IUI More Successful after Varicocelectomy
Anthony J. Thomas Jr.,M.D. and Ashok Agarwal, Ph.D., HCLD

Intrauterine insemination (IUI) with sperm from men with a history of varicocele is more likely to be successful if the varicocele is treated prior to IUI, according to new findings from the Cleveland Clinic Urological Institute's Center for Advanced Research in Human Reproduction and Infertility.

We reviewed the charts of all patients who had come to the Cleveland Clinic for IUI treatment between 1993 and 1996. We found 39 cases in which the men had abnormal semen analyses and a history of varicocele; none of the women in these couples had any risk factors for infertility. Twenty-four of these men had had their varicoceles treated before IUI was attempted, while the remaining 15 had not.

After controlling for other infertility risk factors, we found that IUI was significantly more successful in the varicocele-treated group. Overall, there were eight pregnancies and eight live births among those in the treated group, compared with only two pregnancies and one live birth in the untreated group. The per-cycle pregnancy and live-birth rates in the treated group were also significantly greater.

The treated men experienced these better outcomes despite the fact that their semen analyses were not as promising as those of the untreated men. For example, the mean pre-wash sperm motility in the untreated group was 50.3%, compared with only 37.6% in the treated group (P = 0.008). Likewise, the post-wash total motile sperm counts were significantly higher in the untreated group as well: 15.9X 106 vs. 5.7 X 106 (P=0.02).

An Unknown Functional Factor
Our findings suggest that even though varicocele treatment might not improve semen characteristics in all men, it might improve both pregnancy and live birth rates among couples who undergo IUI for male-factor infertility. We believe that this improvement in fertility might be attributable to a functional factor that is not measured by routine semen analysis. Also, there may be some baseline differences between the treated and untreated groups as a result of a selection bias by the original treating physician.

Our findings are important because IUI is often the treatment of choice when a male factor is the only known contributor to infertility. We recommend that physicians screen all infertile men for varicocele before IUI and correct the varicocele if appropriate based on semen parameters.



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Last Update : December 29, 2008
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