A Comparative Study to Assess the Effect of Testicular Vein Ligation Followed by Six Months Course of Clomiphene Citrate and Testicular Vein Ligation Alone in Patients Presenting With Infertility and Varicocoele

Abstract

BACKGROUNDInfertility 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.Financial or Other, Competing Interest: None.