Live Birth Rates After Varicocele Embolization in Patients After Failed In Vitro Fertilization With Intracytoplasmic Sperm Injection.

BACKGROUND AND OBJECTIVES: While in vitro fertilization with intracytoplasmic sperm injection (IVF-ICSI) bypasses abnormalities in sperm concentration, motility, and morphology, it still has a significant failure rate. We report our experience on the effect of varicocele embolization (VE) on couples with varicocele related primary male factor infertility in whom IVF/ICSI failed to result in a live birth (LB). MATERIAL AND METHODS: This single center retrospective cohort study documents 42 couples who had failed to have a LB after single or multiple IVF/ICSI cycles and in whom the male partner subsequently had left or bilateral varicoceles treated by transcatheter embolization. Other inclusion criteria were maternal age of 35 or less at the time of VE and at least 24 months follow up after embolization. The end point was LB by natural conception or by IVF-ICSI. Pre-procedure data was documented at the time of referral for varicocele embolization. Images of the procedures were reviewed, and post VE data was collected by telephone questionnaire from one of the partners. RESULTS: Prior to varicocele embolization, the 42 couples had undergone 151 oocyte retrievals (median 2, range 1-21) and 200 embryo transfers (median 3, range 1-26) with no LB. During a median follow up period of 54 months (range 25-111) following VE, there were 60 LB (65 children) amongst 36 of the 42 couples (86%). Thirty-four couples underwent a total of 119 oocyte retrievals and 149 embryo transfer procedures with 28 achieving 36 LB (41 children). Fifteen couples had 23 LB (23 children) from natural conceptions. One couple had an LB after intrauterine insemination. CONCLUSION: VE in this challenging patient population may treat varicocele associated sperm function problems not addressed by ICSI and could be beneficial before assisted reproductive techniques in varicocele related male factor infertility.