Percutaneous Embolization Of Varicoceles: Outcomes And Correlation Of Semen Improvement With Pregnancy

G. Nabi, S. Asterlings, D. R. Greene, And R. L. Marsh

Objectives. To assess the technical feasibility and compare the semen quality in men with or without pregnancy after percutaneous embolization of varicoceles in the management of infertility.

Methods. The records of 102 patients who underwent retrograde varicocele embolization between January 1997 and January 2002 were reviewed through the Hospital Information Support System. Infertility was the indication for embolization in 71 cases. The present study consisted of this group of patients. The size of the varicoceles, the size of the testis, the pre-embolization semen analysis parameters, the technical details of embolization procedure, any anomalous vessels seen on venography, and, if unsuccessful, the reason for failure of the procedure were noted. A record of postembolization semen parameters (at least two) was made. Patients were divided into four groups depending on the pre-embolization semen density, and a correlation of this was assessed with improvements in morphology and motility. Follow-up was performed using a questionnaire to evaluate the success rate of the procedure, complications, and any treatment for infertility by the patient or his partner after the procedure. Patients who had a successful pregnancy were compared with those who did not tom determine the correlation between the changes in semen quality and pregnancy rate.

Results. Between January1997 and January 2002, 71 patients underwent retrograde varicocele embolization, using an embolizing coil, for infertility. In 68 (95.7%), it was technically successful. Nineteen patients (26.7%) had various anomalous vessels on venography. A statistically significant improvement (P  0.002) was noted in the motility parameters in patients with a pre-embolization semen density between 10 and 30 million/mL. All patients were followed up by questionnaire. Follow-up was possible in 51 patients (75%). One
patient had varicocele recurrence and underwent open inguinal surgical ligation. Of 45 patients, the partners of 18 (40%) had a successful pregnancy. A comparison of the postembolization semen quality between those with and without a successful pregnancy found no correlation between the changes in the semen parameters and the pregnancy rate.

Conclusions. Varicocele embolization is a technically feasible, minimally invasive, outpatient procedure that improves semen quality significantly in patients with a pre-embolization semen density of 10 to 30 million/ mL. However, no correlation was found between the improvements in semen quality and the pregnancy rate.