Microsurgical Varicocelectomy Versus No Surgery in Men With a Palpable Varicocele and an Abnormal Semen Analysis

NCT ID: NCT00767338

Last Updated: 2013-07-02

Study Results

Results available

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Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

PHASE3

Total Enrollment

3 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-05-31

Study Completion Date

2011-11-30

Brief Summary

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The primary research hypothesis is that microsurgical varicocelectomy will result in an increase in live birth in infertile couples where the male partner has a palpable varicocele and an abnormal semen analysis in comparison to male partners who do not have microsurgical varicocelectomy.

The secondary hypotheses include:

1. To assess whether up to 4 cycles of intrauterine insemination confers any additional increase in live birth rates compared to timed intercourse;
2. To examine spousal pregnancy rate as the secondary outcome; and
3. To study the effect of varicocelectomy in men with infertility, an abnormal semen analysis, and a palpable varicocele on

* Testicular semen analysis parameters;
* Serological measures of FSH, LH, total and free testosterone and
* Measures of quality of life and sexual function in both partners.

Detailed Description

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Study Design

This will be a randomized controlled clinical trial to examine the effect of varicocelectomy in men with infertility, an abnormal semen analysis, and a palpable varicocele. This approach will allow us to compare (i) the effect of microsurgical varicocelectomy on live birth rates after up to four cycles of alternating intrauterine insemination and four cycles of timed intercourse over 8 months and (ii) the relative effectiveness of intrauterine insemination versus timed intercourse on live birth rates. Secondary analyses will explore the effect of the surgical intervention on pregnancy rates, semen analysis parameters, serological hormonal measures in the male subjects, and quality of life measures in both the male and female partners.

Treatment

Two hundred and thirty-two couples will be randomized to the two intervention groups (microsurgical varicocelectomy plus up to four cycles each of alternating intrauterine insemination and timed intercourse or no microsurgical varicocelectomy plus up to four cycles each of alternating intrauterine insemination and timed intercourse).

Timing

We anticipate that it will take 3 years to complete the study. Enrollment will begin in year 1 of the study. 34 couples will need to be recruited per site over the duration of the study to reach the enrollment goal of 232 couples. Participants will be enrolled in the study for one year, with the male partner undergoing periodic study assessments at two month intervals.

Conditions

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Pregnancy Infertility

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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No surgery + IUI

No microsurgical varicocelectomy plus up to four cycles each of alternating intrauterine insemination and timed intercourse starting with intrauterine insemination.

Group Type ACTIVE_COMPARATOR

Timed intercourse

Intervention Type BEHAVIORAL

Timed intercourse

Intrauterine insemination

Intervention Type PROCEDURE

Intrauterine insemination

No Surgery + TI

No microsurgical varicocelectomy plus up to four cycles each of alternating intrauterine insemination and timed intercourse starting with timed intercourse.

Group Type ACTIVE_COMPARATOR

Timed intercourse

Intervention Type BEHAVIORAL

Timed intercourse

Intrauterine insemination

Intervention Type PROCEDURE

Intrauterine insemination

Surgery + IUI

Microsurgical varicocelectomy plus up to four cycles each of alternating intrauterine insemination and timed intercourse starting with intrauterine insemination.

Group Type ACTIVE_COMPARATOR

Timed intercourse

Intervention Type BEHAVIORAL

Timed intercourse

Microsurgical varicocelectomy

Intervention Type PROCEDURE

Microsurgical varicocelectomy

Intrauterine insemination

Intervention Type PROCEDURE

Intrauterine insemination

Surgery + TI

Microsurgical varicocelectomy plus up to four cycles each of alternating intrauterine insemination and timed intercourse starting with timed intercourse.

Group Type ACTIVE_COMPARATOR

Timed intercourse

Intervention Type BEHAVIORAL

Timed intercourse

Microsurgical varicocelectomy

Intervention Type PROCEDURE

Microsurgical varicocelectomy

Intrauterine insemination

Intervention Type PROCEDURE

Intrauterine insemination

Interventions

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Timed intercourse

Timed intercourse

Intervention Type BEHAVIORAL

Microsurgical varicocelectomy

Microsurgical varicocelectomy

Intervention Type PROCEDURE

Intrauterine insemination

Intrauterine insemination

Intervention Type PROCEDURE

Other Intervention Names

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TI Surgery IUI

Eligibility Criteria

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Inclusion Criteria

* 6 months of infertility (primary or secondary - randomization will be stratified to allow equal numbers of primary and secondary infertility couples in the treatment vs. observation group), male partner \> 18 years of age and \< 50 years of age
* Female partner \> 18 years of age and \<= 40 years of age - randomization will be stratified for two groups - female partner \<35 and female partner \>=35
* Evidence of a hysterosalpingogram or Saline Infusion Sonogram with one patent tube and regular ovulatory cycles as defined by the recruiting site \>25 days and \<35 days in duration in the female partner
* Evidence of a bilateral grade I or unilateral grade II-III varicocele on physical exam in the male partner
* Abnormal semen analysis as defined by WHO II criteria with a sperm count of \>5 X106 /ml or the presence of abnormal strict morphology as defined by Kruger criteria.

Exclusion Criteria

* The presence of retrograde ejaculation or uncorrectable ejaculatory dysfunction
* Decreased ovarian reserve in the female partner as evidence by a day #3 FSH \> 12 mIU/ml
Minimum Eligible Age

18 Years

Maximum Eligible Age

50 Years

Eligible Sex

MALE

Accepts Healthy Volunteers

No

Sponsors

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Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

NIH

Sponsor Role collaborator

Penn State University

OTHER

Sponsor Role collaborator

University of Colorado, Denver

OTHER

Sponsor Role collaborator

University of Michigan

OTHER

Sponsor Role collaborator

University of Pennsylvania

OTHER

Sponsor Role collaborator

University of Texas

OTHER

Sponsor Role collaborator

University of Vermont

OTHER

Sponsor Role collaborator

Wayne State University

OTHER

Sponsor Role collaborator

Yale University

OTHER

Sponsor Role lead

Responsible Party

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Heping Zhang

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Esther Eisenberg, MD, MPH

Role: STUDY_DIRECTOR

Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

Nanette Santoro, MD

Role: STUDY_CHAIR

Albert Einstein College of Medicine

Gregory M Christman, MD

Role: PRINCIPAL_INVESTIGATOR

University of Michigan

Dana A Ohl, MD

Role: PRINCIPAL_INVESTIGATOR

University of Michigan

Richard Legro, MD

Role: STUDY_DIRECTOR

Pennsylvania State University College of Medicine

Robert Brzyski, MD, PhD

Role: STUDY_DIRECTOR

The University of Texas Health Science Center at San Antonio

Peter Casson, MD

Role: STUDY_DIRECTOR

University of Vermont

Michael Diamond, MD

Role: STUDY_DIRECTOR

Wayne State University

Heping Zhang, PhD

Role: STUDY_DIRECTOR

Yale University

Christos Coutifaris, MD

Role: STUDY_DIRECTOR

University of Pennsylvania

William D Schlaff, MD

Role: STUDY_DIRECTOR

University of Colorado Denver Health Science Center

Locations

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University of Colorado

Aurora, Colorado, United States

Site Status

Yale University

New Haven, Connecticut, United States

Site Status

University of Michigan

Ann Arbor, Michigan, United States

Site Status

Wayne State University

Detroit, Michigan, United States

Site Status

University of Medicine and Dentistry of New Jersey

Newark, New Jersey, United States

Site Status

Pennsylvania State University College of Medicine

Hershey, Pennsylvania, United States

Site Status

University of Pennsylvania

Philadelphia, Pennsylvania, United States

Site Status

University of Texas Health Science Center at San Antonio

San Antonio, Texas, United States

Site Status

University of Vermont

Burlington, Vermont, United States

Site Status

Countries

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United States

References

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Trussell JC, Christman GM, Ohl DA, Legro RS, Krawetz SA, Snyder PJ, Patrizio P, Polotsky AJ, Diamond MP, Casson PR, Coutifaris C, Barnhart K, Brzyski RG, Schlaff WD, Meacham R, Shin D, Thomas T, Zhang M, Santoro N, Eisenberg E, Zhang H; Reproductive Medicine Network. Recruitment challenges of a multicenter randomized controlled varicocelectomy trial. Fertil Steril. 2011 Dec;96(6):1299-305. doi: 10.1016/j.fertnstert.2011.10.025.

Reference Type DERIVED
PMID: 22130101 (View on PubMed)

Other Identifiers

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5U10HD055925-02

Identifier Type: NIH

Identifier Source: secondary_id

View Link

5U10HD055936

Identifier Type: NIH

Identifier Source: secondary_id

View Link

RMN-VIA

Identifier Type: -

Identifier Source: org_study_id

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