Хотя данное иследование похоже не было рандомизированным, я все же позволю себе его привести как достаточно свежее.
Int J Urol 2002 Aug;9(8):455-61
Clinical study of varicocele: Statistical analysis and the results of long-term follow-up.
Onozawa M, Endo F, Suetomi T, Takeshima H, Akaza H.
Department of Urology, Institute of Clinical Medicine, University of Tsukuba, Tsukuba City, Japan.
BACKGROUND: The results of clinical examinations of varicocele and the clinical outcome of varicocelectomy conducted at Tsukuba University Hospital, Tsukuba City, Japan were analyzed. METHODS: The subjects of the present study were sixty-four infertile male patients with varicocele who visited our hospital from 1991to 1999. A physical examination, semen analysis and hormonal evaluation were performed for each patient. Patients selected their preferred type of treatment (varicocelectomy or conservative treatment) after providing their informed
consent. RESULTS: The age of the patients was 34.1 +/- 5.1(mean +/- standard deviation [s.d.]) years, and the infertile duration was 4.2 +/- 3.0 (mean +/- s.d.) years. Fifty-one cases were left-sided; 13 were bilateral. Mean sperm density ( yen 106/mL) was 37.2 for Grade I, 21.3 for Grade II and 9.4 for Grade
III. Sperm density was significantly lower in the higher-graded patients (P = 0.008). Varicocelectomy was performed in 31 cases; the postoperative/preoperative ratio of sperm density was significantly higher in the higher-graded varicocele (P = 0.04), and the peak/base ratio of follicle-stimulating hormone (FSH) after luteinizing hormone-releasing hormone (LH-RH) stimulation was significantly decreased after varicocelectomy (P = 0.007). The pregnancy rate in the partners of the varicocelectomized group (60%) was significantly higher than in the conservatively treated group (28%) P = 0.04; the mean follow-up duration was 76.2 months. CONCLUSION: These results show that varicocele should influence spermatogenesis, therefore altered spermatogenesis could be effectively treated by varicocelectomy, and varicocelectomy should induce a higher probability of pregnancy.
Еще одно исследование опять же к сожалению ретроспективное. однако достаточно убедительное.
Fertil Steril 2001 May;75(5):1013-6
Microsurgical varicocelectomy in the era of assisted reproductive technology: influence of initial semen quality on pregnancy rates.
Kamal KM, Jarvi K, Zini A.
Division of Urology, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
OBJECTIVE: To evaluate the natural history of infertile couples in whom the man underwent varicocelectomy. DESIGN: Retrospective study. SETTING: University infertility clinic. PATIENT(S): 159 infertile couples. INTERVENTION(S): Microsurgical varicocelectomy. MAIN OUTCOME MEASURE(S): Standard semen
parameters and pregnancy rates (assisted and unassisted). RESULT(S): Postoperative sperm concentration and motility increased significantly compared to before the varicocelectomy (28.9 +/- 3.0 vs. 22.5 +/- 2.1 x 10(6)/mL and 33.9 +/- 1.9 vs. 22.1 +/- 1.3%, respectively). Overall, 48% (76/159) of the couples
achieved a spontaneous pregnancy at the mean of 30 months' follow-up. An additional 10% (16/159) and 11% (18/159) of couples achieved a pregnancy following intrauterine insemination and in vitro fertilization/intracytoplasmic sperm injection, respectively. Significantly higher spontaneous pregnancy rates
were observed in couples in whom the man's initial sperm concentration was greater than or equal to 5 million sperm per milliliter compared to those in whom the man's initial sperm concentration was less than 5 million sperm per milliliter (61% vs. 8%, respectively). CONCLUSION(S): Our data demonstrate that,
in couples in whom the man undergoes varicocelectomy for treatment of varicocele, close to 70% achieve a pregnancy. The initial sperm concentration is predictive of unassisted pregnancy outcome in this population.
Я еще раз хочу подчернуть, чтно ни в литературе (Medline search и мн. др.) ни по данным моих обширных личных контактов и последних съездов и симпозиумов по теме я никогда не встречал информации о том, что варикоцелэктомия не влияет на увеличение частоты беременностей в бесплодных парах. Еще раз, Борис Александрович, убедительно прошу Вас указать мне источник, откуда была взята Ваша информация.
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