Varicoceles are abnormally enlarged veins in the scrotum. The condition can cause testicles to shrink and soften. As many as 16 percent of men have this type of varicose vein, which is a common cause of low sperm count. In fact, about 40 percent of men who are infertile have varicoceles, with the traditional treatment being surgery. Why the condition can cause fertility problems in men remains unknown.
Retrograde venous embolization (RVE) is a procedure done with a tiny catheter that works by blocking excessive blood flow into the veins and allowing them to shrink back to their normal size. During the procedure, a radiologist inserts a small catheter through a small incision in the groin and uses an imaging tool to guide it to the affected right or left-sided varicocele. There is a minimal recovery time and according to researchers, most patients can return to work the next day.
Dr. Sebastian Flacke from the University of Bonn Medical School in Germany led the study of infertile men aged 18-50 with at least one varicocele. All of the men had healthy partners who were trying to become pregnant. There was a total of 228 varicoceles in the 223 men who underwent the RVE procedure. Of them, 226 varicoceles were successfully treated while clinical and ultrasound testing revealed that the varicocele was totally resolved in 92.4 percent of patients (206 participants). The procedure significantly improved both sperm count and their ability to move spontaneously and actively (motility), yet the averages were still abnormally low according to the World Health Organization guidelines.
Of all the potential pre-treatment predictors of pregnancy such as varicocele severity, hormone levels, ultrasound findings, and other semen parameters, the researchers found that the only significant predictor was sperm movement.
In follow-up data on pregnancy in partners for 173 of the men, 45 couples or 26 percent, reported a pregnancy with five of them assisted by intrauterine insemination.
The study findings indicate that RVE does improve semen quality, resulting in pregnancy about one-third of the time, which prompted the authors to conclude that fertility benefits seen with this procedure are "similar to those reported after surgical repair," and refer to the treatment as a "useful adjunct to in vitro fertilization therapy."
The authors acknowledged several limitations of the study which included the absence of a control group, the lack of further assessment and grading of female infertility in women without proven infertility, and the relatively short observation period for treatment success. The study and its findings appear in the August issue of Radiology.