Male Infertility Varicocele Surgery

Why Men Should Choose Microsurgical Repair of Varicoceles Over Embolization

A varicocele is an abnormal dilation of veins draining the testicle.  Varicoceles are found in 15% of men in the general population and 40% of men presenting to fertility clinics for subfertility.  Varicoceles have been shown to decrease sperm production (counts), the ability of sperm to swim (motility), and the number of sperm with normal shapes (morphology) as well as increasing the percentage of sperm cells with DNA damage (sperm DNA fragmentation), which can all negatively impact a couple’s ability to get pregnant and maintain the pregnancy to term.  There are a number of options for treating varicoceles, but the primary decision is between a surgical repair or a percutaneous embolization.

Dr. Parviz Kavoussi performs surgical repairs of varicoceles through a 1 inch incision in the groin as a day surgery with a subinguinal, microsurgical technique (under microscopic magnification) which is advocated as the optimal treatment by the majority of fertility specialists and scientific data.  A percutaneous embolization can be performed by an interventional radiologist where metal coils or a sclerosing agent is placed within these dilated veins to occlude them under fluoroscopic (X-Ray) visualization.

The American Society for Reproductive Medicine’s committee report on varicoceles and infertility state that access to all the veins with embolization cannot be achieved in approximately 20% of varicocele embolization cases, leaving the varicocele untreatable or only partially treatable by embolization, due to technical problems.  This should never be a problem with a properly performed surgical technique.  The recurrence rate of varicoceles coming back after embolization is 15%, where it is 1% in a properly performed microsurgical subinguinal surgical repair in expert hands.

Read ASRM committee report on varicoceles

Dr. Kavoussi states, “It seems clear that with such a high rate of not being able to perform a complete embolization and such a high comparative recurrence rate, a microsurgical repair is a superior treatment for varicoceles in subfertile men.”