Department of Urology, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
Department of Urology, University Vita-Salute San Raffaele, Milan, Italy.
Int Braz J Urol. 2014 Jan-Feb;40(1):62-6. doi: 10.1590/S1677-5538.IBJU.2014.01.09.
To study the effect of high grade varicocele treatment in infertile patients.
Seventy-five patients were selected by the following criteria: infertility persisting for more than 1 year; abnormal semen parameters; no other infertility-related disease; no obvious causes of infertility in the subject's partner; basal eco-color Doppler ultrasound demonstrating continuous reflux in the spermatic vein. All patients considered for the study had at least a six months period from the diagnosis to the surgery due to waiting list, choice of the patient or time needed to complete diagnostic evaluation of the couple. The surgical procedure was performed through an inguinal approach. All enrolled patients were counseled to have unprotected intercourse during the ovulation period in order to maximize the probability of pregnancy within the 6-month preoperative period. The achievement of pregnancy and semen parameters were recorded during the preoperative and postoperative period.
Two of the seventy-five patients were excluded because of persistent varicocele after surgery. The preoperative pregnancy rate was 1.3% (1 couple). The postoperative pregnancy rate was 42.5%. The stratification of pregnancies by semester showed a significantly higher rate in the first postoperative period (p = 0.0012). Mean time to conception was 13.5 months. Mean preoperative sperm count was 17.6x10(6)/mL compared to 19.7x10(6)/mL in the postoperative period (p < 0.0001). Mean percentage of progressive sperm motility was 13.7%, compared to 17.6% in the postoperative period (p < 0.0001). Mean percentage of normal sperm morphology was 7.6%, compared to 15.2% postoperatively (p < 0.0001).
Surgical treatment of high grade varicocele proved to effectively treat associa¬ted infertility by improving seminal parameters and pregnancy rate in our patient cohort.
研究治疗精索静脉曲张的效果。
通过以下标准选择 75 名患者：不孕持续 1 年以上；精液参数异常；患者的伴侣没有其他不孕相关疾病；患者没有明显的不孕原因；基础生态彩色多普勒超声显示精索静脉持续反流。所有符合研究条件的患者都需要至少 6 个月的时间从诊断到手术，因为等待名单、患者选择或完成夫妻诊断评估所需的时间。手术通过腹股沟入路进行。所有入组患者均接受咨询，在排卵期间进行无保护性交，以最大限度地提高术前 6 个月内怀孕的概率。记录术前和术后的妊娠和精液参数。
由于术后精索静脉曲张持续存在，75 名患者中有 2 名被排除在外。术前妊娠率为 1.3%（1 对夫妇）。术后妊娠率为 42.5%。妊娠学期分层显示术后第一个时期的妊娠率明显更高（p = 0.0012）。受孕时间平均为 13.5 个月。术前平均精子计数为 17.6x10（6）/mL，术后为 19.7x10（6）/mL（p < 0.0001）。前向运动精子的平均百分比为 13.7%，术后为 17.6%（p < 0.0001）。正常精子形态的平均百分比为 7.6%，术后为 15.2%（p < 0.0001）。
在我们的患者队列中，精索静脉曲张的手术治疗通过改善精液参数和妊娠率，有效地治疗了相关的不育症。
