In vitro fertilization rates after varicocele repair

Causal relationship of varicocele to infertility is controversial. Studies of hormonal milieu, semen and testicular tissue yield data of debatable significance. We herein assay the fertilizing ability of men with varicocele and monitor changes consequent to surgical correction of varicocele. Zona-free hamster ova were used to determine fertilizing ability. A fertilization rate of less than 10 per cent correlates with infertility. Between May 1978 and November 1979, 75 men with varicocele presenting for fertility evaluation and 23 men with painful varicocele were tested. Of the patients infertile clinically and by in vitro fertilization assay 42 elected ligation of the internal spermatic vein(s). Average fertilization rate of the painful varicocele group was 20.5 per cent and for the infertile group it was 1.2 per cent. Average fertilization rates postoperatively in the infertile group were 2.9 per cent (3 months), 7.7 per cent (6 months), 2.8 per cent (9 months), 7.8 per cent (12 months), 17.5 per cent (15 months) and 8.0 per cent (18 months). Pregnancies occurred only in partners of men whose fertilization rates were between 2.9 and 8.3 per cent preoperatively and who improved to greater than 10 per cent postoperatively. The in vitro fertilization assay may help select those individuals with varicocele and infertility most likely to benefit from varicocele repair.