World J Mens Health.  2016 Aug;34(2):101-109. 10.5534/wjmh.2016.34.2.101.

Clinical Outcomes of Varicocele Repair in Infertile Men: A Review

• Chiba K
• Fujisawa M

• KMID: 2349846
• DOI: http://doi.org/10.5534/wjmh.2016.34.2.101

Abstract

Varicoceles are a major cause of impaired spermatogenesis and the most common correctable cause of male infertility. They are found in approximately 40% of men with primary infertility and 80% of men with secondary infertility, although they also occur in 12% of men with normal semen parameters. The presence of a varicocele does not always affect spermatogenesis, as it has been reported that only 20% of men with documented varicoceles suffer fertility problems. However, varicocele repair appears to have beneficial effects in men with impaired semen parameters and palpable varicoceles. Currently, the main procedures employed for varicocele repair are microsurgical subinguinal or inguinal varicocelectomy, laparoscopic varicocelectomy, and radiological percutaneous embolization. Microsurgical varicocelectomy appears to be the optimal treatment in most cases, whereas the other procedures are useful only in specific cases. After treatment, it typically takes 3 to 6 months for patients' semen parameters to improve; thus, other therapies, including assisted reproductive technology, should be considered if infertility persists after this interval, especially in older couples. Controversies still remain regarding how varicoceles in certain subgroups, such as adolescents or men with azoospermia, should be treated. Due to their relatively high prevalence rate among the general population, varicoceles can occur concomitantly with other conditions that cause impaired spermatogenesis. Further studies are necessary in order to identify the patients who are most likely to benefit from treatment. In this review, we sought to summarize the issues currently associated with varicocele treatment in infertile men.

Keyword

Infertility, male; Therapeutics; Varicocele

MeSH Terms

Adolescent
Azoospermia
Family Characteristics
Fertility
Humans
Infertility
Infertility, Male
Male
Prevalence
Reproductive Techniques, Assisted
Semen
Spermatogenesis
Varicocele*

Figure

• 

  Fig. 1 Schematic diagram of the microanatomy of the spermatic cord. The numbers denote the mean quantity of arteries (red) and veins (blue) at the indicated level. The primary branching point of the testicular artery is often located along the section that passes through the inguinal canal. Internal spermatic veins become substantially less numerous moving from the subinguinal region through the inguinal canal to the internal inguinal ring. Data from the article of Hopps et al (J Urol 2003;170:2366-70) [45] with original copyright holder's permission.

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