Haris C. H1 , Sathish Kumar G2 , Jatin Soni 3 , Shanky Singh 4 , Vaibhav Vikas 5
BACKGROUND Infertility still remains a medical problem where a totally effective treatment remains distant. Approximately 8-12 % (60-80 million) of couples is infertile (WHO estimates).1 Idiopathic male factor infertility accounts for 25% of these cases Male fertility is affected by a number of factors including varicocele, testicular failure, endocrine dysfunction, genital tract infection, testicular disturbances, testicular cancer, hormonal disturbances, retrograde ejaculation, prolonged exposure to heat, obesity, older age, smoking, alcohol, heavy metals, pesticides, oxidative stress, genetic factors and different environmental and nutritional factors. Varicocoele causes 35% of primary and 75% of secondary male infertility and is the most common surgically correctable disorder of male infertility. Testicular vein ligation (TVL) is recommended in men with clinically evident varicocele and sub-fertile semen. TVL can improve semen quality and prevent testicular growth retardation. Apart from surgical correction, many medical management regimes are under trial. Clomiphene citrate is an orally active nonsteroidal agent related to diethylstilbestrol that has been tried independently, combined with other drugs and along with surgical correction, with varying outcomes. It significantly increases the motility percentage and normal morphology of sperms. MATERIALS AND METHODS In this study conducted at Govt. Medical College, Thiruvananthapuram, 45 patients were included during the period March 2016 to March 2017. Patients with male factor infertility, clear abnormalities in semen parameters (according to WHO criteria) and having clinical varicocoele of varying grades were included in the study. Cases were randomized into two groups; one group (23 patients) underwent bilateral TVL (sub inguinal approach) alone; and second group (22 patients) b/l TVL plus a course of clomiphene citrate for a period of six months. Semen analysis was done after six months. The change in seminal parameters was compared and analyzed statistically. RESULTS In this study, we could observe no significant difference / improvement in seminal parameters by adding clomiphene citrate to TVL compared to TVL alone Observations were statistically not significant as the sample size was not adequate. The pregnancy rate in each arm could not be studied as the follow up was short. Pregnancy rate need not always correlate with seminal parameters. Further studies will be required to authenticate our observation. CONCLUSION There is no added advantage in adding clomiphene citrate to testicular vein ligation surgery in male infertility patients with varicocele.
