CHICAGO - Men who have maintained relatively high sperm motility despite the development of varicoceles may improve fertility by undergoing spermatic vein embolization, according to a team of German interventional radiologists.
Lead author Dr. Sebastian Flacke, an assistant professor of radiology at the University of Bonn in Germany, reported the results Tuesday at the 2006 RSNA meeting.
Flacke cautioned, however, that embolization is unlikely to improve fertility for men who have very low sperm motility prior to treatment.
He said that when counseling men prior to embolization, he now routinely advises men with very low sperm counts that "embolization is unlikely to improve their fertility." "These men and their partners usually are referred for IVF," he added.
The relationship between pretreatment sperm motility and post-treatment fertility emerged from a study of 223 men who underwent endovascular embolization of their spermatic veins using distal coil embolization in combination with proximal sclerotherapy using aethoyxsklerol. The men, all of whom had varicoceles associated with oligoasthenospermia, were treated from 1998 to 2004. The mean age of the men was 34 (range 21 to 50).
All men underwent extensive pretreatment assessment including analysis of hormone levels and sperm analysis. Less than 10% of the men had low testosterone levels, Flacke said.
The semen analysis prior to treatment revealed that none of the men had normal-shaped sperm and 213 of the men had subnormal sperm counts or sperm motility.
Treatment was technically successful in 99% of the patients, and clinically successful -- no evidence of varicoceles on post-treatment Doppler ultrasound -- in 92% of the patients.
Treatment failure occurred in a man who had previously been treated with surgery and in a second case in which the researchers "were unable to locate the spermatic vein," Dr. Flacke said.
Following the procedure, sperm count and sperm motility improved significantly
(p < 0.001 for both compared with baseline), he said.
The group was able to follow up 173 men for two years, and of these patients, "45 reported that they were able to impregnate their partners, and those pregnancies resulted in live births," Flacke said.
Sperm motility prior to procedure was significantly associated (p = 0.006) with successful pregnancy, as was postprocedure sperm count (p = 0.03).
Dr. David Hovsepian, an associate professor at Washington University in St. Louis, said that previous studies have been unable to confirm improved fertility following embolization because "those studies typically did not differentiate between men who underwent embolization for treatment of pain associated with varicoceles from those who had infertility associated with varicoceles."
Flacke's study provided the first clear-cut evidence of a fertility benefit, he said.
But Hovsepian noted that in the U.S., embolization is normally done without the use of a sclerosing agent because of concerns about the potential for such agents to leak into the testes and "possibly cause even greater damage to sperm."
By M. Mary Conroy
AuntMinnie.com contributing writer
November 29, 2006
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