Effect of Varicocele Treatment on Conventional Semen Analysis

Abstract

Varicocele is the most frequently identifiable and correctable cause of male infertility. Although impaired spermatogenesis induced by excess heat due to varicocele is the commonly proposed mechanism, the exact pathophysiology of male infertility caused by varicocele has not been completely clarified; thus, the optimal treatment for men with varicocele remains controversial in the field of clinical andrology. The recent advances in biomolecular and development of novel sperm functional tests allowed a better understanding of the mechanism involved in damage provoked by varicocele. Although varicocele repair has been commonly performed as a treatment for male infertility, there are conflicting findings regarding whether varicocelectomy restores fertility potential. Although the pregnancy rate might be the best parameter to validate the effect of male infertility treatment, its use as a primary outcome is not practical in all studies. Instead of pregnancy rate, semen parameter improvements can be considered an alternative for practical reasons. This chapter reviews the effect of varicocele repair on sperm motility, sperm concentration, in different degrees of clinical varicocele and efficacy of varicocelectomy for treatment of infertility. We also review the current guidelines and the need for proper case selection before surgery.