Natural history of varicocele management in the era of intracytoplasmic sperm injection

Objective: To evaluate the outcomes of infertile couples with varicocele. Design: Retrospective study. Setting: University infertility clinic. Patient(s): Six hundred ten consecutive infertile couples in whom the man was found to have a clinical varicocele. Intervention(s): Microsurgical varicocelectomy and assisted reproductive technologies (ARTs; intrauterine insemination and intracytoplasmic sperm injection). Main Outcome Measure(s): Clinical characteristics, pregnancy rates, and ART utilization in two subgroups of couples (those who elected to undergo varicocelectomy and those who did not). Result(s): Sixty percent of the Couples (363/610) opted for varicocele repair. The surgical and nonsurgical groups had comparable ages-and duration of infertility. However, sperm concentration and motility were significantly lower in the surgical group, compared with in the observation one. As well, the surgical group had a significantly higher prevalence of primary infertility (80% vs. 71%) and had significantly smaller testicles bilaterally. Utilization of ART was significantly higher in the observation group compared with the surgical group (54% vs. 38%). Overall pregnancy rates (spontaneous + assisted pregnancies) in the observation and surgical group were not significantly different. Conclusion(s): This study suggests that men with poorer baseline characteristics are more likely to opt. for varicocele repair. Furthermore, couples electing not to repair the varicocele are more likely to undergo ART procedures to improve their chances of conception. (Fertil Steril (R) 2008;90:2251-6. (C) 2008 by American Society for Reproductive Medicine.)