Medical Device Daily

CHICAGO — A primary cause of infertility in males is not only easily correctable, it can significantly improve a couple’s chances for pregnancy, according to Sebastian Flacke, MD, assistant professor of radiology at the University of Bonn in Germany, who presented his findings at the Radiological Society of North America (RSNA; Oak Brook, Illinois) annual meeting ongoing here through Friday.

The study also identified the level of sperm motility prior to treatment as a key predictor of a successful pregnancy.

“We found that spermatic vein embolization combined with anti-inflammatory treatment improves sperm motility and sperm count in infertile men with varioceles,” Flacke said. “Six months after treatment, 26% of couples had achieved a pregnancy.”

Varioceles occur when a series of one-way valves that prevent blood from flowing backward to the testicles become defective, which according to the National Institutes of Health, most often occurs in men between the ages of 15 and 25. Normally, blood flows to the testicles and returns to the heart via a network of tiny veins, but when those veins’ valves become defective, it results in varioceles.

Instead, the blood that does not flow out of the testicles forms a network of tangled blood vessels in the scrotum, which is called a variocele, or varicose vein. According to Flacke, this can also “impair sperm barometers,” traditionally thought to be the result of the warm blood pooling in the vein and therefore affecting sperm counts and motility. Flacke said that sperm motility is the most important factor in achieving pregnancy.

However, “there are men with varioceles whose sperm production is not affected.”

Traditionally, open surgery has been the treatment of choice for varioceles. But more recently, variocele embolization has gained favor as a minimally-invasive outpatient option.

In the procedure, an interventional radiologist inserts a small catheter through a cut in the skin at the groin and uses X-ray guidance to steer it into the variocele. A platinum coil and a few milliliters of an “alcohol-based sclerosing agent” are used to ensure the occlusion of the troubled vein area then inserted through the catheter.

According to Flacke, when this vein is occluded, “the surrounding veins take over” and normal blood flow is regained through those surrounding veins.

In Flacke’s study, which included men who tried to conceive for two or more years, 223 men were included, ages 21-50, all of whom had at least one variocele. The study included men in couples who had tried to conceive but failed, however, their female partners did not exhibit fertility problems.

The purpose of the study, Flacke said, was to “identify predictors of a later pregnancy.”

In the study, 208 of the patients’ 226 varioceles were successfully treated with embolization. Flacke and his colleagues also evaluated patients for a number of factors that might have affected fertility. For example, anti-inflammatory treatment and hormone substitution was initiated if hormone levels were found to be low.

Flacke said this resulted in a 92% clinical success rate, with one-third of the patients and their partners achieving pregnancy after long-term treatment.

The study also involved 189 of 223 patients, or 85%, with 645 post-therapeutic consultations, he said.

“Only motility was predicted for later pregnancy,” he said, noting that other factors possibly prohibiting pregnancy were ruled out.

Also, there were “no major complications” in the study, Flacke said.

“This study confirms that variocele repair can significantly improve sperm count and motility,” Flacke said.

In other RSNA news:

In what could be called a new twist on the slogan “milk does a body good,” radiologists are testing use of the dairy staple as a contrast agent in gastrointestinal imaging exams — with excellent results.

“We are able to achieve similar bowel distension and enhancement as we see with the commonly used contrast agent, VoLumen,” said Lisa Shah-Patel, MD, a radiology resident at St. Luke’s-Roosevelt Hospital (New York). “In addition, we found that patients are more willing to drink milk because it is part of their daily lives, and they know what to expect.”

Computed tomography (CT) imaging of the gastrointestinal tract is often done for abdominal pain. When the condition calls for visualization of the small intestinal wall, a negative oral contrast agent should be used. VoLumen is a barium-based oral contrast agent that works with intravenous contrast to allow better visualization of the bowel wall and clearer delineation between the bowel cavity and soft tissue.

When milk is used, the milk-filled intestinal cavity appears dark, while the intestinal wall appears bright due to intravenous contrast enhancement. The dark intestinal cavity contrasting with the bright intestinal wall makes any evidence of disease on the bowel wall more visible.

The researchers studied 179 adult patients undergoing CT with oral and intravenous contrast for abdominal discomfort to compare cost effectiveness and patient tolerance for whole milk vs. VoLumen. Sixty-two patients received VoLumen, and 117 received milk. Of the 57 VoLumen patients who completed a subsequent questionnaire, 24 (42%) experienced abdominal discomfort such as cramps, diarrhea and nausea, while only 27 (23%) of the 117 patients who received milk reported abdominal discomfort.

Overall, milk was found to be just as effective as VoLumen in bowel distension (expansion) and bowel-wall conspicuity (enhancement).

One important difference is the price. VoLumen costs $18 per patient, while whole milk costs $1.39 per patient.

“There are several advantages to milk. Patients are more willing to drink milk than VoLumen, and it costs a fraction of the price,” Shah-Patel said. “We hope that substituting milk for other contrast agents will reduce the number of people who refuse imaging tests because they do not want to drink the oral contrast, especially children.”

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