Effect of Varicocelectomy on Male Infertility

Abstract

Varicocele is the most common cause of male infertility and is generally correctable or at least improvable by various surgical and radiologic techniques. Therefore, it seems simple and reasonable that varicocele should be treated in infertile men with varicocele. However, the role of varicocele repair for the treatment of subfertile men has been questioned during the past decades. Although varicocele repair can induce improvement of semen quality, the obvious benefit of spontaneous pregnancy has not been shown through several meta-analyses. Recently, a well-designed randomized clinical trial was introduced, and, subsequently, a novel meta-analysis was published. The results of these studies advocate that varicocele repair be regarded as a standard treatment modality in infertile men with clinical varicocele and abnormal semen parameters, which is also supported by current clinical guidelines. Microsurgical varicocelectomy has been regarded as the gold standard compared to other surgical techniques and radiological management in terms of the recurrence rate and the pregnancy rate. However, none of the methods has been proven through well-designed clinical trials to be superior to the others in the ability to improve fertility. Accordingly, high-quality data from well-designed studies are needed to resolve unanswered questions and update current knowledge. Upcoming trials should be designed to define the best technique and also to define how to select the best candidates who will benefit from varicocele repair.

Scrotal pain: Evaluation and management

“…Varicoceles can affect various seminal parameters including sperm production. Most authors agree that surgical therapy of varicoceles is an accepted intervention in the treatment of male factor infertility; microsurgical varicocelectomy is regarded as the gold standard [ 53 ]. When compared to androgen replacement therapy, a study by Cho and Seo [ 53 ] found varicocele repair to be more cost-effective in treating infertility.…”

“…Most authors agree that surgical therapy of varicoceles is an accepted intervention in the treatment of male factor infertility; microsurgical varicocelectomy is regarded as the gold standard [ 53 ]. When compared to androgen replacement therapy, a study by Cho and Seo [ 53 ] found varicocele repair to be more cost-effective in treating infertility. Pain secondary to varicoceles is estimated to affect 2% to 10% of men, but surgical intervention for relief of pain is controversial [ 50 ].…”

Lymphangiocele: A very rare cause of primary infertility

“…Like varicocele, it can contribute to infertility as theoretically it produces the same effect on spermatogenesis as varicocele. [ 5 ] Since the unavailability of good literature, the treatment plan and indication of surgery may be similar to varicocele. This is probably the first case in literature where bilateral lymphangiocele presented with male infertility.…”

The Impact of Loupe-Assisted Inguinal Varicocelectomy on Semen Quality and Pregnancy Rate

“…There is some controversy regarding varicocelectomy as a surgical treatment for male infertility, but most studies have supported the procedure for men with a clinical varicocele (4)(5)(6). It is suggested that varicocelectomy improves semen quality (7), and subsequent pregnancy rates in 34% of the spouses of treated men (8). Moreover, varicocelectomy is more cost effective than both intrauterine insemination and in vitro fertilization (9).…”