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Microsurgical repair of even subclinical Varicoceles improves Fertility in men

Microsurgical repair of even subclinical Varicoceles improves Fertility in men
Researchers have found that Microsurgical repair of even subclinical Varicoceles improves Fertility in men comparable to Clinical or palpable Varicoceles. The study has appeared in Urology. Usually subclinical or nonpalpable varicoceles is managed by observation due to their perceived minimal impact on fertility.
Varicoceles are the most common diagnosis in men questioning their fertility, their diagnosis and treatment can be confused by a complete dependence on the physical exam.
Dr.Nannan Thirumavalavan at Department of Urology, Baylor College of Medicine, Houston, Texas and associates have conducted a study to determine if subclinical varicocele repair produces semen analysis results of subfertile men in a clinically meaningful way similar to palpable varicocele repair.

The researchers performed a retrospective review on 190 infertile men who underwent a microsurgical varicocele repair by two surgeons from 2009 to 2017.  Varicoceles were diagnosed by both physical exam and ultrasound and subsequently classified as “palpable” or “subclinical.” Subclinical varicoceles were not readily palpable on physical examination and were further defined as possessing veins in excess of 3.0 mm of diameter with retrograde flow on Valsalva while standing.

The subjects were stratified into one of three categories based on their pre- and postoperative semen analysis parameters, as defined by their total motile count (TMC) and eligibility for specific assisted-reproductive technology (ART) procedures: IVF (<5 million TMC), IUI (5–9 million TMC), and natural pregnancy (>9 million TMC). Changes in category after varicocele repair were assessed and the proportion of men in each category with clinical varicoceles to those with subclinical varicoceles were compared.

It was found that after varicocelectomy, the entire cohort experienced a mean improvement in their TMC of 8.9 million. Out of total men who were preoperatively characterized as IVF-only candidates, 49% remained in this group, 13% were upgraded to IUI, and 38% were upgraded to a natural pregnancy. The differential between these two increases in TMC was not found to be statistically significant, whereas the rates of “upgrade” between men with palpable and subclinical varicoceles were similar.

The authors concluded that Men with subclinical varicoceles have similar, clinically meaningful improvement in total motile sperm count ( TMC0 after varicocele repair compared to men with palpable varicoceles. There was no difference between the groups for clinical improvement in terms of intrauterine insemination and natural pregnancy.

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Source: With inputs from Urology

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