NEW YORK (Reuters Health) - Despite its widespread use, varicocele repair does not appear to be an effective treatment for male infertility, according to a report published in the May 31st issue of The Lancet.

The finding is based on an analysis of data from seven randomized controlled trials that evaluated the effectiveness of varicocele repair for male infertility. In 281 couples, the male partner underwent varicocele repair and in 259 couples the male partner did not.

Sixty-one pregnancies occurred in the treated group and 50 occurred in the control group, study authors Dr. Johannes L. H. Evers, from the University of Maastricht in the Netherlands, and Dr. John A. Collins, from McMaster University in Hamilton, Canada, note. The likelihood of pregnancy was not significantly different between the groups.

On subgroup analysis, the researchers found no evidence that varicocele repair was effective in men with clinical varicocele, subclinical varicocele, or in men with normal semen analysis. Still, the number of men in each subgroup was small and, therefore, the ability to detect a significant difference may have been limited, the authors note.

Based on these findings, "routinely treating varicocele in men from subfertile couples seems ill-advised, especially if undertaken outside the context of a properly done randomized trial," the investigators conclude.

"At best, varicocele treatment is marginally effective in a selected groups of oligozoospermic men," Dr. Allan Templeton, from the University of Aberdeen in the UK, notes in a related editorial. "At worst, as some studies suggest, it does more harm than good."

Lancet. 2003 May 31;361(9372):1849-52

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