Varicocele and male infertility : current status

The role of varicoceles in the etiology of male infertility continues to be controversial. Due to the numerous variables that impact the outcome of varicocele surgery, the results of various trials are often contrary. Recent studies at the molecular level have demonstrated that varicoceles can cause testicular nuclear DNA damage, apoptosis, and raised levels of reactive oxygen species. Clinical studies have shown that varicocele surgery can improve semen quality sufficient to downgrade the type of ART procedure required, can result in the appearance of sperm in the semen in some cases of non-obstructive azoospermia, and can reverse testicular growth retardation in cases of adolescent varicocele. Hence, despite contradictory clinical results, the best practice guidelines of many associations recommend varicocele surgery in men with sub-fertile semen, clinically evident varicoceles, and infertility. Ultrasonography to detect sub-clinical varicocles is not advocated. Medical therapy may help some men with mild to moderate varicoceles. Older technics of varicocele surgery by mass ligation or non-magnified dissection are associated with higher rates of recurrence, testicular artery damage, and hydrocele formation, as compared to microsurgical methods in which every vein is individually identified and ligated, while preserving the arteries and lymphatics. Laparoscopic ligation is no longer recommended.