A recent study published in the journal, Fertility and Sterility, has provided new evidence that antegrade scrotal sclerotherapy, the minimally invasive surgical technique, substantially improves seminal parameters such as sperm morphology, count, and motility in varicocele patients, thereby increasing pregnancy rates.
Antonio Galfano and colleagues from the Urology Clinic, University of Padua, Italy, conducted the longitudinal non-comparative study to determine the effect of antegrade scrotal sclerotherapy on seminal parameters and pregnancy rates in 364 varicocele patients with seminal impairment. Among the study subjects, 45.3% (n=173) were disinterested in fertility and 52.5% (n=191) were infertile. The main outcomes considered included pregnancy rates following 12 months of treatment in infertile men and the improvement in sperm count, motility, and/or normal morphological forms.
The study results demonstrated the following:
• Persistent reflux occured in 45 (12.6%) cases even after 12 months of treatment
• Significant increase in sperm count from 12 x106 to 19.5×106 per milliliter in 188 (51.6%) low sperm count patients
• Improved progressive motile forms from 25% to 45% in 336 (92.3%) asthenospermic patients
• Increase in normal forms from 17% to 35% in 147 (40.4%) teratospermic patients
• Sixty-five (37.4%) infertile patients without persistent varicocele were able to conceive
• Higher sperm motility (46% vs. 35%) was noted in male partners of the women achieving pregnancy as opposed to the couples who did not conceive
The study concluded that the seminal parameters were significantly improved following antegrade scrotal sclerotherapy of internal spermatic veins.
Earlier, Poulakis, et al. (Asian Journal of Andrology, 2006) conducted a study to determine antegrade scrotal sclerotherapy outcomes, such as improvements in semen parameters and conception rate, on 47 varicocele patients with azoospermia or severe oligoteratoasthenospermia (OTA). Seminal parameters, such as the mean sperm concentration, morphology, and motility, were significantly improved in 74.5% of the patients after 24.8 ± 9.2 months follow-up, with higher values in severe OTA subjects. The study also showed that 29.8% of the patients successfully conceived. Following antegrade internal spermatic vein sclerotherapy, testicular dysfunction was reversed along with an increase in spermatogenesis in men with severe OTA and induction of sperm production in those with azoospermia, consequently improving pregnancy rate in sub-fertile couples. Based on the findings, it was concluded that the procedure is an effective therapeutic strategy for symptomatic varicocele.
In a similar study, Galfano, et al. (The Journal of Urology, 2008) evaluated the outcomes of antegrade scrotal sclerotherapy on 697 idiopathic varicocele patients. A significant improvement in the median sperm count and the median percent of progressive motility and normal forms was found in 414 men with seminal impairment (P<0.001). The researchers suggested antegrade scrotal sclerotherapy as the first-line treatment for varicocele in view of the low persistence and complication rates in all categories of patients (adolescents or adults, first diagnosis, bilateral, and recurrent disease).
The main objectives of varicocele treatment are to relieve pain in symptomatic patients and improve testicular function, semen parameters, and pregnancy rates in couples with male factor infertility. In addition to meeting the primary goals of varicocele repair, antegrade scrotal sclerotherapy offers several advantages such as shorter surgical time, lower complications and quicker recovery compared to open surgery. Although the best surgical option for varicocele treatment is debatable, this minimally invasive method serves as a simple and effective therapeutic strategy for varicocele.
References
1. Galfano A, Novara G, Iafrate M, et al. Improvement of seminal parameters and pregnancy rates after antegrade sclerotherapy of internal spermatic veins. Fertil Steril. 2009 Apr;91(4):1085-9. Epub 2008 Jul 21.
2. Poulakis V, Ferakis N, de Vries R, Witzsch U, Becht E. Induction of spermatogenesis in men with azoospermia or severe oligoteratoasthenospermia after antegrade internal spermatic vein sclerotherapy for the treatment of varicocele. Asian J Androl. 2006 Sep;8(5):613-9.
3. Galfano A, Novara G, Iafrate M, et al. Surgical outcomes after modified antegrade scrotal sclerotherapy: a prospective analysis of 700 consecutive patients with idiopathic varicocele. J Urol. 2008 May;179(5):1933-7.
