Population Health Analysis of Fertility and Offspring Outcomes in Patients Undergoing Varicocele Embolization Versus Varicocelectomy

Varicocele embolization and varicocelectomy are often performed in an effort to improve male-cause infertility.  The purpose of this work is to assess fertility rates and health outcomes of offspring born to patients with varicocele treated with varicocele embolization versus varicocelectomy versus no intervention.

Materials and Methods: IBM MarketScan Commercial Claims and Encounters database (2007-2016) was queried to find patients with a diagnosis of varicocele who underwent varicocele embolization, varicocelectomy, or no intervention.  Patients were further stratified according to ICD diagnosis of infertility.  The number of subsequent children born to each patient was calculated, and ICD diagnosis codes for offspring were examined to assess health outcomes.

Results: Within the database we identified 257,245 patients with varicocele who underwent no treatment, 20,573 who underwent varicocelectomy, and 473 patients who underwent varicocele embolization. Of these patient groups, 8.5, 26.7, and 17.5% carried a diagnosis of infertility, respectively.  45% of nonprocedural varicocele patients who carried a diagnosis of infertility had one or more children, whereas 41% of nonprocedural varicocele patients without a diagnosis of infertility had one or more children. 17% of varicocele embolization patients with a diagnosis of infertility had one or more children.  27% of varicocelectomy patients with a diagnosis of infertility had one or more children.  The children of these patients had incidence of diagnostic codes for intrauterine growth restriction (IUGR), autism, congenital abnormalities, or prematurity as summarized in Table 1, which was not statistically different between groups using Kruskal-Wallis test (p = 0.083).


Conclusion: In a large population health analysis, patients with varicocele who underwent treatment of varicocele with either embolization or surgery had lower fertility rates than patients with varicoceles who did not undergo treatment.  Children of patients with varicocele and infertility were not statistically different with regards to rates of IUGR, autism, congenital abnormalities, or prematurity regardless of treatment.