To Treat Or To Cure - IVF/ICSI Versus Varicocelectomy

Main Category: Fertility
Also Included In: Urology / Nephrology;  Pediatrics / Children's Health
Article Date: 26 Sep 2008 - 4:00 PST

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BERLIN, GERMANY (UroToday.com) - In 2003, nearly 3% of children born in Scandinavia and 1.7% of children born in France were conceived using intracytoplasmic sperm injection (ICSI). Unlike most therapeutic procedures used in medicine, assisted reproductive technologies (ARTs) never underwent rigorous safety testing before clinical use.

Dr Nagler emphasized that there may be unforeseen dangers associated with IVF/ICSI. These risks related to the reported incidence of increased congenital birth defects associated with IVF/ICSI as compared to natural conception. "Congenital Malformations in 4224 Children Conceived after IVF." Anthony et al., Human Reproduction, Vol. 17, No. 8, 2089-2095, August 2002. A little discussed increased incidence of risk of imprinting disorders in offspring conceived by IVF/ICSI was also discussed (Maher ER. "Imprinting and Assisted Reproductive Technology, Hum Mol Genet 2005;(14 Spec No 1): R133-8).

Additionally, there are increased risks associated with multiple order gestations. Multiple gestations, preterm labor and perinatal complications are also increased with IVF cycles. The data supporting the increased incidence of multiple order gestations since the advent of IVF, and paralleling the frequency of these procedures was presented. Along with this, the increased costs of multiple order gestations, as well as the increased infant mortality was presented. Chambers GM. Chapman MG. Grayson N. Shanahan M. Sullivan EA, Human Reproduction. 22(12):3108-15, 2007 Dec.

These issues were then compared with the effectiveness and low risks associated with varicocelectomy. Although the Cochrane reviewed failed to support the effectiveness of varicocelectomy, the contrary analysis of Ficarra V, Cerruto MA, Liguori G, et al. "Treatment of Varicocele in Subfertile Men: The Cochrane Review, a Contrary Opinion," Eur Urol, 2006;49(2):258-63.[53] was reviewed.

The cost effectiveness of varicoelectomy as compared to IVF/ICSI was presented against the backdrop of an index case.

Editorial Comment:

The value of IVF/ICSI cannot be underestimated. It has allowed many couples to become parents when they otherwise may not have been able to. Nevertheless, this technology must be employed judiciously. Therapies which are less costly and less risky should be employed when possible - prior to utilizing advanced reproductive technologies.

Presented by Harris M. Nagler, MD, at the Annual Meeting of the AUA - New York Section - September 6 - 13, 2008 - Berlin, Germany

Written by UroToday.com Contributing Editor Harris M. Nagler, MD

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