RSNA: Sperm Motility Predicts Fertility After Vein Embolization

CHICAGO, Nov. 29 -- When sperm motility is only minimally impaired by varicoceles, spermatic vein embolization may improve fertility, German researchers reported here.

Although the technical success rate was 99% in a study of 223 men who had the embolization, it was pre-treatment motility that proved to be the significant predictor of successful pregnancy, said Sebastian Flacke, M.D., of the University of Bonn.

One hundred and seventy-three men were followed for two years after the procedure and 45 reported that they were able to impregnate their partners, resulted in live births, Dr. Flacke said at the Radiological Society of North America meeting.

The men, all of whom had varicoceles associated with oligoasthenospermia, were treated from 1998 to 2004 with endovascular embolization of their spermatic veins using distal coil embolization in combination with proximal sclerotherapy using aethoxysclerol. The mean age of the men was 34 (range 21 to 50).

Prior to the procedure them men had hormonal and semen analysis. Less than 10% of the men had low testosterone levels.

The semen analysis prior to treatment revealed that none of the men had normally shaped sperm and 213 of the men had subnormal sperm counts or sperm motility.

There were 228 varicoceles, of which 226 were successfully treatment by embolization.

One treatment failure was in a man who had previously been treated with surgery and a second case in which the spermatic vein could not be located, Dr. Flacke said.

Following the procedure, sperm count and sperm motility improved significantly (P<0.001 for both compared with baseline), he said.

Sperm motility prior to procedure was significantly associated with successful pregnancy (P=0.006) as was post procedure sperm count (P=0.03).

On the basis of these results, Dr. Flacke said that he now advises men who have very impaired sperm motility prior to embolization "that this procedure is unlikely to improve fertility."

David M. Hovsepian, M.D., of Washington University in St. Louis, commented that previous studies have been unable to confirm improved fertility following embolization because "those studies typically did not differentiate between men who underwent embolization for treatment of pain associated with varicoceles from those who had infertility associated with varicoceles."

He said the study by Dr. Flacke provided the first clear-cut evidence of a fertility benefit.

But he noted that in the United States, embolization is normally done without the use of a sclerosing agent because of concerns about the potential for such agents to leak into the testes "and possibly cause even greater damage to sperm."