O'Brien Jeanne H, Bowles Ben, Kamal Khaled M, Jarvi Keith, Zini Armand
Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
J Androl. 2004 Nov-Dec;25(6):939-43. doi: 10.1002/j.1939-4640.2004.tb03165.x.
Varicocele represents the most common cause of male infertility, and most reports indicate that varicocelectomy has a beneficial effect on male fertility and pregnancy outcome. Assisted reproductive technologies (ARTs) are an alternative to varicocelectomy for the management of couples with a varicocele. The age of the female partner is important in the decision-making process; however, the true influence of female age on pregnancy outcome following varicocelectomy or ART in these couples is unknown. We evaluated the outcomes of 2 cohorts of infertile men with a varicocele and a female partner 35 years of age or older; one group selected varicocelectomy and the other a nonsurgical approach. We reviewed a group of consecutive infertile men who underwent microsurgical varicocelectomy and whose partners are 35 years of age or older (n = 110). We also reviewed a consecutive group of men with varicoceles who elected not to have surgery and whose partners are 35 years of age or older (n = 94). The outcome measures included changes in semen parameters, pregnancy rates (assisted and unassisted), and use of ART. The surgical and nonsurgical groups had comparable semen parameters and female ages. Mean sperm concentration and motility increased significantly after varicocelectomy (P < .05). At a mean of 30 months follow-up, 35% of couples in the surgical group achieved a spontaneous pregnancy and an additional 6% achieved a pregnancy via ART (20% of this group attempted ART). In the nonsurgical group, 25% achieved a spontaneous pregnancy and an additional 16% achieved a pregnancy with ART (40% of this group attempted ART). This study on the natural history of infertile men with varicocele and advanced female age suggests that the surgical and nonsurgical approaches offer comparable pregnancy outcome (combined assisted and unassisted pregnancy rates are about 40%). Overall, these data suggest that varicocelectomy is an acceptable option for couples with advanced female age, but other female factors must be considered in the decision-making process.
精索静脉曲张是男性不育最常见的原因，大多数报告表明精索静脉结扎术对男性生育能力和妊娠结局有有益影响。辅助生殖技术（ART）是治疗患有精索静脉曲张夫妇的一种替代精索静脉结扎术的方法。女性伴侣的年龄在决策过程中很重要；然而，女性年龄对这些夫妇进行精索静脉结扎术或ART后妊娠结局的真正影响尚不清楚。我们评估了两组患有精索静脉曲张且女性伴侣年龄在35岁及以上的不育男性的结局；一组选择精索静脉结扎术，另一组选择非手术方法。我们回顾了一组连续接受显微外科精索静脉结扎术且其伴侣年龄在35岁及以上的不育男性（n = 110）。我们还回顾了一组连续的患有精索静脉曲张且选择不进行手术且其伴侣年龄在35岁及以上的男性（n = 94）。结局指标包括精液参数的变化、妊娠率（辅助和非辅助）以及ART的使用情况。手术组和非手术组的精液参数和女性年龄具有可比性。精索静脉结扎术后平均精子浓度和活力显著增加（P <.05）。平均随访30个月时，手术组35%的夫妇实现了自然妊娠，另有6%通过ART实现了妊娠（该组20%尝试了ART）。在非手术组中，25%实现了自然妊娠，另有16%通过ART实现了妊娠（该组40%尝试了ART）。这项关于患有精索静脉曲张和高龄女性的不育男性自然病史的研究表明，手术和非手术方法提供了相当的妊娠结局（辅助和非辅助妊娠率合并约为40%）。总体而言，这些数据表明精索静脉结扎术对于高龄女性夫妇是一个可接受的选择，但在决策过程中必须考虑其他女性因素。
