The Role of Varicocele Treatment in the Era of Assisted Reproductive Technology

In the era of sophisticated assisted reproductive techniques (ART), is the role of varicocelectomy in the treatment of male factor infertility anachronistic? Devroey et al. (1) assert that “conventional treatment for male factor infertility has little value and has been revised and abandoned”. They further contend that “intracytoplasmic sperm injection (ICSI) is an effective treatment, even for cases of extreme oligoasthenoteratozoospermia. It has to be considered the method of choice and should replace ineffective conventional therapies”. Certainly, treatment at the gamete level is feasible. However, it should not be unconditionally applied to all males seeking treatment for male factor infertility. A multi-factorial analysis, including outcomes, cost, and morbidity, all lend support to varicocele treatment in the subfertile male.