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Varicocele and Male Infertility: Evidence in the Era of Assisted Reproductive Technology

Eric Chung

Purpose: To evaluate the current literature on the varicocele treatment and impact on fertility. Materials and Methods: Pertinent articles were identified through PubMed search on varicocele repair and male infertility. Discussion: The proposed mechanisms of how varicocele results in impaired spermatogenesis and infertility include an altered or impaired testicular blood flow, increased scrotal temperature and oxidative stress as well as resulting sex hormone changes, reflux of adrenal hormones, and autoimmunity with anti-sperm antibody formation. The repair of varicocele as an infertility treatment is dependent on many factors such as the grade and size of the varicocele, unilateral or simultaneous bilateral repair, female partner’s age, the period during which the couple as failed to conceive and quality of the semen. Summary: Varicoceles can present in up to 40% of men presenting with infertility and published literature support the findings that varicocele adversely affect spermatogenesis. Surgical varicocelectomy is an effective treatment for improving the semen parameters in men and spontaneous pregnancy rate for couples with an infertile male partner who has low semen parameters and a palpable varicocele. Comparative studies favour the microsurgical subinguinal technique as the standard of care with highest rates of success and lowest rates of complications.