Improved fertility after varicocele correction: fact or fiction?

Fertility after varicocele correction by embolization of the vena spermatica in 62 subjects was compared with fertility in an untreated group (n = 20) of subjects with varicocele. One year after varicocele correction of infertile males with oligozoospermia, asthenozoospermia, or teratozoospermia but normal follicle-stimulating hormone levels, 15 of 62 had achieved a pregnancy; in the untreated group, 8 had achieved a pregnancy. Comparison of results by cumulative pregnancy rate analysis reveals that the pregnancy rate was only marginally higher in the treated group. Varicocele correction induced only a modest improvement of sperm quality; the severity of varicocele had no influence either on sperm characteristics or on the outcome of treatment. It is concluded that the effects of varicocele correction on the pregnancy rate can be seriously doubted and that large-scale prospective studies are urgently required to determine whether or not varicocele correction improves the pregnancy rate and which subjects could eventually benefit from the treatment.