polidocanol and Infertility--Male

To identify predictors of future pregnancy in partners of infertile men undergoing embolization of varicoceles.. This study was conducted within local institutional review board guidelines, and written informed consent was obtained. In 223 clinically infertile men (age range, 18-50 years) with varicoceles and associated oligoteratoasthenospermia, endovascular embolization of the spermatic veins was performed with distal coil embolization and sclerotherapy. Additional anti-inflammatory treatment was initiated if required. Baseline clinical examination, semen specimen, and hormone level findings were compared to follow-up data. Posttreatment pregnancy rate of their healthy female partners was assessed with a standardized questionnaire. Unconditioned logistic regression was used to identify factors among all available clinical and laboratory data predicting treatment success (sired pregnancy during follow-up).. A total of 226 of 228 varicoceles in 223 patients were successfully treated. Resolution of varicoceles at clinical examination and ultrasonography (US) was observed in 206 patients (92.4%). Three-month follow-up semen analysis in these patients showed significant improvement in sperm motility (P < .001) and sperm count (P < .001); however, average values remained in the abnormal range (World Health Organization guidelines). In 173 patients, follow-up data were successfully obtained, with pregnancy reported in 45 (26%). Baseline sperm motility was identified as the only significant pretreatment factor (standardized regression coefficient beta = 3.285, t = 7.560, P = .006) predicting sired pregnancy. Hormone levels, clinical grading of varicoceles, Doppler US findings, and other semen parameters did not reach statistical significance.. Sperm motility prior to varicocele treatment in infertile men is an important predictor of later pregnancy.

Topics: Adolescent; Adult; Contrast Media; Embolization, Therapeutic; Female; Humans; Infertility, Male; Logistic Models; Male; Middle Aged; Phlebography; Polidocanol; Polyethylene Glycols; Predictive Value of Tests; Pregnancy; Radiography, Interventional; Sclerosing Solutions; Sperm Count; Sperm Motility; Statistics, Nonparametric; Varicocele

Idiopathic varicocele is nowadays accepted as a "social disease" for both its high incidence among young men and its affecting male fertility. Screening is thus required for young people and, above all, early and definitive treatment. We have evaluated the effectiveness of percutaneous sclerotherapy, which has become a standard procedure, in spite of its recent introduction in interventional radiology. One hundred and thirty-nine percutaneous occlusions were performed on 147 patients with varicocele using a sclerosing agent--polidocanol--and stainless steel coils. The failure rate of percutaneous treatment was about 12%. Complications never required hospitalization or surgery; recurrence rate is 3.66%. The patients were followed 3, 6, 12 and 24 months by US and Doppler to survey recurrences, and sperm analysis to estimate the clinical results of percutaneous therapy in infertile patients. Statistical analysis with linear regression of data from spermiograms showed constant improvement in sperm count, sperm motility percentage, and sperm morphology percentage. Fertility index improvement was similar to that of surgical ligation. The radiation dose received by the patient is negligible. Percutaneous therapy represent thus the treatment of choice in case of varicocele: compared with surgery, it offers similar clinical results and a lower recurrence rate, and it can be performed on an outpatient basis. Surgery should be performed only when anatomic variants make percutaneous treatment not feasible.

Topics: Adolescent; Adult; Aged; Catheterization, Peripheral; Child; Embolization, Therapeutic; Evaluation Studies as Topic; Femoral Vein; Humans; Infertility, Male; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Radiography; Recurrence; Sclerosing Solutions; Testis; Ultrasonography; Varicocele

The results of the treatment of 251 patients with varicocele are demonstrated. By means of spermiographic and histologic investigations the fertility-disturbing influence of this vascular disease of the testis shall be proved and the effect of the operative sanation shall be estimated. For many years the high ligature of the testicular vein has been favoured method of operation; since 1984 exclusively the percutaneous transfemoral occlusion of the testicular vein has been performed, when a left-sided varicocele is present. In 61% of the patients examined an improvement of the spermiogram is to be proved, in which case the most conspicuous rate of increase lies at the motility of spermatozoa with 58%. After removal if the varicocele the investigations of the testicular tissue reveal in 42% of the cases an improvement of the findings by decrease of the tubular atrophy and increase of the tubular cell number. Among the number of our patients the rate of conception is 49%. The treatment of varicocele is a fertility-protective measure and therefore should be performed in all adolescents and males at fertile age.

Topics: Adolescent; Adult; Aged; Biopsy; Child; Humans; Infertility, Male; Male; Middle Aged; Polidocanol; Polyethylene Glycols; Sperm Count; Sperm Motility; Spermatogenesis; Testis; Varicocele