The Role of Varicocele Repair in the New Era of Assisted Reproductive Technology

Abstract

Cocuzza M, Cocuzza MA, Bragais FMP, Agarwal A. The role of varicocele repair in the new era of assisted reproductive technology. Clinics. 2008;63:395-404. Infertility affects 10-15% of couples who are trying to conceive, and half of the cases are due to male infertility. Intracytoplasmic sperm injection is increasingly being used to overcome multiple sperm deficiencies. Due to its effectiveness, some have proposed ICSI as a solution for all cases of male infertility, regardless of the cause. Hence, even men with potentially treatable causes of infertility have sought the aid of assisted reproductive technology, rather than undergo specific therapies to treat their infertility. Varicoceles are the most frequent physical finding in infertile men; indeed, they may be responsible for nearly one-third of cases of male infertility. Varicocele management, however, has always been a controversial issue because very few randomized, controlled studies have been performed to examine varicocelectomy as an infertility treatment. Significant evidence suggests that varicoceles have a harmful effect on the testis and that varicocelectomy can not only prevent progressive decline in testicular function but also reverse the damage. However, the degree to which varicocele repair improves pregnancy rates and the success of assisted reproductive technology remains controversial.

Imaging in male-factor obstructive infertility

“…Varicoceles are the most frequent physical finding in infertile men; indeed, they may be responsible for nearly one-third of cases of male infertility [20] . Scrotal US is a good diagnostic tool for diagnosis of varicocele (sensitivity 97%, specificity 94%) [21] .…”

“…However, the degree to which varicocele repair improves pregnancy rates and the success of assisted reproductive technology remains controversial. Varicoceles are associated with infertility but the significance of this relationship is uncertain; surgical or radiological repair of varicoceles is not recognized as appropriate treatment for infertility [20,[26][27][28][29] . Scrotal US is used to examine the testes in at least two planes, the transverse and longitudinal; the size is measured and the echotexture is evaluated [30] .…”

Study of the effect of varicocelectomy on sperm proteins expression in patients with varicocele and poor sperm quality by using two-dimensional gel electrophoresis

“…Varicocele is the most common abnormal physical finding in male infertility, with a prevalence of 19-41 % of men with primary infertility and 45-81 % of men with secondary infertility [1]. Varicocele is characterized by dilation of veins of the pampiniform plexus and impairs the countercurrent heat exchange mechanism.…”

“…Although varicocele repair is widely used as a treatment for male infertility, its efficacy has been a subject of intense debate for nearly 50 years. Although the ultimate goal of treating male factor infertility is to increase the pregnancy rate, varicocelectomy also seeks to maximize a couple's fertility potential by improving sperm quality or avoiding a decline in testicular function [1].…”

The role of varicocele repair in non-obstructive azoospermic men: A systematic review

“…Only one study performed open varicocelectomy without the use of microscope. The microsurgical technique, either inguinal or subinguinal, demonstrated fewer recurrences and complications and resulted in a higher spontaneous pregnancy rate compared to other techniques [16]. Today, it has become the best treatment modality of varicocele for infertile men.…”