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INTRODUCTION

Bilateral microsurgical varicocele repair versus the non-surgical approach for male-factor infertility is associated with a higher pregnancy rate and lower ART utilization. INTRODUCTION. VARICOCELE. Most common identifiable pathology in infertile men.

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INTRODUCTION

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  1. Bilateral microsurgical varicocele repair versus the non-surgical approach for male-factor infertility is associated with a higher pregnancy rate and lower ART utilization

  2. INTRODUCTION

  3. VARICOCELE • Most common identifiable pathology in infertile men. • Affects 35% - 40% of men presenting for infertility evaluation.

  4. Management of male-factor infertility with clinical varicocele and abnormal semen parameters: • Varicocele repair • Assisted Reproductive Technologies (ARTs) • Intrauterine Insemination (IUI) • In Vitro Fertilization with Intracytoplasmic Sperm Injection (IVF/ICSI) • Observation

  5. OBJECTIVES • Assess pregnancy outcomes of two cohorts of infertile men with bilateral varicoceles: • Bilateral varicocelectomy • No surgery

  6. METHODS

  7. Retrospective review of 610 consecutive infertile couples with clinical varicoceles. • All men had: • one year or more of infertility • bilateral clinically palpable varicocele (examined by same investigator – AZ) • abnormal semen parameters • Couples with subclinical or unilateral clinical varicoceles, tubal obstruction or ovulatory failure excluded.

  8. Couples counseled about treatment options (observation, varicocelectomy & ARTs) • All microsurgical varicocelectomies performed by same surgeon (AZ).

  9. Outcome measures: • Pregnancy rates (natural and assisted) • Changes in semen parameters • Utilization of ARTs

  10. RESULTS

  11. Total of 610 consecutive infertile men with a clinical varicocele • 238 (39%) infertile men with bilateral clinical varicoceles • 157 (66%) chose bilateral varicocelectomy • Surgical (SUR) group • 81 (34%) men chose not to have surgery • Non-surgical (NON-SUR) group.

  12. MEAN (±SD) BASELINE CLINICAL PARAMETERS

  13. MEAN (±SD) BASELINE CLINICAL PARAMETERS

  14. MEAN (± SD) SUR GROUP SEMEN PARAMETERS

  15. Pregnancy outcome and ART utilization data available for: • 67.5% (106/157) of SUR group • 64% (52/81) of NON-SUR group.

  16. MEAN (±SD) BASELINE CLINICAL PARAMETERS IN COUPLES WITH PREGNANCY OUTCOME DATA

  17. PREGNANCY & ART UTILIZATION RATES IN COUPLES WITH PREGNANCY OUTCOME DATA

  18. CONCLUSIONS

  19. Bilateral varicocele repair, when compared to non-surgical management, was associated with: • Significant improvements in semen parameters • Significant increase in natural pregnancy rate • Significantly less overall ART utilization

  20. For bilateral clinical varicoceles, microsurgical repair is a favourable option for treating couples with male factor infertility.

  21. THANK YOU

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