We need a prospective varicocelectomy trial

Capsule:
Controversy exists whether varicocelectomy improves pregnancy rates in couples with male infertility.

Authors:
J. C. Trussell, M.D., Dana A. Ohl, M.D., Stephen A. Krawetz, Ph.D., Peter J. Snyder, M.D.,
Alex J. Polotsky, M.D., Pasquale Patrizio, M.D., M.B.E., Gregory M. Christman, M.D.

Volume 101, Issue 6, Pages 1563–1564.e1

Abstract:
Controversy exists whether varicocelectomy improves pregnancy rates in couples with male infertility. Unfortunately, the majority of data come from retrospective, poorly controlled studies (1), resulting in inadequate evidence regarding the efficacy of this procedure in improving semen quality (2, 3). In addition, results from randomized, controlled trials are conflicting and methodologically of poor quality because of heterogeneous inclusion criteria, limited enrollment, and high dropout rates.

  • Jason Kovac

    Very true… just hard to find supportive colleagues in the obstetrical community to support this philosophy.

  • I cannot agree with Dr Balmori’s comment more. While few level 1 evidence exists for male fertility treatment, the safety of ART is beginning to be questions. A small but significant number of potentially deadly medical conditions can only be diagnosed by proper evaluation and not semen analysis alone. Taking the words from a wise mentor: “bypass male infertility evaluation can be a fatal error”

  • Carlos Balmori

    Congratulations for spreading the initiatives that will lead to more researches on male fertility problems.
    We must insist on the male’s initial evaluation before initiating treatments with IUI/IVF and to keep them from visiting to the urologist only when treatments fail.

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