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Perspectives and Editorials: Letter to the Editor

Pregnancy Rate After Varicocele Repair: How Many Miscarriages?

Your journal has published a review by Çayan et al (2009) on varicocele repair in infertile men. The primary aim of varicocele treatment for subfertility is pregnancy, but no data about live birth rate were available for any of the studies analyzed. This gap has been pointed out by other reviews (Schlegel, 1997; Evers and Collins, 2003) and a search on PubMed, using varicocele (3727 titles) and miscarriage/abortion keywords, resulted in only 1 study (Lukkarinen et al, 1997) on 26 infertile men. These investigators declared 8 spontaneous pregnancies after varicocele repair, with 2 miscarriages. In an attempt to understand the miscarriage rate after varicocele repair, we have retrieved data on 389 infertile couples from our database (October 2005–January 2009; women, median age 34.5 years [range 19.1–41 years]; men, median age 36.5 years [range, 24.1–53.4 years]). All men had some semen anomaly and varicocele surgically corrected, while waiting for assisted reproductive procedures. Diagnosis of varicocele was based on clinical examination and on basal venous reflux in the upright position. All couples respected classic inclusion criteria for male and female pathologies. The follow-up (SE 18.9 ± 0.46 months [range, 9–40 months]) was conducted by chart review and telephone calls/e-mail. One hundred seventeen spontaneous pregnancies were achieved (30%). The spontaneous pregnancy rate results were significantly higher in women aged <35 years (74 of 207; 35.7%) than in women aged 35 years (43 of 182; 23.6%; Fisher's exact test, P = .01). Ten miscarriages (<12 weeks) out of 74 pregnancies (13.5%) were recorded in the younger group vs 8 out of 43 (18.6%) in the older group (NS). Therefore, the live birth rates after varicocele repair are 30.9% in women aged <35 years and 19.2% in women aged 35 years (P = .01). In conclusion, the miscarriage rate (<12 weeks) after varicocele repair is about 15%, very similar to that observed in the general population (Nybo Andersen et al, 2000). This should be taken into consideration in future reviews or meta-analyses dealing with varicocele repair outcome.

References

Çayan S, Shavakhabov S, Kadiolu A. Treatment of palpable varicocele in infertile men: a meta-analysis to define the best technique. J Androl. 2009; 30: 33 –40.[Abstract/Free Full Text]

Evers JL, Collins JA. Assessment of efficacy of varicocele repair for male subfertility: a systematic review. Lancet. 2003; 361: 1849 –1852.[CrossRef][Medline]

Lukkarinen O, Hellström P, Leinonen S, Juntunen K. Is varicocele treatment useful? Ann Chir Gynaecol. 1997; 86: 40 –44.[Medline]

Nybo Andersen AM, Wohlfahrt J, Christens P, Olsen J, Melbye M. Maternal age and fetal loss: population based register linkage study. BMJ. 2000;320: 1708 –1712.[Abstract/Free Full Text]

Schlegel PN. Is assisted reproduction the optimal treatment for varicocele-associated male infertility? A cost-effectiveness analysis. Urology. 1997;49: 83 –90.[CrossRef][Medline]

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