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Controlled trial of high spermatic vein ligation for varicocele in infertile men
I Madgar1, R Weissenberg, B Lunenfeld
1Sheba Medical Center, Tel Hashomer, Israel.
Insights
High ligation effectively treats male infertility caused by varicocele. Surgical correction improves sperm parameters and significantly increases pregnancy rates within the first year post-operation.
Area of Science:
- Urology
- Reproductive Medicine
- Surgical Innovation
Background:
- Varicocele is a common cause of male infertility.
- Reduced testicular function is associated with varicocele.
- The effectiveness of high ligation for varicocele-related infertility requires further investigation.
Purpose of the Study:
- To evaluate high ligation as a treatment for infertile men with clinical varicocele.
- To determine the impact of high ligation on semen parameters and pregnancy rates.
Main Methods:
- A randomized controlled trial was conducted over 3 years.
- Participants included infertile men with varicocele as the sole identified cause.
- High spermatic vein ligation was performed either at the study's start or after one year.
Main Results:
- Pregnancy rates significantly increased after high ligation, particularly within the first year.
- Semen parameters showed significant improvement post-surgery in both groups.
- The difference in pregnancy rates between early and delayed surgery was highly significant.
Conclusions:
- High ligation is an effective treatment for infertility in men with varicocele.
- Varicocele correction improves testicular function and fertility.
- Optimal pregnancy rates are observed within the first year following surgical intervention.
Objective:
To determine whether high ligation is an effective treatment for infertile men with clinical varicocele.
Design:
A randomized, controlled trial of high spermatic vein ligation was carried out. The patients were treated and observed for 3 years.
Setting:
Infertility treatment clinic and andrology laboratory in a hospital.
Patients:
Infertile men with abnormal semen analysis because of varicocele only.
Intervention:
High ligation 1 year postrecruitment (group A) and at the beginning of the study (group B).
Results:
Among the 20 couples in group A, 2 pregnancies (10%) were achieved within the 1st year of observation period. During the year after high ligation, there were 8 pregnancies (44.4%), and during the 2nd year after high ligation, there were 4 more pregnancies (22.2%). In group B, 15 pregnancies (60%) occurred within the 1st year after operation. Three pregnancies (12%) and 1 pregnancy (4%) occurred during the 2nd and 3rd year, respectively. After operation in all patients of both groups, there was significant improvement in semen parameters, regardless of pregnancy occurrence. The difference in pregnancy rate (PR) between the operated group B and nonoperated group A during the 1st year of study was found to be highly significant.
Conclusions:
It is concluded that in a population of infertile men presenting varicocele as the only demonstrable factor of infertility, the varicocele is clearly associated with infertility and reduced testicular function, and its correction by ligation improves sperm parameters and fertility rate. Furthermore, the highest PR in both groups occurred during the 1st year postoperation.