes, a clinical benefit is observed when correcting a clinical varicocele in oligospermic and nonobstructed azoospermic men before IVF/ICSI. In couples seeking fertility with the use of ART, varicocele repair may offer improvement in semen parameters and may decrease the level of ART needed to achieve successful pregnancy.

Keywords: Varicocele; intracytoplasmic sperm injection; intrauterine insemination; in vitro fertilization; varicocelectomy.

Publication types

  • Meta-Analysis
  • Review

MeSH terms

  • Binding Sites
  • Comorbidity
  • Evidence-Based Medicine
  • Female
  • Humans
  • Infertility, Male / epidemiology*
  • Infertility, Male / therapy*
  • Male
  • Pregnancy
  • Pregnancy Outcome / epidemiology*
  • Prevalence
  • Quality Improvement
  • Reproductive Techniques, Assisted
  • Risk Factors
  • Sperm Injections, Intracytoplasmic / statistics & numerical data*
  • Treatment Outcome
  • Urogenital Surgical Procedures
  • Varicocele / epidemiology*
  • Varicocele / surgery*