We reviewed the records of 81 consecutive subfertile men with
oligospermia and/or asthenospermia, treated for
varicocele with either percutaneous embolization or surgical
ligation between 1987 and 1991, and compared the outcomes and costs of the two procedures. All men had presented with
infertility of at least 6 months duration, and in most cases female factors had been previously evaluated and treated. Patients were offered a choice of embolization or
ligation of the internal spermatic vein. Forty-five men (56%) underwent
ligation, and 36 men (44%) opted for embolization. The mean age, serum
follicle-stimulating hormone, pretreatment sperm density, motility, and concentration of motile sperm were similar for the two groups. Seminal quality improved in 65% of all patients after
varicocele ablation (46 of 71). Improvements were seen in postoperative sperm density (P < 0.01), motility (P < 0.002), and concentration of motile sperm (P < 0.001). Thirty-nine percent of the assessable patients established pregnancies during the study interval (26 of 66). The two treatment groups did not differ significantly with regard to the likelihood of postoperative improvement in sperm density (P = 0.64), motility (P = 0.33), concentration of motile sperm (P = 0.11), or pregnancy rate (P = 0.83). Percutaneous embolization and surgical
ligation of
varicocele are equally effective in improving
male infertility and cost about the same. Embolization offers the potential advantage of shorter recovery to full activity as compared to surgical
ligation. Where experienced interventional radiologists are available, percutaneous embolization should be offered as an alternative to open
ligation.