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Scientific Papers - Pre-treatment Sperm Motility Predicts Pregnancy after Embolization of Varicoceles in Infertile Man

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Sebastian Flacke MD  
Abstract Co-Author
Michael Schuster MD  
Attila Kovacs MD  
Holger Strunk MD  
Gerhard Haidl MD  
Hans Schild MD  
  CODE: SSK03-07
  SESSION: Vascular/Interventional (Embolization)
  Pre-treatment Sperm Motility Predicts Pregnancy after Embolization of Varicoceles in Infertile Man
  DATE: Wednesday, November 29 2006
  START TIME: 11:30 AM
  END TIME: 11:40 AM

  S.F. - Nothing to disclose.  
  M.S. - Nothing to disclose.  
  A.K. - Nothing to disclose.  
  H.S. - Nothing to disclose.  
  G.H. - Nothing to disclose.  
  H.S. - Nothing to disclose.  

To identify predictors of a pregnancy after embolization of varicoceles in infertile male patients
223 infertile men with otherwise healthy partners presenting with varicoceles associated with oligoasthenospermia were treated by endovascular embolization of their spermatic veins using distal coil embolization in combination with proximal sclerotherapy using aethoyxsclerol. Additional anti-inflammatory treatment and hormone substitution was initiated if required. Baseline clinical examination, semen specimens and hormone levels were compared to follow-up data. Post treatment pregnancy rate was assessed with a standardized questionnaire. Unconditioned logistic regression was used to identify factors among all available clinical and laboratory data predicting treatment success (reported pregnancy during 6 months follow-up).
226 of 228 varicoceles in 223 patients (age range 18-50) were successfully treated. Disappearance of varicoceles assessed by clinical examination and ultrasound was observed in 208 patients (93%). 3 months follow-up semen analysis of these patients showed a significant improvement in sperm motility (p <.0001) and sperm count (p<.0001) with the average values still in the pathological range according to WHO guidelines. 173 patient were eligible for follow up with a preganancy reported in 45 couples (26%). Baseline sperm motility was identified as the only significant pre-treatment factor (p<.023) predicting pregnancy. Hormon levels including Inhinbin-b and FSH, clinical grading, Doppler findings and other semen parameters according to the WHO criteria did not reach statistical significance.
Spermatic vein embolization combined with anti-inflammatory treatment improves sperm motiliy and sperm count in infertile men with varicoceles. Sperm motility prior to treatment is an important predictor of a pregnancy after successful embolization.
Sperm motility prior to invasive treatment of varicoceles in infertile men is an important predictor of success and should be considered if effects of embolization are compared to medical treatment.
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