Abstract
Varicocele is the most common correctable cause of male factor infertility. The role of varicocele in the etiology of male infertility is still controversial regarding to whom varicocelectomy should be done and the selection should be meticulous. With the recent advances in biomolecular and development of novel sperm functional tests, it has been possible to better understand the mechanism involved in damage provoked by varicocele and therefore, propose ways to reverse them. Clinical studies have shown that varicocele surgery can improve semen quality sufficient to downgrade the type of assisted reproductive technology (ART) procedure required. This reveiw discusses current concepts on the mechanisms for varicocele induced testicular damage and efficacy of varicocelectomy for treatment of infertility. We also review the current guidelines and need for proper case selection before surgery.The authors critically reviewed the cost effectiveness of the surgical treatment of a varicocele compared with assisted reproductive techniques.
Highlights
Infertility is the inability of sexually active, non-contracepting couple to achieve pregnancy in one year [1]
Varicocele repair may allow some couples to proceed with IUI prior to proceeding with more advanced assisted reproductive techniques, since studies suggest that varicocelectomy improves the effectiveness of subsequent IUI [81,82]
Varicocele remains a common finding in infertile men and is often the sole identifiable cause of infertility in couples
Summary
Infertility is the inability of sexually active, non-contracepting couple to achieve pregnancy in one year [1]. In view of these issues, the American urological association and American society of reproductive medicine has clear guidelines for the evaluation and management of these patients [61,62] These guidelines state that a varicocele should be corrected when all of the following are present: 1) A varicocele is palpable; 2) The couple has documented infertility; 3) The female has normal fertility or potentially correctable infertility; and 4) The male partner has one or more abnormal semen parameters or sperm function test results. Application of new WHO reference values into clinical practice will result in patients previously deemed as candidates for varicocele repair are ineligible for treatment if their semen parameters are above new cutoff reference values This should be looked at with caution the adequate timing to intervene and prevent testicular damage. Varicocele repair may allow some couples to proceed with IUI prior to proceeding with more advanced assisted reproductive techniques, since studies suggest that varicocelectomy improves the effectiveness of subsequent IUI [81,82]
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