Varicocele and male infertility

Abstract

Varicoceles are the most frequent physical findings in infertile men. Although the varicocele is generally regarded to be the most common correctable cause of male infertility, whether varicocelectomy is an effective treatment for male factor infertility has been the focus of intense debate. A great deal of evidence indicates that varicocelectomy is clearly associated with a significant improvement in semen parameters (concentration, motility, and morphology). Varicocelectomy also appears to reduce seminal oxidative stress and sperm DNA damage. In contrast, the positive effect of varicocelectomy on improving natural pregnancy rates is less clear based on a few randomized controlled trials. Therefore, the need persists for well-designed, properly conducted randomized controlled trials to address this issue. Considering the beneficial effects of varicocelectomy on semen parameters, varicocelectomy should be considered in men with palpable lesions, at least one abnormal semen parameter and otherwise unexplained infertility. Microsurgical inguinal or subinguinal varicocelectomy techniques have been shown to result in fewer recurrences and postoperative complications than other techniques.