<p>Varicocele Repair Prior to Assisted Reproductive Technology: Patient Selection and Special Considerations</p>

Abstract

Clinical varicoceles are one of the most commonly identified physical exam abnormalities in men presenting with infertility. Clinical varicoceles can cause impaired spermatogenesis and surgical correction can improve semen parameters in select men. Increasingly, andrologists are performing varicocele repairs prior to intrauterine insemination (IUI), in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI) to boost male fertility potential. In this review, we evaluated the available literature 1) to determine if varicocelectomy prior to IUI or assisted reproductive technologies proved to improve sperm production or pregnancy outcomes; and 2) to identify who may be the ideal candidate for pre-IUI/ART varicocelectomy. Overall, few studies have explored this topic and little can be concluded about the impact of varicocelectomy prior to IUI. The evidence, however, does support that correcting a clinical varicocele can increase pregnancy outcomes in couples who plan to pursue IVF or ICSI. When selecting patients for varicocelectomy prior to IUI or ART, clinicians should evaluate female age as improvement in semen parameters can take 6 months after varicocelectomy and this duration of time may be deleterious in cases of advanced maternal age when each cycle becomes increasingly important. Overall, the currently limited literature regarding clinical varicoceles correction demonstrates that pregnancy rates can be increased when comparing patients who have undergone varicocelectomy prior to ART with those who had clinical varicocele but did not undergo surgery.

Effect of Varicocelectomy on Serum Follicle-Stimulating Hormone and Testosterone; The Interrelationship Between Hormonal Variables

“… 20 Another approach is clinical varicocele repair before any intracytoplasmic sperm injection, intrauterine insemination, or in-vitro fertilization to improve fertility among males, and increase pregnancy results among couples considering the age of females as well. 21 The present study showed a significant difference in the levels of LH before and after the surgery, whereas there was no significant difference in the level of testosterone levels. On the contrary, a study conducted by Abdel-Meguid et al 22 monitored a group of men for around 6 months that showed significant improvement in levels of testosterone among patients who had undergone the surgical procedure.…”

Jiawei Runjing Decoction Improves Spermatogenesis of Cryptozoospermia With Varicocele by Regulating the Testicular Microenvironment: Two-Center Prospective Cohort Study

“…Age is also an important factor for aggravating varicoceles ( Kimura et al, 2017 ; Bolat et al, 2019 ; Zampieri et al, 2021 ). The effect of spermatogenesis drug intervention in men of different ages has not been recognized ( Palmisano et al, 2019 ; Kohn et al, 2020 ). Animal experiments also confirmed that zinc concentrations varied in different seasons and ages ( Kandiel and El Khawagah, 2018 ).…”

Is It Time for Andrology and Endocrinology Professionals in Assisted Reproduction Centers?

“…The American Urological Association’s guidelines for Varicocele and Infertility recommend treatment for a varicocele only if the clinical varicocele is palpable, the couple has known infertility, the female partner is normal or has a potentially treatable cause of infertility and the male partner has abnormal sperm parameter(s), while treatment of subclinical varicocele is not recommended as it has been shown that it is not related to improvement of sperm parameters or pregnancy outcomes [ 44 ].…”