Vein treatment may have little effect on fertility

About 40% of men with low sperm counts have varicoceles, an enlargement of the veins within the scrotum, and many of them seek treatment in hopes of improving their chances of having a child. The treatment, however, may not have much effect.

A survey of studies comparing pregnancy rates of couples in which men had the condition repaired with those who had no treatment found little evidence that treatment is effective.

Some fertility experts believe that the enlarged veins increase the temperature within the scrotum, impairing sperm production. However, since some men with varicoceles do have normal sperm counts, questions have been raised about whether the condition really leads to infertility. When researchers at the University of Maastricht in the Netherlands and McMaster University in Hamilton, Canada, combined the results from seven randomized studies, they found a 22% pregnancy rate among the 281 couples in which the man had the veins closed with surgery or embolization, in which a tissue adhesive closes off the enlarged vessels. There was a 19% pregnancy rate when men had no treatment. Only one small trial showed a significant benefit.

According to the American Urological Assn., reduced sperm counts or sperm motility or both improve in about 60% of men who have varicocele repair, but the effects on fertility are not clear.

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-- Dianne Partie Lange