Microsurgical varicocelectomy in the era of assisted reproductive technology: influence of initial semen quality on pregnancy rates

Objective: To evaluate the natural history of infertile couples in whom the man underwent varicocelectomy. Design: Retrospective study. Setting: University infertility clinic. Patient(s): 159 infertile couples. Intervention(s): Microsurgical varicocelectomy. Main Outcome Measures(s): Standard semen parameters and pregnancy rates (assisted and unassisted). Result(s): Postoperative sperm concentration and motility increased significantly compared to before the varicocelectomy (28.9 +/- 3.0 vs. 22.5 +/- 2.1 X 10(6)/mL and 33.9 +/- 1.9 vs. 22.1 +/- 1.3%, respectively). Overall, 48% (76/159) of the couples achieved a spontaneous pregnancy at the mean of 30 months' follow-up. An additional 10% (16/159) and 11% (18/159) of couples achieved a pregnancy following intrauterine insemination and in vitro fertilization/intracytoplasmic sperm injection, respectively. Significantly higher spontaneous pregnancy rates were observed in couples in whom the man's initial sperm concentration was greater than or equal to 5 million sperm per milliliter compared to those in whom the man's initial sperm concentration was less than 5 million sperm per milliliter (61% vs. 8%, respectively). Conclusion(s): Our data demonstrate that, in couples in whom the man undergoes varicocelectomy for treatment of varicocele, close to 70% achieve a pregnancy. The initial sperm concentration is predictive of unassisted pregnancy outcome in this population. (Fertil Steril(R) 2001;75:1013-6. (C) 2001 by American Society for Reproductive Medicine.).