New male infertility guidelines – are some men missing out?

This study assessed new guidelines for diagnosing infertility, and whether this may exclude men who could benefit from vein removal surgery (varicocelectomy). 

Enlargement of the veins within the testes is a common cause of infertility in men. It is easily treated and surgical removal of the vein has been shown to improve the quality of semen and increase pregnancy rates. However, under new 2010 guidelines for diagnosing infertility, some men may be denied surgical vein repair because their sperm readings are considered “normal”.

This study examined 445 infertile men who were diagnosed according to the old guidelines (before 2010). A diagnosis of infertility was made based on 1) the presence of enlarged veins that could be felt under the skin and 2) low sperm readings.

The definition of low sperm readings has changed since the guidelines were updated in 2010. For example, the definition of infertility used to be less than 20 million sperm per milliliter. The new guidelines state that a patient should have less than 15 million sperm per milliliter, meaning there are significant differences between the new and old guidelines.

This study found that 13% of these infertile men (56 men) would actually be classified as having normal sperm if they were assessed under the new guidelines used today. In these 56 men, those who underwent surgical vein removal had a 56% increase in the number of sperm. Pregnancy rates were also slightly higher following surgery.

The authors conclude that, under the new diagnosis guidelines many men may be denied potentially beneficial vein removal surgery. 

Vein removal did not improve all aspects of sperm quality. Sperm motility (the ability of the sperm to move) or semen volume was not significantly increased. This could be due to the small study size (<56 men). 

If considering testicular vein removal for infertility, talk to your doctor about the potential benefits.