Varicocelectomy in Male Subfertility Treatment: ‘‘Updated’’ Indications for Surgery

Abstract

We analyzed the recent literature data on varicocelectomy in treatment men from infertile couples. There are still a lot of unresolved issues that require clarification. It is still unclear the exact pathogenesis of testicular malfunction in some men with varicocele. Recent European and American urological guidelines recommend varicocele repair in men from infertile couples with “abnormal” semen parameters. Although, according to the 6th ed. of WHO laboratory manual for the examination and processing of human semen it is not clear the cut-off values between normal and abnormal semen parameters. Also, still unclear why approximately third part of patients do not experience any improvement after varicocele repair. According to the recent data analysis, total progressively motile sperm count (TMSC) and sperm concentration can be the significant predictors of semen improvement and pregnancy after varicocele repair. However, it should be remarked that the mean quality of existed data from low to moderate. All mentioned issues indicate the necessity of further large-scale multicenter randomized clinical trials.