Surgical ligation vs. angiographic embolization of the vena spermatica: a prospective randomized study for the treatment of varicocele-related infertility

TLDR

Varicoceles are a common cause of male infertility and are treated either by surgical ligation or, more recently, by angiographic occlusion of the spermatic vein. In this prospective randomized study, 38 patients underwent surgical ligation while 33 received angiographic embolization. During 12 months of follow‑up both groups showed significant increases in sperm count and motility, unchanged morphology, and 22 pregnancies (31 %) were reported—29 % in the ligation group and 33 % in the embolization group—indicating equivalent efficacy and an outpatient advantage for embolization. Summary.

Abstract

Summary. Varicoceles as a common cause of male infertility are treated either by surgical ligation or, more recently, by angiographic occlusion of the spermatic vein. In the present prospective randomized study 38 patients were treated by surgical ligation and 33 by angiographic embolization. During the 12-month follow-up period a significant increase in sperm number (at 3 and 12 months) and sperm motility (at 12 months) occurred in both groups while sperm morphology remained unaffected. Altogether, 22 pregnancies (31%) were reported within the year following treatment, of which 11/38 (29%) occurred in the ligation group and 11/33 (33%) in the embolization group. Thus both treatment modalities appear equivalent, whereby embolization has the advantage that it can be performed on an outpatient basis.