Microsurgical varicocelectomy in the era of assisted reproductive technology: influence of initial semen quality on pregnancy rates.

OBJECTIVE

To evaluate the natural history of infertile couples in whom the man underwent varicocelectomy.

DESIGN

Retrospective study.

SETTING

University infertility clinic.

PATIENT(S): 159 infertile couples.

INTERVENTION(S): Microsurgical varicocelectomy.

MAIN OUTCOME MEASURE(S): Standard semen parameters and pregnancy rates (assisted and unassisted).

RESULT(S): Postoperative sperm concentration and motility increased significantly compared to before the varicocelectomy (28.9 +/- 3.0 vs. 22.5 +/- 2.1 x 10(6)/mL and 33.9 +/- 1.9 vs. 22.1 +/- 1.3%, respectively). Overall, 48% (76/159) of the couples achieved a spontaneous pregnancy at the mean of 30 months' follow-up. An additional 10% (16/159) and 11% (18/159) of couples achieved a pregnancy following intrauterine insemination and in vitro fertilization/intracytoplasmic sperm injection, respectively. Significantly higher spontaneous pregnancy rates were observed in couples in whom the man's initial sperm concentration was greater than or equal to 5 million sperm per milliliter compared to those in whom the man's initial sperm concentration was less than 5 million sperm per milliliter (61% vs. 8%, respectively).

CONCLUSION(S): Our data demonstrate that, in couples in whom the man undergoes varicocelectomy for treatment of varicocele, close to 70% achieve a pregnancy. The initial sperm concentration is predictive of unassisted pregnancy outcome in this population.