Does treatment of a varicocele in subfertile men result in more spontaneous pregnancies?

Varicocele is a physical abnormality present in 10-15% of the adult male population. It is more common in men of infertile marriages, affecting 25-30% of those with abnormal semen analysis. The exact association between reduced male fertility and varicocele is unknown, but analysis of the WHO data clearly indicates that varicocele is related to semen abnormalities, decreased testicular volume and decline in Leydig cell function. Five prospective randomised studies of varicocele treatment in adults gave conflicting results, the largest of them indicating benefit (WHO-study, Hargreave et.al.).



We perform a prospective randomised trial on varicocele treatment in oligospermic men, comparing treatment to watchful waiting. 130 couples with an infertility duration of at least 1 year, are to be randomised for treatment or no treatment. All varicoceles will be confirmed by ultrasound investigation of the scrotum. Men with no other abnormalities than a varicocele and a subnormal sperm count according to the WHO-guidelines for semen analysis are included, excluding men with azoospermia. After 1 year of follow-up the couples can choose for either artificial reproductive techniques or (delayed) varicocele repair.

Early treatment of a clinical varicocele in subfertile men results in more spontaneaous pregnancies as compared to no treatment.

1. Primary outcome: 1 year;

2. Secondary outcome: 3 and 6 months.

The treatment group wil have a varicocele repair by surgery or embolisation with a follow-up of 1 year. The controls will have no treatment and a follow-up of 1 year.