| | PURPOSE |
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To identify predictors of a pregnancy after embolization of varicoceles in infertile male patients
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| | METHOD AND MATERIALS |
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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).
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| | RESULTS |
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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.
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| | CONCLUSION |
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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.
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| | CLINICAL RELEVANCE/APPLICATION |
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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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