Treating Varicoceles may Not Improve Fertility Rates in Men: Study

A recent review of studies from the Netherlands finds no evidence that treating varicoceles, a somewhat common condition in men with fertility problems, improves a couple’s chances of conceiving a baby.

However, a U.S. commentator questions the review’s study selection and the way it defines infertility.

Fertility experts have long thought that varicoceles, an enlarged group of veins within the scrotum, could be a cause of male fertility problems. Varicoceles occur in 15 percent of all men, and in nearly 40 percent of men undergoing infertility treatment.

Surgery or embolization, a procedure that blocks blood supply to the varicoceles, is often performed in an effort to increase fertility.

“Every year thousands of men are operated on without sufficient scientific evidence that the surgery will have any impact,” said Johannes Evers, the lead review author. “There have been dozens of observational studies published showing a positive effect. However, high-quality, randomized trials were not able to confirm these positive conclusions.”

The review included eight studies involving 607 men. In addition to the presence of a varicocele, study authors looked at other fertility indicators such as quantity and quality of the man’s semen. Pregnancy and live birth were the main outcomes measured. Treatment was either by surgical removal of the varicocele or embolization, where a surgeon inserts a small coil or scarring agent into the vein to block it off.

“This review fails to offer evidence that treatment of varicoceles in men from couples with otherwise unexplained subfertility improves the couple’s chances of pregnancy,” Evers said. “Treatment of varicoceles in men cannot be recommended. The ‘first, do no harm’ principal should guide us as long as there is no evidence to the contrary.”