Simple Procedure Improves Male Fertility
THURSDAY July 24, 2008 -- A simple, minimally invasive procedure can treat a common cause of male infertility and improve a couple's chances of having a baby, a new study finds.
The condition, called varicocele, is a network of tangled blood vessels in the scrotum which prevents the normal circulation of blood through the veins in the testicles. A minimally invasive radiological procedure called embolization can, in most cases, correct the problem.
"Using the embolization of varicoceles, we were able to improve factors related to infertility, especially sperm count and sperm motility," said lead researcher Dr. Sebastian Flacke, an associate professor of radiology at Tufts University School of Medicine in Boston.
In embolization, a small catheter is inserted into the groin and, using X-ray guidance, is placed in the varicocele. Once the catheter is placed, a tiny platinum coil and a few milliliters of an agent to ensure the closure of the gonadic vein are also inserted.
The minimally invasive procedure has a short recovery time; most patients go home the next day.
Varicoceles are very common, Flacke noted. In fact, about 20 percent of all men have them. Not all of these cause infertility or need to be treated, he said. The problem is usually treated if it causes pain, shrinkage or fertility problems.
"If you're dealing with infertility and have varicoceles -- this should be treated," Flacke said. By improving sperm count, the treatment could also be valuable in situations where the woman is having problems conceiving, he added.
"Most of the time, infertility is on both the male and female side," Flacke said. "Most of the time females get treated first if there is an issue, and men are neglected. I think you could boost the performance of the sperm if a varicocele is present and treated."
Flacke noted that the success rate of the treatment is very high. More than 95 percent of the time the procedure corrects the problem.
The report is published in the August issue of Radiology.
For the study, Flacke's team collected data on 223 infertile men with at least one varicose vein. All the men had healthy partners with whom they wanted to have a baby.
Flacke's group used embolization to successfully relieve 226 of the 228 varicose veins among the men. Three months after the procedure, the researchers analyzed the sperm of 173 patients. The analysis showed, on average, that sperm motility and sperm count had significantly improved.
After six months, 45 couples (26 percent) reported a pregnancy. "That's a very large number for a simple procedure," Flacke said.
Infertility expert Dr. Hossein Sadeghi-Nejad, an associate professor of urology at UMDNJ New Jersey Medical School and Hackensack University Medical Center, thinks this procedure can be useful even if it is not the preferred one.
Sadeghi-Nejad noted that, as a rule, infertility treatment begins with a woman. "The fact is that a male factor is responsible for infertility in about half of the cases," he said. "Varicoceles are one example of the male factor that can affect fertility."
If you do treat varicoceles properly, you do get improvement in sperm counts and pregnancy rates, Sadeghi-Nejad said.
However, there are drawbacks to embolization, Sadeghi-Nejad added. These include a steep learning curve to get used to doing the procedure and the danger of prolonged or misdirected radiation, especially if there are varicoceles on both sides of the scrotum.
"I recommend, in experienced hands, a microsurgical varicocelectomy, which is a very quick operation with minimal time off work," Sadeghi-Nejad said. "The patient is back to work in two or three days."
For more on infertility, visit the U.S. National Library of Medicine.
Posted: July 2008
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