Interactive Session - Varicocele—If and When to Treat

Date:October 21, 2014

Time:1:15 pm - 2:15 pm

Location:HCC318 - Hawaii Convention Center

Presenters

James H. Segars, M.D. (Chair), National Institute of Child Health and Human Development

Daniel H. Williams, M.D., University of Wisconsin School of Medicine and Public Health, Madison

Edward Kim, M.D., University of Tennessee Graduate School of Medicine

Margareta Pisarska, M.D., Cedars Sinai Los Angeles


(Alternate Panel –Letterman)

Needs Assessment and Description
Varicoceles are commonly encountered in men, both incidentally and in men seeking fertility care. Evidence and indications regarding possible benefits of varicocele ligation in men can be confusing to patients and practitioners. The evidence is conflicting and opinions differ, especially regarding whether ligation can result in an increased likelihood of pregnancy. This symposium for urologists and allied health-care professionals will examine this controversy using an interactive and dynamic “no holds barred” talk show–host format to provide participants with the latest information regarding treatment of men with varicoceles in order to properly counsel couples on this topic. 

Learning Objectives
At the conclusion of this session, participants should be able to: 

  1. Summarize the evidence regarding treatment of the male with varicocele who is pursuing fertility treatment. 
  2. Identify modifiable semen parameters with varicocele treatment. 

ACGME Competency
Patient Care 

TEST QUESTION
A couple presents with 2 years of infertility. Evaluation of the female reveals no abnormality. Evaluation of the male discloses normal levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone. A semen analysis (repeated) confirms a count of 20 million/ mL and motility of 39%, with 12% normal forms by World Health Organization (WHO) criteria. A grade 3 varicocele is detected on the left, and a grade 1 is present on the right side. The patient’s urologist recommends varicocele ligation. After participating in this session, in my practice I will advise this man that the following is MOST likely to be improved as a result of the varicocele ligation:
a. Sperm concentration
b. Sperm motility
c. Sperm oxidative stress (DNA fragmentation assay)
d. Likelihood of pregnancy
e. Likelihood of live birth
f. Not applicable to my area of practice

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