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RECOVERY FROM INTERVENTIONAL TREATMENT FOR MALE INFERTILITY FAR EASIER THAN SURGERY; SUCCESS IS AS GOOD ORLANDO, Fla. -- A minimally invasive technique to treat a common cause of male infertility is as successful as the surgical alternative, while recovery takes one-sixth the time, according to a study presented here today at the 24th Annual Scientific Meeting of the Society of Cardiovascular & Interventional Radiology (SCVIR).
About 15 percent of American men are born with varicoceles, varicose veins in the scrotum that in some cases can lead to reduced sperm production and groin pain. At least 40 percent of men evaluated for infertility have varicoceles. The current standard of care is surgery, which involves making an incision near the scrotum and tying off the swollen, twisted veins. An alternative performed by interventional radiologists called varicocele embolization involves making a tiny nick in the neck or at the top of the leg and advancing a tiny tube, or catheter, to the affected vein. A liquid and tiny stainless steel plugs are released through the catheter into the vein to block it off. Embolization affects only one of the three sets of veins that move blood away from the testicles.
"In our study, men who had embolization took only 1 or 2 days off work, versus an average of 6 days for those who have the surgery," said Lindsay Machan, M.D., the Joachim Burhenne Scholar in Abdominal Rad
The procedure is available at hospitals throughout the United States and Canada.
Embolization is an outpatient procedure performed with local anesthesia, while surgery may require a one-night hospital stay and usually is performed while the patient is under general anesthesia.
In the University of British Columbia study, 64 veins were embolized in 45 men. Including the day of the procedure, the patients missed an average of 1.78 days of work, and it took an average of 4.5 days to resume full activity, including sports.
Dr. Machan notes the success rates for surgery and embolization are virtually identical: about 85 percent of men treated surgically or with embolization experience improved sperm counts and approximately 45 percent with fertile partners eventually achieve pregnancy.
Recurrence of the problem is more likely after the surgical procedure. While 12 percent to 16 percent of men who have standard open surgery experience a recurrence of the problem, less than 1 percent of men who have embolization have a recurrence. Typically, that's because not all of the veins have been tied off, according to Dr. Machan -- a rare occurrence during embolization, because interventional radiologists use moving X-rays (fluoroscopy) as they're performing the procedure to see which veins are causing the problem and use both liquid and metal plugs to block blood flow to the veins.
Varicoceles, or varicose veins, are caused by a weakness in the wall of the vein which is present at birth, and which causes a backwards flow of blood. Varicoceles are suspected of leading to infertility because the veins cause the temperature in the testicles to rise too high for optimal sperm production, said Dr. Machan.
Co-authors of a paper on the topic being presented by Dr. Machan are: Amir Neyestani, B.Sc.; John Masterson, M.D.; and Mark Nigro, M.D.
An estimated 5,000 people are attending the Annual Scientific Meeting in Orlando, Fla., of SCVIR, a professional society based in Fairfax, Va., for physicians who specialize in minimally invasive interventional procedures.
An interventional radiologist is a physician who has special training to diagnose and treat illness using miniature tools and imaging guidance. Typically, the interventional radiologist performs procedures through a very small nick in the skin, about the size of a pencil tip. Interventional radiology treatments are generally easier for the patient than surgery because they involve no surgical incisions, less pain and shorter hospital stays.
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Copies of 1999 SCVIR news releases are available online at www.pcipr.com/scvir beginning Monday, March 22.
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