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Un procedimiento simple no-invasivo permtie tratar una causa corriente de esterilidad masculina, como es el varicocele. Este problema consiste en la existencia de una densa red de vasos sanguíneos, dilatados en forma de varices, en el escroto y produce aumento de la temperatura testicular. El nuevo procedimiento terapéutico se llama embolización y tiene por objetivo normalizar la irrigación del testículo.

El tratamiento se realiza bajo control radiológico y al cabo de un tiempo aumenta la producción de espermatozoides y el porcentaje de formas móviles. El Dr. Sebastian Flacke, de la Universidad de Bonn, usa una técnica introduciendo un catéter por la ingle y coloca un pequeño tapón de platino para obstruir la vena gonadal. El tratamiento es especialmente útil cuando no hay otra causa de esterilidad. Flacke consigue una tasa de éxitos del 95%.

Department of Radiology, University of Bonn Medical School, Bonn, Germany.

PURPOSE: To identify predictors of future pregnancy in partners of infertile men undergoing embolization of varicoceles. MATERIALS AND METHODS: This study was conducted within local institutional review board guidelines, and written informed consent was obtained. In 223 clinically infertile men (age range, 18-50 years) with varicoceles and associated oligoteratoasthenospermia, endovascular embolization of the spermatic veins was performed with distal coil embolization and sclerotherapy. Additional anti-inflammatory treatment was initiated if required. Baseline clinical examination, semen specimen, and hormone level findings were compared to follow-up data. Posttreatment pregnancy rate of their healthy female partners was assessed with a standardized questionnaire. Unconditioned logistic regression was used to identify factors among all available clinical and laboratory data predicting treatment success (sired pregnancy during follow-up). RESULTS: A total of 226 of 228 varicoceles in 223 patients were successfully treated. Resolution of varicoceles at clinical examination and ultrasonography (US) was observed in 206 patients (92.4%). Three-month follow-up semen analysis in these patients showed significant improvement in sperm motility (P < .001) and sperm count (P < .001); however, average values remained in the abnormal range (World Health Organization guidelines). In 173 patients, follow-up data were successfully obtained, with pregnancy reported in 45 (26%). Baseline sperm motility was identified as the only significant pretreatment factor (standardized regression coefficient beta = 3.285, t = 7.560, P = .006) predicting sired pregnancy. Hormone levels, clinical grading of varicoceles, Doppler US findings, and other semen parameters did not reach statistical significance. CONCLUSION: Sperm motility prior to varicocele treatment in infertile men is an important predictor of later pregnancy.