The outcomes measured include postoperative changes in semen parameters, pregnancy rates (assisted and unassisted) and use of assisted reproductive technology (intrauterine insemination and in vitro fertilization with intracytoplasmic sperm injection). The groups were comparable with respect to male and female ages, and baseline semen parameters. In each group there was significant improvement of semen parameters after varicocelectomy. However, the improvement in percent motility was significantly greater in the bilateral compared to the unilateral group (8.0% ± 1.7% compared to 4.4% ± 1.5% (p less than 0.01) and the spontaneous pregnancy rate was significantly higher in the bilateral compared to the unilateral group (49% vs. 36%, respectively, p less than 0.05). There was no difference in success after assisted reproductive technology was employed. The authors conclude that both unilateral and bilateral varicoceles affect spermatogenesis. However there is a greater effect of bilateral varicoceles demonstrating a dose effect.

Editorial Comment
It is important to recognize that this is an uncontrolled retrospective study. However, it does again demonstrate the effectiveness of varicocelectomy in improving spermatogenesis and improving spontaneous pregnancy rates. Although, the authors believe that the fact that there is a greater improvement when bilateral varicoceles are repaired when compared to unilateral demonstrates a "dose effect" of varicoceles on spermatogenesis. If this were the case one would expect that the semen parameters of patients with bilateral varicoceles would be worse than those of men with unilateral varicoceles. This, in fact, was not the case. This study reinforces the importance of identifying patients with bilateral varicoceles and repairing them. It is also important to note that the patients in this study had clinical varicoceles. These findings do not justify bilateral varicocelectomy unless the varicoceles are clinically apparent.

Libman J, Jarvi K, Lo K, Zini A

Journal of Urology Volume 176(6), 2602-2605

Written by Harris M. Nagler, MD, a Contributing Editor with UroToday.

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